Eat less, and go to the gym more. Alas, easier said than done in some Gulf states, especially during Ramadan.

Kuwait, Qatar, the United Arab Emirates and Bahrain are among the world’s top ten overweight nations, a new report by BMC Public Health has found. The extra weight has severe individual health consequences as well as a broader ecological impact.

Perhaps not surprisingly, the United States, home of the Big Mac and supersize fries, is the heaviest country in the world. What is surprising is that it is closely followed by Kuwait. The average person in Kuwait weighs 77.5 kg, which is 15.5 kg heavier than the average around the world. Kuwait is followed by Qatar, with the UAE in fifth place. Rounding out the top ten heaviest nations is Bahrain.

“We have to educate people on the importance of a healthy diet and exercise,” Mark Botha, sales and marketing director for Fitness First Middle East, a chain of fitness clubs across the Middle East, told The Media Line.

“The climate is also a challenge, as people tend to stay indoors.” Summer temperatures in the Gulf can exceed 42 degrees Celsius. Fitness First has 31 clubs around the Middle East, including some where all of the staff and all of the members are female. “The ladies really enjoy our fantastic environment,” Botha said. “It’s a chance for them to take off their abaya (the traditional long black cloak worn out of modesty) and just have a great time.”

The upcoming month of Ramadan, when many Muslims fast from dawn to dusk, which is expected to begin July 20, presents unique challenges. Although one might think that fasting is a good way to lose weight, people tend to actually eat more total calories as they make up for lost time during the iftar, or break-the-fast meal that is held after dusk. These also tend to be family celebrations which continue for hours into the night, and where hosts offer a range of tempting dishes.

“When you’re hungry, you tend to go first for the fatty foods,” Deepa Al-Meida, a nutritionist at the Cedars-Jebal Ali International hospital in Dubia, told The Media Line.

“Then you go to sleep and you do not do any activity to burn off the calories.” Al-Meida says the lifestyle in the Gulf makes it easy to gain weight. “People work too many hours and they are often very sedentary,” she said. “Women, especially, tell me that they have no time to exercise as after work they need to go home and take care of their families. If they want to lose weight they try fad diets which don’t really work.”

Government officials are trying to encourage fitness with the Dubai Fitness Competition sponsored by Majid Bin Mohammed Bin Rashid Al-Maktourm, the Chairman of the Dubai Culture and Arts Authority and Fitness First Middle East. The contest, which will be held during Ramadan, seeks to identify the “Fittest Man” and “Fittest Woman” in Dubai.

A first prize of 50,000 dirhams ($ 13,600) followed by other cash prizes will be awarded. “During Ramadan, when people are tired from fasting and then attend a lot of family events at night, it’s hard to get to the gym,” Botha of Fitness First said. “We try to encourage them to do even a light workout – to come for a half hour – since anything is better than nothing.”

During Ramadan, nutritionist Al-Medei encourages her clients to first drink several glasses of water before eating any food, as fasting in the heat can lead to dehydration.

Then she encourages clients to go for the salads, vegetables, and lean meat and chicken. Only two percent of adults are members of fitness clubs in the UAE, Botha said, as compared with 13 percent in the US, and 11 percent in the UK.

Fitness is a habit that takes time to develop. “We found that it works best when a fitness club is no more than a ten minute drive away,” said Botha. “That is why we put our clubs in shopping malls, which is where people congregate.”

Fitness First has almost doubled the number of its clubs, from 16 to 31 in the past year. “We do see an increasing interest in fitness and the importance of exercise,” Botha says. “But we still have a long way to go.” The BMC public health report found that the world’s population as a whole is getting increasingly fatter.

“Increasing biomass will have important implications for global resource requirements, including food demand, and the overall ecological footprint of our species,” said the report. “Tackling population fatness may be critical to world food security and ecological sustainability.”

The report found that the United States accounts for almost one third of the world’s weight even though they are only five percent of the world’s population. North Korea is the world’s slimmest nation, with an average weight under 50 kilometers per person.