Spectrum of BMI & Assessment of Body Composition in Female Medical Students and Role of Riyazat (Exercise) in the Management of Obesity

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1 International Journal of Advances in Health Sciences (IJHS) ISSN Vol 3, Issue 2, 2016, pp Research Article Spectrum of BMI & Assessment of Body Composition in Female Medical Students and Role of Riyazat (Exercise) in the Management of Obesity Khan Shaheen Akhtar Moinuddin*, Sufyan Ghawte**, Jalis Ahmed***, Ghazala Mulla**** and Jamal Akhtar***** *P.G Scholar, Department of Moalijat, Z.V.M Unani Medical College, Pune. **Asstt. Proff.Department of Moalijat (P.G), Z.V.M Unani Medical College, Pune. ***Principal : Z.V.M Unani Medical College, Pune. ****Asstt. Proff.HOD, Department of Munafe-ul-Aza, Z.V.M Unani Medical College, Pune. *****Prof & HOD, Department of Ilaj-Bit-Tadbeer S.T.T College, Lucknow. [Received-12/06/2016, Accepted-22/06/2016, Published- 27/06/2016] ABSTRACT Body mass index (BMI),can be calculated from the mass (weight) and height of an individual. The BMI is an attempt to quantify the amount of tissue mass (muscle, fat, bone) in an individual, and then categorize that person as underweight, normalweight, overweight or obese based on that value. Commonly accepted BMI ranges are underweight: under 18.5, normalweight: , overweight: 25-30, obese: over 30. Obese persons are prone to various type of disorders like heart disease, type 2 diabetes, obstructive sleep apnea, high blood pressure, high blood cholesterol and high triglycerides level, certain types of cancer and osteoarthritis. Obesity is observed in most of the college going students. Students residing at hostels either eat tiffin food or canteen food. They don t have balanced diet. They usually consume junk food having high calorie value together with lack of Riyazat (exercise) which leads to obesity. Hence a randomized clinical assessment of BMI and body composition of female medical students residing at Azam Campus Girls Hostel (Pune) between years of age group has been carried out. BMI and their body composition is compared with above mentioned range. Conclusions were drawn after appropriate statistical analysis. Dietary advice and Riyazat(Exercise) has been explained to the female students having higher BMI and higher percentage of general body fats. Keywords: BMI (Body Mass Index), General Fats, Skeletal Muscles, Riyazat, Diet. INTRODUCTION: Unani System of Medicine is one of the oldest systems of Medicine.This system of medicine has a holistic approach towards the management of the disease.the principles of treatment are Illajbilgiza (Dietotherapy), Illajbildawa (Pharmacotherapy), Ilaj bit Tadbeer (Regimenal therapy) and Illaj-bil-yad (Surgery).Ilaj-bit- TadbeerincludesDalak(Massage),Hamam(Turkish bath),fasd(venesection), Taleeq(Leeching), Hijammah(Cupping), Kayy(cauterization), Qay (Emesis), Tariq (Diaphoresis), Takmeed (Fomentation), Mushil (Purgative) and Idrar (Diuresis) is gaining fast popularity among masses. 1,2 Ilaj-bit-Tadbeer: Tadbeer is an Arabic word meaning Regimen (systemic plan) whileilaj means therapy or treatment. Therefore Ilaj bit tadbeer (IBT) is defined as treatment through regimen,which is decided according to the cause or pathogenesis of the disease.different regimens (course of therapy)are adopted as per the cause of the disease. If the cause of the disease is Su-e-

