Paraphrasing Sample

Paraphrase the article below:

Noncommunicable diseases cause 72.9% of all deaths. Cardiovascular diseases account for

40.8% of all deaths, cancers 13.7%, respiratory diseases 1.9% and diabetes mellitus 3.9% (1).

As a result, 12.0% of adults aged between 30 and 70 years are expected to die from one of

the four main noncommunicable diseases (7).  The prevalence of insufficient physical activity in adolescents (11– 17 years of age) is 84.9% (77.0% of boys, 92.9% of girls); age-standardized values are 53.6% (48.3% of males, 62.8% of females) (10). Raised blood pressure in adults aged over 18 years affects 20.0% of the population (21.1% of males, 16.5% of females), while obesity affects 42.0% (37.5% of males, 49.8% of females); this is the highest rate in the Region (7).

ADULTS

Kuwait ranks among the top countries worldwide for the prevalence of overweight and obesity.3 The country’s BMI profile has rapidly changed over the last four decades shifting from one where the majority of adults (~60%) were of a normal weight range to one where more than two-thirds of adults are either overweight or have obesity.3 The Kuwait STEPS survey of non-communicable diseases (NCDs) report from 2014,20 which investigated the prevalence of main NCD risk factors among Kuwaiti nationals, estimated that eight in every ten (77.2%) adults (aged 18–69) are either overweight or have obesity. Two fifths (40.2%) have obesity.20 The proportion of women with obesity (44.0%) was 1.2 times higher than that of men (36.3%).20 Although there are few studies documenting the

prevalence of overweight and obesity among non-Kuwaiti nationals living in Kuwait, a study from 2013 indicates high prevalence rates among the South Asian population in the country.21 Of the more than 1,000 individuals involved in the study, 46.1% were overweight and 24.0% had obesity, classified according to BMI. On investigation of waist circumference, 73.3% of the group had abdominal obesity. Asians account for more than 40.0% of the population in the country.22

 CHILDREN AND ADOLESCENTS

Over the past two decades, there has been a dramatic rise in the prevalence of overweight among Kuwaiti schoolchildren, and Kuwait consequently ranks among the countries with the highest prevalence of childhood obesity in the region.23 Alarmingly, when the prevalence of obesity among children and adolescents (aged between two and 19) was compared across 22 countries in the Eastern

Mediterranean Region, using the findings from the Global Burden of Disease 2015 study, the highest prevalence was observed in Kuwait with 22.1% for boys and 19.2% for girls.24 The findings reported in other local studies similarly showed disconcertingly high prevalence rates of overweight and obesity among children in various age categories, for example, those in their pre-teen and

teenage years. A survey from 2016 of Kuwaiti children between the ages of 11 and 14, reported that a quarter (25.5%) were

overweight and an additional third of the participants (36.5%) were classified as having obesity.25 While another study from 2013 of more than 900 Kuwaiti adolescents between the ages of 14 and 19 found that approximately half of them (50.5% boys and 46.5% girls) were either overweight or had obesity.26

Health impact of obesity

Cardiovascular complications

Obesity directly affects the cardiovascular system and is associated with numerous heart complications, including congestive heart failure, arrhythmia (abnormal heart rhythm), coronary artery disease and stroke.46

Type 2 diabetes

Type 2 diabetes is strongly associated with obesity.48 People with obesity are seven times more likely to develop type 2 diabetes, while being overweight increases the risk threefold.49 People with severe obesity (BMI ≥ 35) have a risk of developing type 2 diabetes that is up to 60 times greater than among those with normal weight.50 Among young Kuwaiti adults, obesity is a major predisposing factor for impaired fasting glucose and diabetes.51 The International Diabetes Federation estimates the prevalence of diabetes in Kuwait to be 15.8% among adults aged 20–79 in 2017,52 more than double the prevalence in 200053. Without action on underlying factors such as obesity, the prevalence could reach 21.4% by 2045.52

Hypertension

Research from Kuwait shows that the risk of hypertension increases with obesity levels,54 and the risk increases with increasing BMI.42 Furthermore, a person with hypertension who has excess body weight may develop type 2 diabetes five to 12 years earlier, depending on their BMI, compared with nonhypertensive individuals.55

Dyslipidaemia (abnormal lipid profile)

Dyslipidaemia is associated with obesity. Obesity has an impact on blood lipids, resulting in increased cardiovascular risk.56 Of the 14 countries included in the Africa Middle East Cardiovascular Epidemiological (ACE) study, which aimed to estimate the prevalence of cardiovascular risk factors, Kuwait had the highest prevalence of dyslipidaemia.57

Cancer

Excess body weight is associated with an increased risk of several types of cancer, such as breast, colon, rectal, endometrial, oesophageal, kidney and pancreatic cancer, and contributes to as many as 20% of all cancer-related deaths.58 A review of data between 1974 to 2007 from the Kuwait Cancer Registry at Kuwait Cancer Control Center (KCCC) established that there is an increasing trend in cancer prevalence, especially of certain types of cancers. For example, colorectal cancer among Kuwaiti men has increased approximately five-fold over the past 33 years, similarly over the same period prevalence of breast cancer among women grew three-fold.59 The difference in prevalence over time is attributed to changes in lifestyle and habits, such as diet and physical activity, as well as obesity.59

Joint problems

Osteoarthritis is the most common joint disorder, with symptoms affecting the hands, knees, hips, back and neck. Excess body weight increases the load placed on joints such as knees, increasing stress and possibly hastening the breakdown of cartilage.62 Sleep apnoea Sleep apnoea is a serious, and relatively common disorder where the person sleeping has periods of shallow or interrupted breathing during sleep.63,64 Sleep apnoea is strongly linked to obesity and often other metabolic factors such as hypertension, hyperlipidaemia, insulin resistance are also already present at the time of diagnosis.65 It is also a severe risk factor for cardiovascular disease.65 Mental health Among adults, there is a complex relationship between obesity and mental health conditions. Obesity has been associated with mental health problems due to poorer perceived health, low selfesteem and concern about body image.66 It is also seen as a consequence of mental health conditions, with people eating as a coping strategy.66 Maternal health risks for the mother and child Obesity is associated with both short- and long-term health risks for women as well as their off-spring.67,68 A woman who is pregnant and has obesity is more likely to encounter complications during birth and have a higher risk for caesarean delivery than a woman of normal weight. For the unborn child, risks include macrosomia and risk for components of metabolic syndrome in the long-term.67 In Kuwait, the Transgenerational Assessment of Children’s Environmental Risk (TRACER) study70 investigated the link between a mother’s pre-pregnancy weight and that of her offspring’s to assess the risks in childbirth. Findings from the study showed that the percentage of foetal macrosomia (6.1%) and large for gestational age (23.0%) infants were higher than expected.70

Quality of life

In a study of 98 paired samples of obese and healthy weight adolescents in Kuwait, quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL™ 4.0)†. The physical health summary score was significantly higher in the healthy weight adolescents than in those individuals with obesity, but the psychosocial health summary score and total scale score showed no significant difference.71

Sexual dysfunction

Sexual dysfunction in people with obesity is affected by several factors including body image, body confidence, low mood, depressive symptoms, coexistent pelvic floor dysfunction such as urinary incontinence, prolapse or faecal incontinence that may cause embarrassment during sexual intercourse.72