“A big part of Ramadan is the hospitality we give to others and…one of the big purchases (Muslims here) make is sweetened soft drinks which are very unhealthy,” Barakat told The Jerusalem Report.
By JUDITH SUDILOVSKYThe recent international ‘Colors of Nutrition in Israel’ brought together world leading nutritional experts and policy makers to expose them to innovation in Israel and challenges in nutritional science, agriculture, industry, sustainability and national policy.(photo credit: COURTESY COLORS OF NUTRITION)
Raghda Barakat, a clinical nutritionist in the nutrition division of the Ministry of Health, was overwhelmed during the hot month of Ramadan by the thought of what the holiday meant for the diet of the thousands of Muslims celebrating in Israel.“A big part of Ramadan is the hospitality we give to others and…one of the big purchases (Muslims here) make is sweetened soft drinks which are very unhealthy,” Barakat told The Jerusalem Report. As nutrition professionals, she said, “we need to remind people that we traditionally have a very healthy way of eating, very nice foods we eat traditionally. When we have guests we can put out dates or some nuts for them,” instead of processed snacks and sugary drinks.But in Arab society the issue of hospitality is a year-round consideration, even with a cup of coffee offered to a guest. Cookies or chocolates are also almost a pre-requisite, she says.“These are traditional habits, all hospitality related, family bonding,” said Barakat. “It is interesting how one thing affects another. But I don’t want to change the traditional habit of hospitality, I just want to show a way of making healthier choices.”A resident of east Jerusalem, Barakat was one of the professional speakers at a full-day session of the recent “Colors of Nutrition in Israel” workshop sponsored by the Ben-Gurion University of the Negev, which focused on the nutritional challenges in the Arab population. The session was held in the town of Baka al-Gharbiya, which has launched a pilot program to introduce healthier eating habits into Arab communities.The international workshop brought together leading world nutritional experts and policy makers to expose them to innovation in Israel and challenges in nutritional science, agriculture, industry, sustainability and national policy.Iris Shai, professor of Nutrition and Epidemiology at Ben-Gurion University who organized the “Colors of Nutrition in Israel” workshop, says the Israeli Arab population is experiencing the high cost of a fast transition from a traditional diet to a Western diet high in unhealthy foods, and faces the highest levels of obesity, diabetes and cardiovascular disease in Israel.“We all share here a very healthy basic platform of healthy food,” Shai told The Jerusalem Report. “The problem is the additional (fast food we eat) such as sweetened beverages — which is the No. 1 culprit — simple carbohydrates, processed food and a sedentary lifestyle that we are challenged now to reverse. I am quite optimistic about our abilities, including the health policy undertaken now with the new nutritional labeling regulations.” There are several ways to address the major nutritional issues facing the Arab community in Israel, says Barakat.“We are in a nutrition transition, having left our healthy traditional diet and moving over to the Western diet,” she said. “But we are now still also eating our traditional foods plus all the junk food and ready-made foods like pizza and hamburgers. That means that the amount of calories we are eating are much beyond our needs,” a problem compounded during the month of Ramadan.The enticement for unhealthy eating especially in the neighborhoods of her east Jerusalem home is even greater, she says, because the shelves of convenience stores and markets are not only stacked with local Israeli processed and junk food, snacks and sweetened beverages, but they also have an array of such sweets and processed foods from the Gulf Region and the UAE.“So eating habits are also affected by the Arab region (in general),” she says. “You can see it in the markets – there are a lot of products from outside the country, from the Palestinian territories, and this is a problem: since the products are from abroad, they are seen as more tempting. We are talking about industrial food such as Coca-Cola and potato chips.”Arab citizens drink sugary beverages at almost double the rate of Jewish Israelis, says Barakat, with almost 40% of the Jewish population not purchasing sweetened soft drinks as compared with less than 20% of people in the Arab population.The problem is most acute among teenagers, with 14% of Arab youngsters considered obese while only 9% of Jewish youth fall into that category. Indeed, one local speaker at the conference noted that in Baka al-Gharbiya where the workshop was taking place, 48% of the children were overweight according to statistics from 2018.Arab society in Israel is not the only population going through this diet transition, said speakers at the Baka al-Gharbiya session. Also the Ethiopian community has experienced similar changes in their diet, and traditional societies such as China are also struggling to tackle the issue of recently acquired unhealthy eating habits.Ironically, they noted, while the Israeli kitchen has been influenced for the better by the traditional Mediterranean diet, in the past 20 years or so the Arab diet has been negatively affected by the Western diet.“We have gotten used to little treats thanks to hamburgers and shwarmas, so we have abandoned our healthy food,” Zahi Sa’id of the Counsel for Arab Society, Clalit Health Services, told The Jerusalem Report. “Food used to be like a festival, the whole family would sit around and prepare it together. There were a lot of fresh vegetables and olive oil. But that has been lost. Now I am work from morning till night so fast food is not easy and tempting. And just like for cigarettes (which are more prevalent among Arabs than among Jews,) advertisements influence our food choices.”Another phenomenon which largely no longer exists in Jewish schools but which has yet to be addressed in Arab communities is the easy availability of sugary soft drinks and “energy” drinks near or even inside of the schools, he adds.