Most of the United Arab Emirates exists somewhere between the fantasy of wealth and the reality of adjusting to a fast-changing society, for few places have gone from relative poverty to extreme wealth in such a short period of time.
Once an obscure land of Bedouins and pearl divers on the southeastern tip of the Arabian Peninsula, the country was formed in 1971 following the discovery of oil, transforming it into a cosmopolitan society symbolized by skyscrapers, shopping malls, the sparkling city of Dubai and the cultural center of Abu Dhabi, the capital city. Like many nations, the UAE is experiencing a higher rate of obesity among children and adults. Rates of cardiovascular diseases and hypertension have increased, and in 2003 the International Diabetes Federation ranked the UAE’s prevalence rate for type 2 diabetes (20 diabetes) and prediabetes (26 percent) as the second highest in the world. A deep-seated tradition of hospitality persists throughout the United Arab Emirates. Here, to be fed is to be loved. Guests are greeted with plates of fruits and dates and children are rewarded with sweets. Even at hospitals, portion size is sometimes an afterthought as hospital lunch trays come down the line carrying mountains of rice, meat and potatoes.
Nonetheless, modernization seems to be straining the connection with food and culture. Younger generations of women, who unlike their mothers or grandmothers attend school and hold careers, are less interested in what is going on in the kitchen. A majority of indigenous households employ cooks and servers, further removing them from food preparation considerations. Eating out at restaurants, including Western quick-service chains, is also increasingly popular. And while fitness centers exist, the habit of regular exercise is not main stream.
But increased focus on public health by the media and government is bringing new hope. The Ministry of Health is developing strategies to improve understanding of diet and health among health care providers, encourage research, educate new mothers about nutrition and support chronic disease clinics.
While increased prevalence of conditions such as obesity and diabetes may not be unique to United Arab Emirates, some statistics about the country’s exploding population are unique. For example, of the 4.3million people who live in the UAE, less than 25 percent are citizens, known as Emiratis. The remaining 77 percent fall into the “expat” category, a term that in the UAE refers to everyone whose family roots are not indigenous, regardless of how long they have lived there. For many health-care facilities, this high rate of diversity is mirrored not only in the patients they serve, but in those who serve them; at Sheikh Khalifa Medical City in Abu Dhabi, the staff are from about 40 different countries. Among them is Ellen Edwards, RD, who came to the UAE in 2000.Originally from Montana, Edwards has worked in international nutrition outreach and program development in the Caribbean, South America, Eastern Europe and the Gulf for more than 20 years.
Today, Edwards specializes in children with metabolic disorders such as proprionic acideuria or methalmelonic acideuria at Sheikh Khalifa Medical City, which is managed by Cleveland Clinic. As head dietitian, she oversees dietitians from the Middle East, Philippines, Asia, Africa, NewZealand, Europe and the United States, as well as the United Arab Emirates. “[The cultural mix] is more complicated than you’d think, but in some ways, more simple,” says Edwards, referring to the advantages of multilingual members who understand cultural nuances, including cooking methods, ingredients and other cultural traits of patients. “Having a diverse staff helps me quite a bit.” It also comes with some challenges; staff members’ education and strengths can vary depending on where they were trained. Therefore Edwards spends much of her free time analyzing competencies and figuring out where, if any, gaps exist.
As with other health-care professionals in the UAE, there is a shortage of qualified dietitians to serve the growing population. However, that is something that may change. The United Arab Emirates University’s dietetics program is working toward Substantial Equivalency status through ADA’s Commission on Accreditation for Dietetics Education. If they obtain it, the school could be graduating future dietitians as early as 2010. Substantial Equivalency is not only viewed as an opportunity to expand the role of dietitians and improve nutrition-related health trends in the UAE, but also as one to allow students to obtain their educations locally. Otherwise they would have to attend an accredited program elsewhere in order to qualify for the RD exam.
Habiba Ali, PhD, RD, CDE, who teaches nutrition at the university, explains that the required 1,200 hours of practical training would be a major change for her department. “This affects how we teach, but more important is the practical work,” she says. “We’re talking about extensive training for dietetics students so that when they graduate, they are ready to assume positions.”
Clinical dietitians in the United Arab Emirates perform initial dietetic intakes, review charts, conduct patient assessments and make dietary decisions. Dietitians can also work as community nutritionists or as foodservice managers. Still others are getting involved in clinical research. Taif Al Sarraj is head dietitian at Tawam Hospital, a government hospital affiliated with Johns Hopkins University. There, Al Sarraj is studying the effects of a low-carbohydrate diet as part of a PhD program in clinical nutrition. “The main reason I wanted a PhD was to conduct clinical research,” says Al Sarraj. “Without that [evidence], we will not be able to go to the government to say, ‘This is important.’”
“The dietetics profession in the UAE is advancing and I am proud of my courageous colleagues as changes are implemented toward that goal,” says Edwards. “The Arabian Gulf is great because the people are so lovely and hospitable. They are also very open to advancement and meeting the future.”