With Few Healthy Options, Egyptians Often Turn to Fast Food

Marwan Imam eats a lot of fast food. A 29-year-old film director from the upmarket suburb of New Cairo, he spends long hours out on shoots or editing in the studio, and regularly resorts to ordering takeout. "For 15-hour work days, you really don't want to be thinking about what kind of food to have," he says. "I'll always just go for the easiest option." In Cairo, that means junk food. Imam's favourite restaurants—McDonald's, KFC, and Hardee's—deliver almost anywhere in the city, and they're open 24-hours a day. Imam orders from them three or four times a week. Weighing in at 300 pounds, he's also among the one-third of Egyptian adults classified as obese.

Fast food is everywhere in Cairo. The streets are packed with takeaway restaurants and the roads are jammed with Chinese-made motorcycles with top boxes filled with fatty food. In contrast to the West, American fast food chains like the ones Imam orders from are marketed to the upper classes, and are unaffordable to the estimated 22 million Egyptians who live in poverty. But when it comes to takeout, there's something for everybody, and a cheaper tier of local restaurants provide the same high-fat food as the big brands for a fraction of the price. In Egypt's class-segregated society, love of fast food transcends class boundaries, as does an obesity epidemic: Egypt has the highest rate of adult obesity in the world.

Omar Rohaiem is a 31-year-old marketing consultant. He guesses "probably half" of the people he works with order takeout to their desks on a daily basis. Part of this is down to the prevalence of food delivery in the Egyptian capital. In Cairo, you can order pretty much everything to your house, from Viagra to artisan dog food. With cheap petrol and low wages, almost every restaurant provides a delivery service, and food delivery has become a key part of Cairo life.

Delivery is available well into the early hours, too. "You would be surprised how many people order late at night," says Rohaiem. "A couple of times I've come back late, like 12 or 1 AM, extremely hungry, and called McDonald's and they've told me: 'We've had a rush of orders so the the delivery time has been increased.'" In a notoriously chaotic city like Cairo, few things are easier than ordering food; the city has become addicted to takeaways.

Rohaiem is no exception. Like 70 percent of Egyptians, he's overweight. He lives in a one-bedroom apartment in the well-heeled neighborhood of Nasr City, but he works erratic hours and his kitchen "isn't so well equipped," so he ends up ordering about half his meals from fast food joints. "Mostly, it's Chicken Tikka," he says, referring to a Western-style Egyptian chain that sells large portions of grilled meat, "but also I get McDonald's, Hardee's, and Pizza Hut."

Whereas big fast food chains are marketed as a budget option in Europe and North America, in Egypt they pitch themselves as more upmarket. "These brands are associated with a sort of general Westernisation," says Dr. Mona Mowafi, a visiting scientist from Harvard's School of Public Health. "It's about cultural affinity to the West." With these brands targeting the upper classes, the poor are priced out. For example, in Egypt, a family bucket from KFC costs more than a third of the average weekly salary. "If you look at the price of a meal in Egypt, they're basically inaccessible to the lower classes," explains Mowafi. While the Economist's Big Mac Index rates Egypt as the second-cheapest country in which to buy a Big Mac in US dollar terms, many locals would blanch at spending LE 33.62 (US $1.87) on a sandwich.

For the average Egyptian, a cheaper tier of fast food exists. In the slum area of Manshiyet Nasser, 36-year-old Eid Kamal orders delivery every day. He works in a small plumbing-supplies shop on a dusty high-street crammed with tuk-tuks and donkey carts. Manning the store for ten hours a day, he doesn't have time to run home for a bite to eat, and instead gets breakfast and lunch brought to his store. "I can call the restaurant up now and they'll be here with my food here in five minutes," he says from behind the counter of his store. On his LE 3,000 ($167) monthly salary, it would take Kamal a couple of days to earn enough to afford Imam's standard order of a large MegaMac meal with a side of McNuggets. But Kamal has other options.

"I normally spend LE 5 ($0.28) on breakfast," he says. As is the case for most Egyptians, breakfast is ful (stewed fava beans, usually served smothered in cooking oil) and taameya (a kind of falafel, again made with fava beans, and deep fried). He might eat the same for lunch, or have a sandwich filled with fried beef liver or chicken pane (breaded, deep-fried chicken breasts). Often, he orders koshary, a carb-heavy Egyptian staple consisting of macaroni, rice, and lentils, covered in tomato sauce with plenty of oil and MSG. It has little nutritional value, but Kamal can get a small plate of it for LE 3 ($0.17). It's all washed down with cans of soda or cups of tea sweetened with heaped spoons of sugar.

A few years ago, Mowafi of Harvard conducted a study to assess the relation between obesity and class background, to compare with other countries. In the developing world, the poor tend to be thinner whilst the rich are more likely to be overweight. "When you get wealthier, you get fatter," she says: "'Now I have money, I'm gonna buy more food.' Then, over time, as a country gets wealthier and more educated, that switches." In the developed world, it's the lower classes that tend to be overweight, while the rich, with better access to education and healthier food, tend to be slimmer. Mowafi's study found that, in Egypt, neither trend applies. Instead, obesity is prevalent and evenly spread among all social classes.

With so many people eating badly, Egyptians suffer from a range of health issues. In addition to its obesity epidemic, it now has one of the world's highest rates of diabetes, with nearly 16 percent of working-age adults diagnosed with the disease and 86,500 dying from it every year, according to a 2014 study. Imam, the director from New Cairo, has a number of friends living with diabetes, and he also suffers from health problems himself. With high rates of uric acid, he's showing the early stages of gout-based arthritis, and three years ago he went under the knife to have his gallbladder removed. "The weight is crippling in many ways," he says.

Thanks to the physical requirements of working in his store, Kamal appears to be in good shape, but his insides are paying the price for his poor diet. He suffers from stomachaches daily, and says he's had diarrhea for the past two years. He blames his health problems squarely on the food he eats but asks: "What can I do?" His options for eating healthily are limited; the floor of his shop is littered with the empty cans of tuna in sunflower oil with which he's tried to supplement his fast food diet. It's not enough, but it's the best he can find. "What healthy food is there around here?" he asks.

The Egyptian government is doing little to stem obesity, and in some ways may be making it worse. While in some Western countries, ingredients linked to obesity—like hydrogenated oils and trans fats—are often taxed or restricted, in Egypt many of these products are actually subsidized by the government. Although they were originally introduced during World War II to assure the poor had access to basic food commodities, nowadays some 80 percent of Egyptians benefit from state-subsidized bread, flour, rice, cooking oil, sugar, and tea. Mowafi argues that these subsidies help encourage unhealthy food choices. "It's very carbohydrate-heavy loads and a sugar-heavy load that the lower classes are getting," she says. While the current economic crisis is pushing up prices for fruits and vegetables, "it's very inexpensive for the lower classes to gain access to literally just bread and sugar."

And like most streets in Cairo, the road Kamal's store is on is lined with "kiosks," small shops selling vending-machine type snacks like Twinkies, Ho-hos, bags of chips, and cans of Coke. You'll find nothing nutritious there, but it's cheap and very convenient. Kamal wants to improve his diet, but when he's hungry, he says, "it's difficult to resist the temptation."

Imam also wants to lose weight and come out of obesity. He's identified fast food as the main cause for his weight problems, but cutting it out is difficult. "Making the healthy choice is hard," he says. "It requires you doing your own grocery shopping and getting your meals prepared for the week." On the other hand, ordering fast food couldn't be easier. "You don't even have to call anymore," he says. "It's all available online and there are mobile apps; 24-7, something will come and feed you."