NEAR EAST AND NORTH AFRICA Regional Overview of Food Security and Nutrition 2023: Statistics and trends

2.3. Overweight among children under 5 years of age

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health throughout the life cycle. Among adults, obese people have higher rates of mortality due to an increased risk of NCDs such as cardiovascular disease, cancer and diabetes. (WHO, 2021). Overweight and obesity are complex and multifaceted problems. While genetics can increase an individual’s susceptibility to overweight, it cannot explain population-level increases over time. Intrauterine growth, infant feeding, and eating habits during preschool are significant determinants of overweight and obesity during adulthood (WHO, 2014c; FAO et al., 2019). Other key risk factors of obesity and overweight are an increased availability and intake of energy-dense foods that are high in fats and/or sugars, poor dietary practices, and an increase in physical inactivity (FAO et al., 2018).

In 2022, the prevalence of overweight among children under 5 years of age (Figure 14, Table 9) in the Arab States (9.5 percent) was 69.6 percent higher than the world average (5.6 percent). Overweight children globally are more likely to live in lower-middle- or upper-middle-income countries and reside in wealthier households (FAO et al., 2022). In the Arab States, the prevalence of overweight children under the age of 5 years was by far the highest in lower-middle-income countries (14.4 percent), followed by high-income countries (9.5 percent) and upper-middle-income countries (8.7 percent). Overweight was the lowest in Arab LDCs (2.4 percent) and low-income countries (3.6 percent). Overweight among children in conflict countries (4.8 percent) was 35.8 percent lower than in non-conflict countries (13.4 percent).

Overweight among children increased more in the Arab States (8.0 percent) than globally (5.7 percent) between 2000 and 2022. Overweight increased significantly between 2000 and 2008, by 21.6 percent, since then it decreased by 11.2 percent until 2022 in the Arab States. Overweight increased drastically, more than doubled (143.6 percent increase) among high-income countries between 2000 and 2022.

There are several explanations for the high rates of overweight and obesity in most Arab States, including lifestyle changes that reduced people’s physical activities and a nutrition transition that shifted dietary patterns and increased the intake of energy-dense but low-nutrient foods (IFPRI, 2020). The dietary and nutrition transition is fueled by rapid urbanization, economic development, and food consumption patterns that are partly characterized by increased intake of fats, sugar and processed foods of high energy density and minimal nutritional value.

At the country level, the prevalence of overweight among children (Figure 15) is the highest in Libya 28.7 percent, Tunisia (19.0 percent), and Egypt (18.8 percent). What is even more alarming is that the prevalence of overweight children increased sharply between 2022 and 2000 by 77.2 percent, by 375 percent, and by 55.4 percent in these countries respectively. Significant growth between 2000 and 2022 in overweight children can be observed also in Oman (+282.4 percent), Djibouti (+166.7 percent), and Saudi Arabia (+180.6 percent). In 2022, the lowest prevalence of overweight was in Yemen (1.7 percent), Mauritania (2.0 percent), and Somalia (2.7 percent) and Sudan (2.7 percent). However, the majority of Arab States are far from meeting the 2030 target of less than 3 percent.

The dietary energy supply from cereals in the region was significantly higher in the period of 2010–2019 than the world average and is particularly high in Egypt and Morocco. In addition, the second-highest dietary energy supply in the region comes from sugar, syrups and honey, which is 31 percent higher than the world average in the same period (FAO et al., 2023). These might also contribute to high overweight/obesity in the Arab States.

Furthermore, there is evidence that food subsidies that are not targeted towards nutritious foods but to staple foods can increase obesity in low- and middle-income economies (Abay et al., 2022). In low- and middle-income countries, market price controls such as minimum or fixed price policies overwhelmingly target commodities like wheat, maize, rice, as well as sugar. While these policies have contributed to food security, they do not incentivize the production of nutritious foods and do not promote the consumption of healthy diets. In many countries, fiscal subsidies have increased the availability and reduced the price of staple foods and their derivatives, discouraging and making relatively more expensive the consumption of unsubsidized or less subsidized nutritious foods such as fruits, vegetables and pulses (FAO et al., 2022).

In the Arab States, agricultural subsidies and food security policies have been implemented generally also in favour of staple food production, such as cereals (FAO et al., 2023). According to IFPRI 2020, food subsidies in the Arab region could interact with the region’s nutritional transition and associated high prevalence of overweight and prices of unhealthy diets are inversely associated with body weight outcomes. For example, there is evidence that food subsidies are associated with negative nutrition (both undernutrition and overnutrition) outcomes in Egypt because they incentivize overconsumption of staple foods, such as Baladi bread, rice, sugar, cooking oil (Ecker et al., 2016). Latter study found that in urban areas of Egypt, the probability of child overweight and stunting increases with the subsidy levels. As the prices of the subsidized foods were fixed in Egypt, and the prices of free-market foods increased particularly rapidly during economic crises, the resulting loss in real incomes encouraged households to shift their diet toward more calorie-rich and micronutrient-poor foods. As food prices in the free market stay high, households tend to stick to unbalanced diets.

According to the World Bank (Gatti et al., 2023), there is a positive correlation between the level of development and how well children reach Minimum Dietary Diversity (MDD)—the percentage of children between ages 6 and 23 months who have consumed foods and beverages from at least five out of eight defined food groups during the previous day.⁹ A later study tested this correlation for 99 economies, including seven Arab States. Only two (Palestine and Tunisia) perform better in children reaching MDD; the other five (Algeria, Egypt, Iraq, Jordan, and Yemen) perform worse than their income peers in other regions of the world. These findings confirm that the challenge in the region is not only food security and sufficient calorie intake, but also diet quality and eating a variety of nutritious foods every day. ⁹ The eight food groups included in the MDD indicator are: breast milk; grains, roots and tubers; legumes and nuts; dairy products (infant formula, milk, yogurt, cheese); flesh foods (meat, fish, poultry and liver/organ meats); eggs; vitamin-A rich fruits and vegetables; other fruits and vegetables (UNICEF, 2022; WHO et al., 2008).