Sport and Exercise Medicine: The UK trainee perspective (A BJSM blog series)

By Dr Farrah Jawad

Obesity is becoming a major public health issue in the Middle East and in other developing regions. Estimations of overweight or obese individuals include: 42.2% of Kuwaiti adolescent males and 42.4% of Bahraini adolescent females ¹. The World Health Organisation indicates that the global burden of non-communicable diseases in developing countries will substantially increase over the next decade². Physical inactivity is one major factor leading to an increased prevalence of obesity and the health burden it confers in young people^3-5.

Barriers to maintaining physical health: understanding differences across culture, gender and age

It is necessary to identify and address the barriers to physical activity for people living in the Middle East and other developing regions to reduce the effects of this public health burden. Obesity is taking a particular toll on Arab women, with 45.3% of Qatari and 44% of Saudi Arabian women being obese, nearly double the rate of obese men in those countries⁶. Over the last three decades there has been a big shift in diet in the Middle East, with Western food, some of which is high in calories, fat and sugar, increasing in popularity, particularly as more women are entering the workforce and fast food is replacing traditional home-cooked food.⁶ The opportunities to exercise in public are extremely limited for women living in many Middle Eastern countries due to cultural factors such as accepted dress codes and modest conduct. The fuller figure is seen as a desirable trait in women in the Middle East, being considered a thing of beauty and higher social standing.

One study on schoolchildren in Iran explored the barriers to physical activity. Researchers found that studying was prioritized over physical activity. The students described a lack of safe and easy-access places to partake in physical activity and reported a lack of encouragement from their parents to engage in physical activity, with a greater emphasis on studying⁷. The authors noted an inverse association between children’s activity level and the level of the parents’ education⁷. There was also inadequate public knowledge of how to integrate physical activity into routine daily life⁷.

UAE: Lack of visible active living, and health promotion initiatives for change

On a recent trip to Dubai I was struck at how much it had changed since I had last visited in 1994; it has become so much more urbanised, more populated and appears to be thriving in economic terms. I was struck by how few people could be seen walking, cycling or running in public, so different from where I live in London. The summers in the UAE are hot and dry – too hot perhaps to do anything but swim outdoors at that time of year. An ice rink and indoor snow resort have been opened in Dubai and in summer months, indoor leisure centres may be the best way for people to get the exercise they need. Dubai seems very safe, even for the young, and it was a surprise not to see more children playing outdoors. I have been interested at looking into some of the public health measures which have been set up in the Middle East in order to combat the problems of lack of physical activity and obesity in the region. In the UAE, two Imperial College London Diabetes Centres have been set up in Abu Dhabi and Al Ain (since 2006 and 2012 respectively).

Walk for Life: A Diabetes Prevention Initiative

Since 2006, the Imperial College London Diabetes Centre in Abu Dhabi (and later the Al Ain centre), has developed a public health initiative which is intended to reach all levels of UAE society using four “pillars”: Walk for Life, Play for Life, Eat for Life and Cook for Life. The Walk for Life is an annual 5K walkathon for the community, which took place last November and saw 20,000 people participate. The aim is to inspire people to walk, build walking communities and encourage healthy lifestyles. Social media, email marketing, public relations, radio, newspapers and magazines advertised it. Friday sermons across approximately 2000 mosques also mentioned the event⁸. During the event, 633 people took part in a survey to explore their knowledge about the benefits of exercise and their motivations for taking part in Walk for Life. Of those surveyed, 70% said they were aware that a regular walk helps to reduce the risk of diabetes and 70% declared they were interested in forming their own walking groups, requesting more information⁸. The Walk for Life is due to take place again this year on 14^th November 2014.

Play, Eat, and Cook for Life

Play for Life involves a football tournament organised for corporate employees in Dubai. The campaign also supported the Family Development Foundation’s Women’s Fitness Challenge which was spread over 12 weeks and was aimed at educating women in the emirate’s Mirfa region on how to balance work and exercise with a busy lifestyle. Eat for Life promotes a balanced diet to schoolchildren and Cook for Life aims to inspire families to cook healthy meals at home. Cook for Life’s message is delivered by a television programme watched by millions of viewers.

Steps in the Right Direction

Clearly, in the UAE at least, public health initiatives are underway to tackle the burgeoning problem of obesity and non-communicable diseases. Their focus is on addressing people’s lack of physical activity and poor diet choices. I am not presently aware of any other similar initiatives across the Middle East but I hope that they exist. If they do not, perhaps the good example set by the UAE may inspire other nations in the region to follow suit in order to protect the health and welfare of their people.

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Dr Farrah Jawad is an ST3 in Sport and Exercise Medicine at the Hammersmith Hospital in London.  She is particularly interested in the public health aspect of Sport and Exercise Medicine and dance-related musculoskeletal injuries.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

1. Ng, SW, Zaghloul S, Ali HI et al. The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States. Obes Rev. 2011 Jan; 12 (1): 1-13.
2. World Health Organisation Global Status Report on Noncommunicable Diseases 2010.
3.  Dishman RK, Motl RW, Sallis JF, Dunn AL, Birnbaum AS, Welk GJ, et al. Self-management strategies mediate self-efficacy and physical activity. Am J Prev Med. 2005;29(1):10–8.
4. Makinen TE, Borodulin K, Tammelin TH, Rahko-nen O, Laatikainen T, Prattala R. The effects of adolescence sports and exercise on adulthood leisure-time physical activity in educational groups.Int J BehavNutr Phys Act. 2010;7:27.
5.  Lee IM, Sesso HD, Paffenbarger RS., Jr Physical activity and coronary heart disease risk in men: does the duration of exercise episodes predict risk? Circulation. 2000;102(9):981–6.
6. Sarant, L. The hidden obesity toll on women in Arab states. http://www.natureasia.com/en/nmiddleeast/article/10.1038/nmiddleeast.2013.161. Accessed on 24^th May 2014.
7. Kelishadi R, et al. Barriers to Physical Activity in a representative sample of Children and Adolescents in Isfahan, Iran. Int J Prev Med 2010 Spring; 1(2):131-137.
8. Walk 2013 Overview: Celebrating 70,000,000 steps, a document produced by Imperial College London Diabetes Centre, 2014.