December 2008 no white pages.indd Hazardous Waist Tackling Male Weight Problems SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL NOVEMBER 2008, VOLUME 8, ISSUE 3, P.364-365 SULTAN QABOOS UNIVERSITY© SUBMITTED - 4TH SEPTEMBER 2008 IF YOU THINK THAT YOUR DISHDASHA*, AFTER tucking your khanjar** around it, is helping you hide your extended waistline, you may actually be hiding something of sinister consequence to your health. Male fatness, or android obesity, that mani- fests as an expanded waistline is now perceived in the medical profession as an key precursor of many intractable illnesses from diabetes to cancer, as well as a myriad of others that lead to poor quality of life, disability or simply shortened lives. Of course, this is not new; the ‘father’ of medicine, Hippocrates, long ago indicated that corpulence leads to untimely death. This view has been recently resurrected in the volume, Hazardous Waist: Tackling Male Weight Problems. When one sees the title of this book, it appears that it is one of those ‘self-help’ books with directions on how to curb one’s mass of adiposis tissue. The title appears to suggest new age themes like those of Dr. Deepak Chopra, (Indian medical doctor and popular writer on spirituality and diverse topics in mind-body medicine), but browsing through the pages, we realize that this book is no ‘psycho babble’ or esoteric book enticing people to recharge their ‘chakra’. The volume is neither reminiscing of ‘gutbuster’ exercise or drugs that often appears as e-mail spam. Alan White and Maggie Pettifer have edited chap- ters from presentations previously conducted under the auspices of the Men’s Health Forum which took place from 2004 in the UK. It synthesises the litera- ture and all that the services of weight problems entail among the male population. The statistics are stagger- ing and the situation is overwhelming bleak. Males are more gluttonous and sedentary and are unlikely to be unaware of their belly fat or simply deny its size. More dishearteningly, males are less likely to do something about it than females. Most demoralising, males with central obesity have a higher risk of succumbing to ill- effects of obesity. Although there are many academic publications highlighting the global epidemic of obesity, this vol- ume uniquely focuses on the male gender. The motto of the book is the formula that what works for females may not be the best solution to preventing the rising tide of hazardous waist among males. Then, you may wonder, in the age of ‘schism’ and ‘ism’, is this book just dangerously revamping and evoking ‘gender wars’ and اخلطر اخلصر لدى الذكور الوزن معاجلة مشاكل بيتيفر وماجي وايت االن : املؤلفون Editors: Alan White and Maggie Pettifer Publishers: Radcliffe Publishing, Oxford & New York, 2007. No. of pages 225 ISBN: 10 1846191033 Orders: www.radcliffe-oxford.com B O O K R E V I E W * Traditional Omani men’s robe ** Traditional Omani dagger B O O K R E V I E W : H A Z A R D O U S WA I S T 365 stereotypes? Is a thin veneer of health-speak actually just masking male bashing? The answer is emphati- cally no. The book simply raises awareness of male weight problems and it is built around the theme that the waist’s circumference in males has reached the danger zone and that this trend is taking on epidemic proportions. The first part of the volume addresses the challenges of male weight problems. Under this head- ing, there are six chapters synthesising the multidisci- plinary and gender sensitive approach to central obes- ity and its impact on psychological, medical and social outcomes. The second part of the book, divided into fifteen chapters, addresses how to tackle male weight problems. It highlights the important roles of primary health care, community and an ‘obesogenic’ environ- ment in the effort to confront the health risks posed by obesity in men. Although eating disorders are becoming global challenges, the book derives its database from the UK and Australian populations. Both of them are a heter- ogeneous collection of different ethnic groups, so the book does transcend the white middle class situation. References to the World Health Organization also crop up on many occasions. Scholarly work and sta- tistics on the prevalence of obesity in minorities and even a chapter featuring the situation among South Asian men are given audience in this volume. Despite the well established association between genetic fac- tors and obesity, it is the socio-cultural context that is central to the predisposition, onset, course and out- come of obesity and more importantly, biopsychoso- cial factors that are of major importance in designing interventions and obesity management plans. Whereas the lower classes are increasingly suc- cumbing to obesity in Western Europe and North America, in the Arabian Gulf its first victims are ur- ban elites who are likely to live a sedentary life with no physical activity to balance out its effects. Related to this, in many societies, is the message that obes- ity is bad for health would likely go unheeded. There many societies where thinness is perceived as socially undesirable whereas plumpness is regarded as a sta- tus symbol and beautiful. There is also the percep- tion that the ‘cult of thinness’ pervading our media is deeply rooted in a western-centric perspective on body-image. Against this background, unless cultural forces are employed as catalysts for curbing obesity, health education among different ethnic groups will have a limited impact due to their different concepts of health and body image. As this volume does discuss the situation in some sub-cultural groups in the UK, its message can be applied to situations elsewhere. Reading between the lines, however, this volume appears to be insidiously polemical, trumpeting great tribulation. The argument is that if no urgent meas- ures are taken, obesity will be equivalent to the medi- aeval bubonic plague or other more recent scourges that have decimated humanity. As any fear monger or student of social stigmatisation would attest, the con- sequence of grandiloquent rhetoric can be the birth of negative perceptions which can in turn cause the intended message to trigger a boomerang effect. It is widely known that any social construct or culturally de- valued phenomenon that is labelled as negative is like- ly to go underground only to resurface later when the condition has reached a stage of irreversible deteriora- tion. Despite this caveat, the chapters are well-written, backed up with citations and fully indexed. Although the book has as many as twenty-five authors, we do not find the common rumblings often come across in books authored by many contributors. The approach of this volume is to give balanced practical guidance to individuals, institutions and all the stake-holders, de- rived from empirical and evidence-based research as well as personal experience. The book is technical and yet any avid reader could grasp its content. Most of the jargon is well defined. The book draws its expertise from the myriad talents of professors of men’s health, dieticians, sociologists, psychologists and others. This is indeed a multidisciplinary endeavour. This volume should be on the reading list for all health care practi- tioners, nutritionists and other professionals who are advancing the cause of health education. If there is no steadfast effort to curb the obesity of their husband and boys in the household, women would also benefit from reading it to know why their husbands are likely to leave them as widows. R E V I E W E R Samir Al-Adawi Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Email: adawi@squ.edu.om