Noura A. Abouammoh

Chapter 1

Background

1. Introduction

This chapter describes the context of the Kingdom of Saudi Arabia (SA). This is followed by an overview of the lifestyle of Saudi people, with regards to dietary customs, physical exercise and alternative medicine. It then highlights key information about type 2 diabetes mellitus (T2DM) and finally, it offers an overview of the Saudi Arabian health care system and provides background information on the status of international medical graduates (IMGs) in the country.

1.1 The Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (SA) is located on the Arabian Peninsula, in the southwest of the continent of Asia. It occupies 2.15 million square kilometres and its estimated population is 29 million inhabitants (MOH, 2012). The Riyadh region - in which Riyadh city, the capital of SA, is located - has a population of around 7 million, of whom 68% are Saudi nationals (MOH, 2012).

SA shares borders with Kuwait Iraq and Jordan to the north, the Sultanate of Oman and Yemen to the south, Bahrain, Qatar and the United Arab Emirates and the Arabian Gulf to the east, and the Red Sea to the west (Figure 1.1).

Figure 1.1 Map of the Kingdom of Saudi Arabia

Due to its different geographical terrains and the influence of high tropical air, the climate in SA varies from one region to another. Generally, however, it has a very hot summer (> ) a cold winter () and the northern and southern regions are rainy in winter.

Some outsiders see SA as the source of oil and the land of wealth. Others link it to the desert, extreme heat and camels, while to many it means the birthplace of Islam. All Saudi citizens are Muslims; however, as in any other part of the world, the degree of practice varies from conservative, traditionalist or liberal. Nowadays, SA has become well known as the largest oil producer and exporter. It has experienced rapid socio-economic development since the discovery of oil, which constitutes the major portion of the country’s revenues.

Oil wealth has allowed SA to provide free health services, education and a tax-free society to its residents.

1.2 An overview of the general lifestyle among Saudi people

1.2.1 Dietary customs

Saudi people tend to have a traditional approach to their diet and prefer to eat certain foods. Some of the traditional Saudi foods that are commonly consumed are “Kabsa” and dates.

“Kabsa” is a rice dish that is usually cooked with red meat and sometimes with poultry. The main meal of the day in SA is lunch, and it usually includes “Kabsa”, which is rich in carbohydrates and fats. In addition to “Kabsa”, dates have a special place among Saudis. The date has a religious value as well as cultural importance because it was mentioned in the Quraan; and Prophet Mohammad’s teachings encourage the consumption of dates. The palm tree is referred to in the Quraan as “the blessed tree” and the Prophet Mohammad, whose sayings and actions most Muslims try to follow as much as possible, advocated eating seven dates early in the morning. Additionally, date farming was the dominant sector of the Saudi economy before the oil industry. Therefore, the Palm tree is the national symbol of SA. There are many types of dates. They are rich in carbohydrates, sugar and high in calories. Dates are served with honey, caramel and chocolate, which can add to their richness and glycaemic index. Due to the small sizes of dates, they are usually served in large numbers. A tradition followed by almost all families in each Saudi house, is to gather for Arabic coffee and dates after sunset.

Younger Saudi generations have adopted a non-traditional lifestyle which is characterised by unhealthy dietary patterns (Midhet et al., 2010). This is supported by the spread of fast food restaurants, especially in urban areas. However, traditional dietary habits are also still prevalent among young people.

The main recreational activities in SA involve formal and informal socialising. The concept of hospitality is very important, and revolves around offering food to guests. Offering a meal that does not involve rice and meat is considered impolite. Furthermore, it is not considered polite for guests to refuse food offered by the host.

All of these cultures and traditions around food can make it difficult for people to control their diet, therefore leading to a high prevalence in the country of chronic conditions such as type 2 diabetes mellitus (T2DM).

1.2.2 Physical exercise

The climate in SA is extremely hot, and in summer it can reach more than . Because of this weather, coupled with a lack of paths and pavements for pedestrians, and a high usage of cars, it is rare to see people walking outdoors.

Saudi Arabia has many gymnasiums, but it is not considered culturally acceptable to see people over 40 years of age using them and they are mainly occupied by people from younger generations. Some families do not allow females to join the gymnasiums and many families do not allow them to walk outdoors. Therefore, middle aged, older people and females are restricted in terms of being physically active.

A national survey showed that 96%, of the 17395 male and female respondents aged 30-70 years, have inactive lifestyles (Al-Nozha et al., 2007). An inactive lifestyle in this study was based on less than 30 minutes of moderate-intensity physical activity fewer than three times a week. This kind of lifestyle was the most common in the central region of Riyadh and the least common in the southern region (Al-Nozha et al., 2007). This is likely to be because Riyadh is much more urbanised than the Southern region in which there are a lot of people who work as farmers and shepherds and have more active lifestyles (Al-Nozha et al., 2007).

In short, the living environment, habits and customs, in addition to a more modern lifestyle in SA can encourage people to have sedentary lifestyles (Al-Hazzaa, 2004), again leading to a prevalence of chronic conditions such as T2DM.