Western tastes and Turkey's obesity problem

The Western world has made its presence known in Turkey in so many ways: over the last five years squatter toilets have been outnumbered by seated toilets; reality TV shows like Survivor hog the screen and, in forward-thinking establishments, wheelchair-friendly ramps replace stepped kerbsides.

The latest invader brings with it an addition to the Turkish vocabulary, “nugget”, specifically “tavuk nugget” – that is to say chicken nugget. This new word does not arrive alone, its comrade-in-arms is the worldwide pandemic -  “obezite” (obesity) .

Neither word existed in the Turkish language 20 years ago, but both are now daily features. Turkish restaurants still offer plenty of tomato and aubergine-based casserole dishes, but the nugget now lies alongside them, gleaming greasily under the heated lamps and obesity, childhood obesity in particular, is big news.

McDonald’s brought the nugget to Turkey in 2002 and, as its popularity grew, so did its ubiquitousness. Migros sells seven types of nugget and Carrefour eight. İnternational food companies market the same foods that jeopardise health in wealthy countries to developing ones. Urbanisation, easy availability of prepared food, computers, tablets and TV have waved their wicked wand over Turkey, and the results are frightening.

İn 1990, the overall prevalence of obesity in adults was 18.6 percent. Ten years later, this had grown to 21.9 percent and recent estimates place it as high as 33 percent. However, obesity rates among children had remained low until recently, as up until a decade ago malnutrition was still a problem.

Healthy choices

New research, though, from February 2014, suggests that 12 per cent of seven to 12-year-olds are overweight or obese with inactivity pinpointed as the main cause. The report suggests that 50 per cent of children only spend two hours outside the house at the weekend and even less during the week. Meanwhile, 61 per cent of children in this age group do no sport with their family. Childhood obesity has tripled since 1970.

Although the problem is mainly an urban one, there have been changes in rural diets too that indicate that the problem will develop here as well. Previously most Turkish farmers were subsistence farmers, raising their own chickens, goats, sheep, and vegetable and cereal crops.

The traditional Mediterranean diet, if imagined as a triangle, had cereals and pulses as the wide base, fruit and vegetables as the middle of the triangle and calorie-rich meats as the peak and smallest part. The agricultural changes that have led to the introduction of cash crop economics mean that often only one plant is being harvested and the balanced diet high in complex carbohydrates is disappearing, and being replaced with one rich in fats, saturated fats and sugars.

İt seems that obesity is the price children pay for their parents’ success, studies have documented that unlike developed countries where obesity is prevalent among low-income groups, in Turkey it is more prevalent in high-income groups. A child is twice as likely to be obese if his father has had higher education than if his mother is illiterate.

Previously schools rather than the state were trying to take the lead in the “food fight”, with private schools being the most proactive. Primary school students can choose to eat at the school canteen and here their diet can be modulated through the choices they are offered, some wealthier establishments even have fingerprint İD methods for payment in the canteen and tuckshop that enable parents to check via the internet what their child has eaten.

These proactive schools, though, are few and far between; in the majority of schools lunch is an open buffet and children choose their food themselves. Most often they pick pizzas, burgers, chips, desserts and fizzy drinks, and some are so vegetable averse that they even pick the slice of tomato out from under their burger bun. Those that don’t eat at school go out and buy sandwich toasts or doner kebabs accompanied with an obligatory Coke.

Dr Rustem Eyupoglu, of the Eyüpoğlu schools group points out: “When we have tried to inform parents about the dangers of letting their children eat whatever they like, they accuse us of profiteering and say that we just want to make money from the canteen.”

Parental indulgence

İn fact, the biggest problem in the fight against obesity is the parents themselves for two reasons. Firstly there remains the vestiges of the “fat is fabulous” school of thought. An overweight baby is thought to be especially thriving, plump children are often regarded as cute and parents show their love by feeding their kids. The words tombiş and tombul, both describing plumpness, are affectionate terms. İf questioned parents will say: “Oh he’ll lose it when he starts walking ... he’ll lose the weight when he starts school,” but the reality is that up to 20 percent of obese 0 to 2-year-olds are obese when they are 6 to 10-years-old as well, and 40 per cent of these 6 to 10-year-olds become obese adolescents.

For many, their parents’ indulgence is a lifelong sentence. The second obstacle presented by the parents is the attitude that the school should not interfere with how they choose to raise their offspring. Many argue that childhood only comes once and that children should be as free to choose what they like to eat, and others hide behind these attitudes rather than risk showing their own lack of discipline and care.

This year the government is trying to (literally) step up to the mark with its proclamation that 2014 is Turkey’s year for “Healthy Living, Healthy Eating and Activity”. The health minister Dr Mehmet Muezzinoglu has become a key supporter of the Walking to Health movement and appears every Sunday in different location all over Turkey walking with health campaigners.

İn previous summers, some children were sent to attend American-style “fat camps”. The esteemed hospital Acibadem in İstanbul used to run a two-week programme at its Education and Sports Centre.

But try and find such a camp online now and you will have no luck. Perhaps the tide turned when, in 2012, Dr Muzzafer Kushan, one of Turkey’s “fat-camp” pioneers, was sentenced for aggravating the death from chronic heart failure of 19-year-old Dila Kurt. Kurt was encouraged to lose 13 kilos in 44 days and, despite early warning signs, her regime was not adjusted.

In 2012, Dr Kushan was found knowingly negligent in his care of her and sentenced to one year and eight months in jail. This was appealed and, in April 2014, his sentence was adjusted to a longer 3 years and six months, and he was struck off the medical register for more than two years. It is no wonder then that some parents might feel more comfortable about their child’s safety at home in front of the computer with a plate of nuggets.

- Fazile Zahir is of Turkish descent, born and brought up in London. She moved to live in Turkey in 2005 and has been writing full time since then. 

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Eye.

Photo Credit: A traditional Turkish kebab stall in Istanbul (Flickr)