Egypt"s obesity battle: "No one cares about calories here"

Inside the neon palace that is Koshary Abou Tarek in downtown Cairo, the air smells of fried onions. Plates are heaped high with koshary, a traditional dish containing rice, macaroni and lentils topped with tomato sauce and onions – a filling mainstay across all Egyptian social classes.

An average serving at the restaurant costs the equivalent of £1.80, and contains an estimated 800 calories. The place is filled with families who are given a choice of sugary soft drinks as an accompaniment.

“We don’t measure the calories in the dish as no one here cares about that,” laughs the manager, Tarek Hosny. He elaborates on a prevailing theory that while koshary is all carbohydrates, these are somehow removed with the water they are cooked in.

Low to mid-income countries have some of the highest child obesity rates in the world and, Egypt ranks seventh with 32% of children obese, according to datafrom the World Obesity Federation. A diet heavy in meat, carbohydrates and sugar combined with few opportunities for exercise are taking a toll on the Arab world’s most populous country.

Nor is obesity bound by social class. Low-income families turn to rice and potato dishes to fill stomachs at the end of a long day. The wealthy, who can afford to eat meat with almost every meal, also have access to fast food, considered a luxury in the Middle East.

Koshary, a popular carb-dense dish, is served in a restaurant in Cairo. Photograph: Alamy

A survey by the World Health Organisation (WHO) covering 2011-12 found that 62.2% of Egyptian adults were overweight, and 31.3% of them were classed as obese.

“This is more than a health issue,” said Dr Randa Abou el Naga of the WHO in Egypt, who cites a lack of physical activity as the main driver of obesity.

“City planning is responsible,” she said. “There should be proper places for playing sports. Overcrowding in schools also means no sports classes; 75% of Egyptians aren’t doing any vigorous physical exercise.”

Naga said the Egyptian government could easily switch from subsidising sugar and oil to healthier options such as milk. Kiosks and corner shops throughout the country offer a range of sugary and salty snacks, a cheap option for children and their parents.

A Pizza Hut restaurant near the Giza pyramids in Cairo. Photograph: Alamy

“It might sound like a cliche, but Egyptians really love sugar. It’s an addiction,” said dietician Dr Sherine el Shimi. “They add sugar in their tea, and have five or six of these per day, each with two or three teaspoons of sugar in. If they just took out the sugar, their lives would be different.”

She said most if not all social gatherings revolve around food, and that social pressure to eat more was high. “Plus we also have delivery for everything,” Shimi said. For those who can afford it, a burger from one of Egypt’s growing number of burger chains can be delivered to your home within an hour.

“Fighting this starts in schools,” she said. “I know we’re not doing great economically right now, but nutrition classes and subsidising one fruit or vegetable per day per child would given them something they don’t get at home.”

Egypt"s obesity battle: "No one cares about calories here"

The NHS must show it cares about gay men’s lives – and roll out PrEP HIV drugs | Owen Jones

The health and lives of gay men matter. That’s what the high court ruled on Tuesday morning. Last year, NHS England decided against rolling out a treatment called PrEP – which prevents the transmission of HIV. The wellbeing of gay men was overriden by other priorities. Given it costs substantially more money to treat HIV than to prevent it, even financial considerations weren’t a good reason.

Related: NHS can fund ‘game-changing’ PrEP HIV drug, court says

On Tuesday, NHS England was defeated in court and told it was responsible for funding the treatment, and that they have a “preventative role and power to commission preventative function”. Pressure must now be placed on the NHS to start rolling this drug out immediately. As the British Medical Journal pointed out, “delays by NHS England will cost lives”.

If you want to stop HIV spreading, then PrEP is one among many solutions. It works. As studies in the United States have shown, if taken every day, it has been shown to reduce the risk of HIV infection in high-risk individuals by up to 92%. The objections to PrEP, in truth, are based on moral objections. If you do not want the risk of HIV, goes the argument, then wear a condom. Those who get HIV are, by implication, morally condemned for bringing it on themselves.

Of course, safer sex messages must always emphasise the importance of condoms: after all, they protect against many other STIs. But – in the real world, rather than the non-existent world of the morally self-righteous – things are more complicated. People get carried away; people get drunk (yes, in the real world imperfect people sometimes drink more than the recommended daily amount); condoms break. The same moralising is used against the right of women to have control over their own bodies, whether it be the right to abortion or even the morning-after pill. The standards set by the “morally pure” cause harm – or even kill.

We have come so far with the treatment of HIV, once a disease that ravaged the gay world. But according to the Terence Higgins Trust, there are 45,000 men who have sex with men living with HIV; and thousands of them do not know they even have it. The annual rate of newly infected men in 2014 was higher than the decade before. If you genuinely want to send HIV infection rates hurtling into reverse, then PrEP is not the only solution – but it is a good one.

Gay people, their health and their lives, matter. That’s a court judgment. NHS England must now accept the defeat – and start doing its job: protecting health and saving lives.

The NHS must show it cares about gay men’s lives – and roll out PrEP HIV drugs | Owen Jones

Well being Care"s March Madness: Buzzer Sounds On Exchanges Deadline

The fourth anniversary of the signing of the Reasonably priced Care Act (ACA) passed on March 23 with out significantly notice or fanfare.

As an alternative, all eyes were on March 31, the final deadline for purchasing well being insurance by means of state and federal well being care exchanges – and the day that fines for non-participation kicked in.

Supporters and opponents of the ACA are on the edge of their seats, anxious to know the final result: Specifically how numerous individuals signed up, will they pay out their premiums and for how extended will they do so?

In contrast to March Madness, we won’t know how this dance ends for months to come. But like the NCAA tournament, the ACA has presently had its share of victories and significant upsets.

The Victories

As a end result of well being care reform, the number of uninsured or underneath-insured Americans will be decrease in 2014 than in the current previous.

By April one, the White Property estimated it was on track to attain seven million enrollees through the state and federal exchanges. An estimated 9 million more enrolled in Medicaid.

Open enrollment is above for 2014 whilst many inquiries stay open-ended. (Picture courtesy of HealthCare.gov)

The vast majority of the newly enrolled will receive subsidies to assist shell out for coverage. Their coverage will consist of totally free preventive screenings, which should boost their overall nicely-currently being and contribute to lower well being care charges in the long term.

In addition, health care reform allowed far more than three million otherwise uninsured young grownups to obtain entry to coverage underneath their parent’s policy right up until age 26.

One more victory in government’s eyes is that people with “pre-existing conditions” – these who had been unable to buy individual insurance in the previous – can no longer be denied coverage. Meanwhile, tens of thousands of ladies whose plans previously excluded maternity coverage can now receive the prenatal care and delivery solutions they require.

And lastly, individuals who after identified it tough to navigate the arcane personal overall health insurance coverage market place, and had been frustrated by their restricted alternatives, can now go to an on the web exchange and choose from a broad set of alternatives.  

The “Upsets”

For all the victories, other outcomes have left several ACA fans upset and disappointed.

In spite of the large push by supporters, it is estimated that only 15 percent of Americans eligible to enroll through the exchanges signed up.

In the 17 states that constructed their very own exchanges, 20 percent of eligible individuals enrolled on average. Vermont led the pack at 54 %. In contrast, the 27 states that defaulted to the federal exchange saw an typical enrollment of only 12 percent.

And a mere 25 percent of folks in between 18 and 34 many years of age decided to enroll, compared to the government’s target of 40 percent.

Well being Care"s March Madness: Buzzer Sounds On Exchanges Deadline