Recently I met an American pediatrician who works at a hospital in the town of Al Ain, in the Emirate of Abu Dhabi. If was fascinating to hear about the culture of the United Arab Emirates, especially its health care system.
When the doctor (who wishes to remain anonymous, noting it is easier for Emiratis to comment on their own country than it is for foreigners) found out that one of the topics I write about is eating disorders, she told me an interesting story:
One day a girl of about 14 came into the clinic where she works, suffering from severe weight loss and fainting spells. “After doing the full history and asking many questions about the more common causes for weight decrease, none of which fit her case,” says the pediatrician, “it occurred to me that we had not asked any screening questions to rule out eating disorders.”
Her patient, she recalls, “was very engaging and cute. She was wearing the traditional abaya and shayla (the long, loose cloaks and head scarves wrapped to frame the wearer’s face), and she spoke Arabic. Through a pediatric resident who both conversed with the girl and acted as translator, the doctor asked the patient if she was satisfied with her body size.The answer came “clearly and quickly,” recalls the pediatrician: “she thought she was fat.” The physician suspected the girl might have an eating disorder.
I found this story surprising in a region where public dress for women is extremely modest and unrevealing, and where once a girl reaches puberty the culture dictates she wear the abaya and shayla. Yet even though no one could discern the shape or exact size of her body, at least in public, this 14-year-old seemed to be suffering from body image distortion and possibly an eating disorder.
The few Emirati women who are from families liberal enough to permit them to swim remain completely covered in the water. Some more fashionable types might sport a bathing outfit known as a “burqini,” a headscarf-tunic-pants ensemble that covers the head, arms and legs completely but is slightly more form fitting. Even that, explains the doctor, would be seen only occasionally, say at a Dubai water park.
It is only either in the home among immediate family, or when a woman is alone with girlfriends, the physician explains, that women can wear Western-style street clothes. Female entrances to homes are separate from buildings’ main entrances, and in large gatherings of extended family or friends, the women are cloistered together in the “ladies living room,” she adds, “where they can enjoy abaya-less fashions together.”
So in a society where revealing clothing is taboo, where there are limited opportunities to see a woman’s size and shape, where did the 14-year-old patient’s notions and standards about what is “fat” come from?
A quick search called up this article about a 2010 survey of 500 Emirati university women, a quarter of whom were deemed to possibly have an eating disorders. The study showed that increased media influence played a significant role in the high percentage of women considered at risk for an eating disorder. Almost 90 percent of study subjects reported watching at least 17 hours of television a week, while nearly 75 percent reported reading appearance-related magazines.
The Muslim Observer noted that despite innumerable fatwas issued by Muslim clerics against TV, western television and movies are “the daily bread of many Gulf residents and have made an irrevocable mark on the social fabric of the region.” Western fashion magazines such as Vogue, Cosmopolitan, Marie Claire and Elle are all sold in the UAE, the says the pediatrician, adding, “Shopping and fashion are national past times. The clothing women wear beneath the abayas and the handbags they carry are top-notch fashions.”
Sadly, treatment of eating disorders in the UAE lags far behind its incidence, and this article in the Abu Dhabi publication The National notes that many families must leave the country for the U.K., Switzerland or the U.S. to get adequate treatment. Marcia has seen evidence of this first-hand: Last spring she treated an Emirati patient at a private school in New England, and recalls. “Her team here insisted she live with relatives in Houston to get further treatment before returning home.”
So what happened to the 14-year-old girl? Alas, the Emirati healthcare system, while great at dealing with acute illness, says the physician, is not as good with long-term issues. She sent the patient to get some baseline lab work and referred her to both a psychologist and nutritionist/dietician. Now many months later, the patient has not made an appointment with the psychologist, has not returned to the pediatrics clinic as requested and still has not had her appointment with the nutritionist.
Unlike in America, where pediatricians follow patients through their college years, there is no such protocol in the UAE. “For many years teenagers were considered ‘lost’ patients,” whose needs were largely overlooked,” says the pediatrician. “Outside the U.S., health care of the adolescent has a very long way to go.”