Hidden casualties of war

For many Iraqis, sectarian violence holds a hidden danger - a sedentary lifestyle of TV and food, writes Tina Susman

For many Iraqis, sectarian violence holds a hidden danger - a sedentary lifestyle of TV and food, writes Tina Susman

IN A LAND where just staying alive is a challenge, Haider Kareem Said's problem might seem trivial. He is overweight.

But that isn't a mere annoyance or something Said can fix with diet and exercise - he's five feet four inches and weighs 495lbs. So in August, Said had a band surgically strapped around his stomach, an operation relatively new to Iraq that is proving to be a godsend for people facing an unusual consequence of war: obesity.

For most of the past five years, sectarian violence has drastically altered Iraqis' lifestyles. Most retreated to the safety of their homes and became increasingly sedentary. To go out was to risk being kidnapped, killed by a bomb or caught up in the other violence plaguing Iraq. Curfews hindered people who tried to remain active.

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Said, 25, had a photographic supply shop but closed it for three years because of security concerns.

"I stayed home and couldn't do anything. All I did was play PlayStation and eat," Said says, while awaiting his surgery in Baghdad's St Raphael Hospital.

The ankle-length brown gown he wore could not hide his weight. Fat rolled around his ankles, and his rounded feet barely fit into his slip-on sandals.

His face, soft and absent of contours and lines, made him appear younger than his years. "When I worked, my weight was a lot less, but those three years really had an impact," he says, estimating his weight gain in that time at about 200lbs.

Statistics on obesity in Iraq are difficult to come by, but a 2006 World Health Organisation survey found 26 per cent of men and 38 per cent of women aged 25-65 were obese, with a body mass index of 30 or above.

Although no direct comparisons are available, about 33 per cent of American men and 35 per cent of American women were considered obese in a 2005-06 study done by the Centers for Disease Control and Prevention's National Centre for Health Statistics.

Said's BMI is 83, the highest seen by Dr Ramiz Mukhtar, the only surgeon in Iraq who performs gastric band surgery.

Mukhtar will not discuss the reason for Iraqis' growing weight problem, beyond saying that they eat too much unhealthful food and don't move around enough.

But Said's uncle, Jabar Said, agrees that the war had made many Iraqis fatter, himself included.

"People are unemployed. They're sitting at home. Sometimes they're depressed and that makes them eat more. Obviously, the security has had a direct influence on the activities of people,'' he says, his round belly pressing against the fabric of his white dishdasha. "I've been on a diet for the past two years. I've only eaten one meal a day, but I didn't lose anything because I don't move a lot."

Now that the violence has decreased, he hopes to shed the 65lbs he's gained.

The uncle speaks in the Said family home in east Baghdad the day after his nephew's surgery. Friends and relatives have gathered to welcome home the younger Said, who arrived a few hours earlier.

A plasma TV sits on one wall of the long, narrow living room. At the opposite end is another television. They are symbols of the Saids' comfortable middle-class life and of the unhealthy habits adopted by many Iraqis during the war.

The fall of Saddam Hussein didn't just usher in chaos and violence - it also introduced satellite television to Iraqis. Suddenly, with scores of channels to watch, even people who aren't forced to stay inside often do.

Ironically, TV might have saved Said.

About a year ago, he was channel surfing and stumbled on Beauty Clinic, a show on Lebanon's Future TV that focuses on cosmetic surgery. It featured a segment on gastric banding.

"I saw the before and after results, and I was amazed, so I decided to do it," he says.

He began planning a trip to Lebanon to find a doctor. Then a friend told him that Mukhtar could perform the operation which, in simple terms, drastically shrinks the stomach by strapping a band around it.

Once the band is in place, the amount of food patients can consume is limited.

For Said, finding a Baghdad surgeon meant avoiding the humiliation of travelling in public.

"I was embarrassed to be so fat," he says. "When I walk down the street, everyone looks at me. It's as if I were Saddam Hussein, the way everyone stares."

Said says that even as a child he had a weight problem, something he attributes to loving food and hating exercise.

The surgery took about 45 minutes, Mukhtar says. He estimates that he has performed about 150 of the operations in the past two-and-a-half years. He would have done more if the price tag of about $4,000 (about €2,826) wasn't too steep for most Iraqis.

For Said, the next step is learning to eat tiny portions totalling about 2,500 calories a day, a fraction of what he used to consume. That means giving up the delicious mounds of chicken, beef, sheep's head and fish, along with honey-soaked sweets, that his mother used to make for him.

He acknowledges being worried that, when his appetite returns, he will have problems adjusting to his stomach's limited capacity. And he says he has no intention of starting to exercise.

"I'm not into sports," he says with a laugh. "If I wanted to exercise, I wouldn't have had to do this operation."

But Mukhtar disagrees. Most of his patients take up exercise when they reach their ideal weights, once they see how good they look, he says.

"You'll see," he says knowingly. "I know them very well."

- Additional reporting by Saad Khalaf

• (LA Times/Washington Post)