2 MizajSada (derangement of temperament without the involvement of humor), life style modifications like change in Dietary habits, Physical Exercise are advice along with Ilaj-bit- Tadbeer regimens like, Dalak(Massage) and Hamam(Turkish bath).if the cause of disease is Su-e-Mizaj Maddi(derangement of Temperament due to morbid humor),regimens like Fasd (Venesection), Taleeq(Leeching), Hijammah(Cupping), Kayy(cauterization), Qay(Emesis), Tariq(Diaphoresis), Takmeed (Fomentation), Mushil (Purgative), Mudir (Diuretic) is employed. 1,2 India is a fast developing country. Globalization has a great impact on the Indian citizens.standard of living of an average Indian becomes high. Technology has changed the life style of Indians. Technologyhas made the life easier than ever before.besidecomforts, the life style diseases like obesity,diabetes and Cardio vascular disease have emerged. 3,4 In Unani literature obesity is known assaman-emufrat.obesity is defined as deposition of excess amount of fat subcutaneously in the body or it is a condition when there is excess accumulation of fat in the subcutaneous tissue and other parts of the body. 5,6,7 A person is said to be obese when his body mass index (BMI) is 25or higher. 8 Nearly one third of adults in India areobese. It is a serious condition because it increases the risk of major illness like heart disease, type 2 diabetes, obstructive sleep apnea, high blood pressure, high blood cholesterol and high triglycerides level 9, certain types of cancer and osteoarthritis 10 Riyazat or Exercise is one of the modalities of Ilaj-bit-Tadbeerthat has been described in classical Unani literature. 11 There are certain types of exercises that can help achieve an ideal weight and normal BMI. Hence, an ideal weight can help minimize the risk of several obesity-related diseases, including heart disease, stroke and Type 2 diabetes. 12 Review of literature: Obesity has been a matter of concern to physicians. Most of the Unani physicians, Buqrat ( BC) the father of medicine, describe the disease obesity in detail in his famous book Fusool-e-Buqrat. 13 Ibn-Sina ( ) androfas (98-117AD) described the etiology, clinical features, complications and management of obesity in their book Al-Qanoon-Fit-Tibb and Kitab-Ul-Tahzeel-Ul-Saman 14,15 respectively.jalinoos ( AD) described the importance of evacuation (Istefarag) in the management of obesity. 13 ZakariyaRazi ( AD) described obesity in detail in his famous book Al-Havi-Fit-Tibb. 16 The obese people are prone to various types of disorders like heart disease, type 2 diabetes, obstructive sleep apnea, high blood pressure, high blood cholesterol and triglycerides level, certain types of cancer and osteoarthritis. 9,10 Lately, it has been shown that most disorders associated with obesity occur prematurely and at a higher prevalence in the population with lack of exercise and inappropriate diet. 17 The Body Mass Index (BMI) is a measure of body fat based on your weight in relation to your height. It is a simple tool that helps to figure out the amount of excess body fat. It can be applied to both men and women. It is wise to use Body Mass Index along with Waist to Hip Ratio to get a complete picture of the weight status and the associated risks of carrying this extra weight. 18,19 Most of the aforementioned studies used body mass index (BMI, kg/m 2 ) as a surrogate measure of obesity. BMI has an advantage of being a relatively simple tool, requiring only the measurement of height and weight. However, no study has been carried out to evaluate the body compositions like General body fat,percentage of subcutaneous fat,percentage of visceral fat,percentage of skeletal muscle and body age and resting metabolism/kcal(rm) of female medical students residing in hostels and their association with BMI and obesity. Hence a pilot study was conducted to know the body composition and the status of obesity amongst the girls medical students residing at hostels of Azam Campus. Khan Shaheen Akhtar Moinuddin, et al. 130

3 What is riyazat orexercise? Riyazat is a kind of work out to develop or maintain physical and mental fitness and overall health. It is a series of voluntary movements which produce deep and rapid respirations. 11,20,21,22 A moderate amount of exercise, taken regularly, is an effective prophylactic against all temperamentaldisturbances. 23 How does Riyazat(exercise) help in the treatment of obesity and maintaining BMI? Weight loss and the maintenance of BMI should be the prime goal while treating obesity. Exercise is an essential part of any weight loss program and should become a permanent part of your lifestyle. Here follows the good:- Burning off calories and losing weight. Improves the muscle tone. Increases the metabolic rate. Improves circulation. Improve heart and lung function. Increase sense of self control. Reduces level of stress. Increases ability to concentrate. Reduces depression. Helps in better sleep. OBSERVATION: Table No.1: Master Chart. Prevents diabetes, high blood pressure and high cholesterol. 24,25 MATERIALS AND METHOD: Sample size: Sixty female medical students of Azam Campus Girls Hostel (Pune) between years of age group were invited to participate in an observational study for the assessment of the body composition with no history of any chronic illness. Inclusion and Exclusion criteria: The inclusion criterion for the study is female medical students residing in Azam Campus Hostel (Pune) between years of age group. Local female medical students were excluded from the study. Place of study: Body composition analysis and measurement of height was carried out at Dept. of Munafe-ul-Aza [Physiology] of Z.V.M Unani Medical College & Hospital, Pune under the guidance of Dr.GhazalaMulla.Subjects were asked to answer the questionnaire. The questionnaire is based on the dietary habits and exercise. Equipment: Karada Scan Body composition analyzer,height measuring scale,questionnaire based on dietary habits and exercise. MASTER CHART (UNANI) G. I BASIC INFORMATION BODY COMPOSITION ANALYSIS SR. NO. AGE SEX DIET PULSE B.P mm/hg TEMP F HEIGHT WEIGHT CALORI E % OF GF % OF VF RM (Kcal) BMI BA SF IN % SM IN % W.B T L A W.B T L A 1 22 F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / Khan Shaheen Akhtar Moinuddin, et al. 131

4 11 21 F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / F V / F MX / F MX / F MX / F MX / F V / F MX / F MX / F MX / F MX / F MX / F V / F V / F MX / F MX / F MX / F MX / Khan Shaheen Akhtar Moinuddin, et al. 132

