War's toll shows up on Iraqis' waistlines

In a land where just staying alive is a challenge, Haider Kareem Said's problem might seem trivial.

He's overweight.

But that isn't a mere annoyance or something Said can fix with diet and exercise – he's 5-foot-4 and weighs 495 pounds. 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 the 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.

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 said while awaiting his surgery in Baghdad's St. Raphael Hospital.

The ankle-length brown gown he wore could not hide his heft. 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,” Said said, estimating his weight gain in that time at about 200 pounds.

Statistics on obesity in Iraq are difficult to come by, but a World Health Organization survey in 2006 found that 26 percent of men and 38 percent of women ages 25 to 65 were obese, with a body mass index of 30 or higher. Although no direct comparisons are available, about 33 percent of American men and 35 percent of American women were considered obese in a 2005-06 study done by the Centers for Disease Control and Prevention's National Center 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 would 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, agreed 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 said, 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 roughly 65 pounds he's gained.

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

A plasma TV was on one wall of the long, narrow living room. At the opposite end was 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 weren't forced to stay inside often did.

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 said. 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 traveling in public.

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

The surgery took about 45 minutes, Mukhtar said. He has performed about 150 of the operations in the past 21/2 years, he said. He would have done more if the price tag of about $4,000 wasn't so steep for most Iraqis.

For Said, the next step is learning to eat tiny portions totaling 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 acknowledged being worried that when his appetite returns, he will have problems adjusting to his stomach's limited capacity. And he said he has no intention of starting to exercise.

“I'm not into sports,” he said with a laugh when asked whether he planned to change his lifestyle. “If I wanted to exercise, I wouldn't have had to do this operation.”

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

“You'll see,” he said knowingly. “I know them very well.”