“If we do not do something drastic there will be a disaster for the national health system,” warned Sa’id, who also spoke at the conference session. “The best investment for the Ministry of Health is to educate the Arab population.”Israeli media recently reported about data from a new research study by Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, which found that Israel has the world’s healthiest eating habits. The results of the study, “Global Burden of Disease,” were published in the British medical journal The Lancet. In his extensive research, Murray studied diet consumption trends in 195 countries looking at 15 dietary factors from 1990-2017.Israel was listed among the top five countries with the lowest rates of diet-related deaths, with only 89 deaths per 100,000. Also among the top five were France, Spain, Japan and Andorra.However, that study was not looking at the isolated statistics of the Arab population in Israel, whose risk factors for diabetes, hypertension and fatty liver disease have grown exponentially, according to experts speaking at the Ben-Gurion conference.So while Jewish Israelis are becoming more aware of healthy eating habits, the Arab population is still struggling with issues related to nutrition transition. This is mainly because the majority of the Arab population in Israel is on a lower socio-economic and educational level than their Jewish counterparts, Barakat says.“The problem is worsening,” said Barakat. “The level of awareness is really a problem.”The problem is similar in Jewish ultra-Orthodox communities, she noted, where the health statistics are comparable. And the Israeli government needs to start caring because all of the health risks associated with unhealthy diets are already coming to roost on the health care system in the form of needing a “huge number” of dialysis centers for diabetes patients, and more medical care for patients suffering from fatty liver disease.Another concern in Arab society, said Sa’id of the Counsel for Arab Society, is the issue of obesity among the women, who often have a higher than average number of children. While there are also overweight Jewish women, most Jewish women are aware of the importance of exercise in general and after pregnancy in specific. However, most Arab women tend to keep the extra kilos following every pregnancy. According to statistics he gathered, 70% of Arab women over 55 are overweight, with 35% of the women in that age group also having diabetes.Sa’id noted that 30% of the general Arab population in Israel has diabetes, and the average life expectancy for Arab citizens is four to five years less than for Jewish citizens.“Before, the Arab population was considered a population which didn’t ‘cost’ the government very much, but as the population has been gaining weight it has become more expensive for the health system to treat the subsequent weight-related diseases,” said Sa’id. “If we continue like this without doing exercise and having an unhealthy diet, we will cost the system more and more.”It isn’t that the Health Ministry has been ignoring the needs of the Arab population, said Barakat, but it took a while for them to realize that the risk factors within different societies are different and specific, and their health policies need to be population-specific.In 2018 the Health Ministry started a national program in Arab sector schools called “Health is Possible, with the pilot program beginning in Baka al-Gharbiya.“The idea is to teach children about healthy eating habits and to show them easy ways they can prepare healthy meals,” Barakat said. “Then they can bring this home with them. We need to work together with the population to find a solution which is best for them.”Eating habits for the Arab population are also different in each region of the country, she says, so a program designed for residents of eastern Jerusalem may not be the best for Arab residents in the north, where education levels are higher, or Bedouins in the south. Local councils and the local population must be brought in as partners for any project focusing on improving dietary health, she said.Medical personnel who are part of the community and understand the local concerns and traditions must also be brought in as partners, notes Sa’id. In the South of the country, a local Bedouin doctor will know better how to approach his Bedouin patients than an Arab doctor from the North of the country who has come to work there, he says, and so there must be investment in creating local medical teams to help tackle the various health issues associated with proper nutrition and weight in each region.Indeed, he says, in some northern villages imams have even started to include tips on health and diet in their sermons to bring the issue to the attention of the residents.“The challenge is very high, and I would love to see the population as a partner,” said Barakat, who is currently the only dietitian in the Ministry of Health working on the Arab sector. “If we come in and tell them what to do, the results will be very low. I have been working on this for two years and it is nothing. It is a process, and I am also learning and trying to move forward. It took me a while to realize that I am also a part of this population, and that I am also a part of this problem. You have to start with yourself. All the time I feel that (what I am doing) is not enough. It is a long road. Maybe we will start seeing results in 10 years.”But the change needs to come from inside.“It is not only one way,” said Barakat. “It is not only the government, it is not only politics. It is also within our houses, our decisions – they are small decisions we can be aware of and make which can also lead to a healthier lifestyle. I don’t want to change the population. I want to go back to the traditional old ways, how we did it before but adapting it to today’s society.”For example, she says, in the traditional maqluba – a beloved upside-down rice, chicken, and vegetable dish – where the vegetables are all fried before being slowly cooked together with the rice, the vegetables can be oven-roasted in the oven with much less oil before mixing them with the rice instead of deep-frying them.“The possibility to change is in our hands,” Sa’id said. “There are a lot of different challenges, but the solution is very easy and does not need any new technology or instruments.”
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