5 53 20 F MX / F MX / F MX / F MX / F MX / F MX / F MX / F MX / G.I= GENERAL INTEROGATION, GF= GENERAL FAT, VF= VISCERAL FAT, RM= RESTING METABOLISM, BA= BODY AGE BMI= BODY MASS INDEX, SF- SUBCUTANEOUS FAT, SM= SKELETAL MUSCLE, W.B= WHOLE BODY, T= TRUNK, L= LEGS, A= ARMS. TEMP F= TEMPERATURE DEGREE FERENHITE, F= FEMALE, MX= MIXED, V= VEGETARIAN. HEIGHT IN CENTIMETER, WEIGHT IN KILOGRAMS. RESULT: Table No.2: Comparison of Calorie and RM in Studied Students: RM (Kcal) CALORIE No. % No. % No. % No. % No. % Total n = 60 *p < 0.05 is statistically significant P- Value Table No.3: BMI Chart: BMI BMI Students P - value Khan Shaheen Akhtar Moinuddin, et al. 133

6 (Designation by the WHO) No. % Less than 18.5 (Underweight) or more and less than 25 0 (Normal) or more and less than 30 + (Overweight) or more ++ (Obese) n = 60 *p < 0.05 is statistically significant Table No.4:Body Fat Chart: Age Low (-) Normal (0) High (+) Very High (++) No. % No. % No. % No. % P - value n = 60 *p < 0.05 is statistically significant Table No.5: Whole Body Muscle: Khan Shaheen Akhtar Moinuddin, et al. 134

7 Age Low (-) Normal (0) High (+) Very High (++) No. % No. % No. % No. % P - value n = 60 *p < 0.05 is statistically significant DISCUSSION: Table No.2 shows that: The calorie intake of 3.3% of the subjects is between kcal/day where as their kcal. The calorie intake of 6.7% of the subjects is kcal. The calorie intake of 3.3% of the subjects is between kcal/day where as their kcal. The calorie intake of 21.7% of the subjects is between kcal/day where as their kcal. The calorie intake of 16.7% of the subjects is kcal. The calorie intake of 11.7% of the subjects is between kcal/day where as their kcal. The calorie intake of 6.7% of the subjects is between kcal/day where as their kcal. The calorie intake of 8.3% of the subjects is between kcal/day where as their kcal. The calorie intake of 6.7% of the subjects is kcal. The calorie intake of 3.3% of the subjects is between kcal/day where as their kcal kcal. The calorie intake of 3.3% of the subjects is between kcal/day where as their kcal. between kcal/day where as their kcal. between kcal/day where as their Khan Shaheen Akhtar Moinuddin, et al. 135

8 kcal. between kcal/day where as their kcal kcal. Table No.3 shows that: The Basal Metabolic index of 50% of the subjects is between 18.5 or more or less than 25 which is normal as per the WHO guidelines. Whereas the BMI of 38.3% subjects are having BMI 25 or more or less than 30.These students are overweight (+) as per the WHO guidelines.11.7% of the students are having BMI 30 or more and they are obese (++) as per the WHO guidelines. Table No.4 shows that: 40% of the subjects are having normal whole body fat as per their age,whereas 50% of the students are having high percentage of whole body fat.10% of the students are having very high percentage of fat in their whole body. Table No.5 shows that: 70% of the students are having normal percentage of whole body muscles as per their age, whereas 26.7% of the students are having high percentage of muscle in their whole body. Only 3.3% of the students show very high percentage of muscles. CONCLUSION: Sixty female medical students residing at hostels of Azam Campus were selected for the pilot study. General interrogation was conducted regarding the dietary habits and exercise regime. Assessment of General fat, Visceral fat, Resting Metabolism, Body Age,BMI,Subcutaneous Fat of whole body,arm, legs, Skeletal Muscles of whole body, arms, legs, weight, were done on Karda Scan body composition analyzer. Height in centimeters is also measured. The statistical analysis has been carried out using SPSS version 20 by applying t-test for n=60 considering p<0.05 statistically significant for the approximate calorie intake and Resting metabolism. The p value is for the said parameters hence statistically it is nonsignificant. Hence there is no relevance between calorie intake and RM in an individual. The p value for BMI is which is highly significant. Hence BMI which is a measure of body fat based on the weight in relation to the height is important tool for the assessment of obesity. The p value for whole body fat is which is again statistically highly significant. It indicates that assessment of whole body fat is important for assessment of BMI &obesity. The p value for whole body muscle is which is statistically highly significant. It indicates that assessment of whole body muscle is also important for the assessment of obesity. SUMMARY: Sixty subjects (all female medical students of Azam Campus residing in Girls Hostel, Pune) met the inclusion criteria of study, and found that, the calorie intake of these students is more than their resting metabolism. 50% of the students falls into the obese or higher obese category. This could be due to their faulty dietary habits or imbalance diet and lack of exercise. Diet and Exercise play an important role in the management of obesity. Ancient Unani Physicians know the importance of these two factors.hence they have enlisted them in Asbab-e-Sitta Zaroriya. Ilaj-bil-Ghiza( Diet therapy) is the first line of treatment in Unani System of Medicine. After diet therapy non-invasive measures like Riyazat or exercise has been mentioned in detail in Unani literature. By assessing the whole body muscle and fat one can recommend custom tailored exercise to an individual so as to bring the abnormal BMI at normal level. REFERENCES: Khan Shaheen Akhtar Moinuddin, et al. 136

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