Type 2 Diabetes Epidemic Threatens Morocco: Obesity in Morocco (Part SIX of a SIX-Part Series)

My grandmother has diabetes. She doesn’t read or write, like many people in Morocco. So when telling her which foods to eat, and which to avoid, the doctor gave her a paper with colored pictures of foods divided into different categories (unlimited, moderate, and to be avoided). They come up with a lot of good solutions in Morocco, for people who can’t read.

All the foods which Moroccans eat as staples are on the lists to be consumed in moderation (potatoes, carrots, beets, peas, legumes, canned corn, macaroni, spaghetti, fruits), or to be avoided (sugar, oil, white bread, white rice). Generally speaking, most Moroccans (especially the middle and lower classes) do not like very much the types of foods which can be consumed in unlimited amounts (cauliflower, lettuce, cabbage, celery, broccoli, cucumber, radishes, turnips, eggplant). Accustomed from childhood to eating “only what they like,” many people find it very difficult to follow the correct diet.

Furthermore, over the past ten-fifteen years, there has been a switch away from whole-wheat breads to white bread (in which the flour is not fortified with the missing nutrients, as it is in America). As substantial bread is consumed at every meal, the white bread is contributing to the problem. Unfortunately, most middle and lower-class people now feel that whole-wheat bread is for “poor” people and white bread is for “rich” people. People say for various reasons that they don’t want whole-wheat bread (more expensive cost, preference for white, and some diabetics actually say they they buy white because the whole-wheat has sugar in it)! There is perhaps a “pinch” of sugar in whole-wheat, to make the yeast rise, but that would be all. Most people aren’t realizing that white bread turns directly to sugar in the bloodstream. Conversely, some upper-middle and upper class mothers make a point of buying whole-wheat for their families (which is no longer widely available, due to so many people spurning it).

Choosing white, or whole-wheat bread?

The problem of following a correct diet is even more complicated for women, than for men, because they are preparing the foods for the family. The rest of the family (both fathers and children) often refuse to eat foods that might be good for the diabetic person (and the culture here never forces people to eat what they “don’t like”), so either two meals need to be prepared (very expensive, and time consuming), or the diabetic person is left with going hungry, or eating the wrong foods (french fries, bread, tea with sugar, pastries,) even when they do wish to make the effort.

I personally know seven or eight people with Type 2 diabetes, the type that generally develops from being overweight. In just six years (between 2000 and 2006) the prevalence of diabetes in Morocco has shot up from 6.6% to 10%, according to Diabetes’ Voice, the publication of the International Diabetes Federation September, 2006 report (Vol. 51, Issue 3). The report says that levels of obesity continue to rise in urban populations, where 40% of women were obese in the year 2000. The International Diabetes Foundation feels that these figures are likely to represent “the tip of the iceberg.” The report quotes two Moroccan diabetologists in Tétouan, Loukoch Nahid, and Kerbab Abdelilah.

Tétouan

According to doctors I have spoken with, and websites discussing the problem, many Moroccan patients do not comply with dietetic requirements. Many doctors say that many Moroccan patients (especially from the middle and lower classes) just cannot understand or comply with life-long lifestyle changes (of course some do follow the guidelines very successfully, but they are most often men, whose wives are preparing their food).

In the case of one of our previous maid’s mother, not only was she developing severe circulation and eyesight problems from her diabetes, but she refused to change her diet in spite of this, even though her family begged her to repeatedly. She says she “doesn’t like” eating as the doctors recommend. My grandmother lost a lot of weight, but even so, could not continue to follow the doctor’s recommendations, saying she was “tired” of it.

According to a Spanish web site, doctors in Spain see a much greater prevalence of diabetes among Moroccan immigrants, than among the general Spanish population; AND they find it much harder to gain compliance with lifestyle changes in diet. The Moroccan patients often seem to have trouble understanding the concept of chronic disease, and view diabetes as an an “occidental illness,” that can be cured as soon as they return to Morocco (where diabetes rates were only 1-2% a generation ago). Doctors in Spain seem to think that Moroccan immigrant men living in Spain without their families tend to eat more sweet drinks and pastries, as well as fast food, than they would in Morocco–which could account for part of the high rate of diabetes (more than 100% higher among immigrant Moroccans, than among Spaniards). Spanish doctors say, “As there is a higher prevalence of diabetes in Moroccans, and their metabolic control is poorer, we consider them to be a group in need of specific education.”

Spanish Web Site:

http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1885-642X2006000200005&lng=es&nrm=&tlng=en

As a follow-up to my post mentioning the force-feeding of girls in Mauretania–also taking place to a much lesser degree in the southern Moroccan province of Western Sahara, a 2004 study published in the American Journal of Biology found that fully 75% of Moroccan Sahraoui adult women suffer from metabolic syndrome (the combination of medical disorders that increases the risk of developing cardiovasucalr disease and diabetes). See this site:

http://www3.interscience.wiley.com/journal/109594230/abstract?CRETRY=1&SRETRY=0

It seems that certain populations are more prone to developing diabetes with a very slight weight gain (such as American Indians). In my opinion, it seems to be so in Morocco, too. Half the people I know with diabetes (Moroccan) don’t look the least bit overweight. Just as many researchers say that Asian develop diabetes at a body weight considered “normal by most standards, it appears this may be the case for Moroccans, as well. So, it appears with the rapid increases in overweight and obesity that are now taking place in Morocco, it is no wonder that an epidemic of diabetes looms on the horizon.

This concludes my six-part series on Obesity in Morocco. I hope you have enjoyed it, and found it informative!

Margot

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