health threats of sedentary lifestyle and its management.

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management of sedentary disease and their prevention briefly discussed.

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health threats of sedentary lifestyle and its management.

  1. 1. HEALTH THREATS OF SEDENTARY LIFESTYLE ByAnkur Singhal Batch-08 G.R.M.C. Gwalior
  2. 2. Outline  What are “sedentary lifestyles?”  Epidemiology pertaining to us and the world.  Overview of Health Consequences  Hypokinetic  The diseases Evidence  Sedentary Lifestyle is an Independent Risk Factor for Cardiovascular Disease & Mortality  What Can Be Done?
  3. 3. What are sedentary lifestyles?  Any lifestyle that has - insufficient physical activity or exercise + =
  4. 4. EPIDEMIOLOGY: The INDIAN SCENARIO It’s Crazy to be Lazy… “Physical inactivity contributes substantially to the global burden of disease, death and disability.” WHO: ~ 2 million deaths per year can be attributed to sedentary life style due to increased co-morbidities.
  5. 5. India is, in our own eyes, still a country of poverty, hunger and malnutrition. India is one of the capitals of diabetes and cardiovascular diseases. Accordig to NFHS, The overall prevalence of subjects >23 kg/m2 was 50.8% and central obesity was 52.6%. The overall prevalence of sedentary behavior was 59.3% among women and 58.5% among men. Both sedentary behavior and mild activity showed a significantly increasing trend in women after the age of 35–44 years. In men, such a trend was observed above the age of 45 years.
  6. 6.  But today, obesity in children and adults is a reality that poses a double jeopardy to the government and health experts - on the one hand, they have to tackle the malice of malnutrition and on the other, they have to fight obesity among children.  The prevalence of overweight rose from 2% to 17.1% in rural india due to changing life style of the rural dwellers as it was found to be a contributory factor for the rising rates of obesity and associated metabolic diseases, such as diabetes according to NFHS survey being conducted in 1989 and 2009 respectively.  The prevalence of overweight in 14 to 17 years old school children has increased significantly from 10% in 2006-2007 to 12% in 2009, while those underweight decreased in Delhi. Affluence clearly impacts body weight.
  7. 7. States of India ranked in order of %age of people who are overwt. or obese, based on data from the 2007 National Family Health Survey
  8. 8. The European Youth Heart Study Results: 3.29 times increased Risk! Independent of weight status!! Kuopio Ischemic Heart Disease Risk Factor Study Increased risk of “Metabolic Syndrome” Strong predictor of cardiovascular mortality Study conclusion: Sedentary lifestyle is actually a “feature” of MS The Health and Retirement Study
  9. 9. Overview of health consequences
  10. 10. EFFECTS Of A Sedentary Lifestyle - Weight Gain - Obesity Heart Disease Joint Pain Diabetes Weakened Immune System Plethora of Ds.BAD
  11. 11. Hypokinetic diseases are conditions that occur from a sedentary lifestyle. Examples could include Anxiety Colon cancer Cardiovascular disease blood pressure High Mortality in elderly Obesity men by 30% and double Osteoporosis the risk in elderly women Lipid disorders Deep vein thrombosis Kidney stones Depression Diabetes
  12. 12. Co-morbidities associated with obesity Depression Sleep apnoa Ischemic stroke Coronary heart disease Respiratory disease Gallbladder disease Dyslipidemia Osteoarthritis Hyperuricemia and gout Type 2 Diabetes Cancer (breast, endometrial, colon, prostate) Hormonal abnormalities and pregnancy complications
  13. 13. The problem of sedentary lifestyle: The Diabesity Obesity in type-2 diabetic patients is a very common phenomenon and often termed as "Diabesity." Diabetes, obesity, hypertension, dyslipidemia are grouped under one name "Metabolic syndrome." The rising prevalence of these lifestyle disorders in India is of concern as singly or in combination, which act as major risk factors for coronary artery diseases (CAD). Increased predisposition to diabetes and premature CAD in Indians has been attributed to the "Asian Indian Phenotype" characterized by less of generalized obesity measured by BMI and greater central body obesity as shown by greater WC and WHR. Many Indians fit into the category of metabolically obese, normal weight individuals. The body fat percentage of an Indian is significantly higher than a western counterpart with similar BMI and blood glucose level. It has been hypothesized that excess body fat and low muscle mass may explain the high prevalence of hyperinsulinemia and the high risk of type-2 diabetes in Asian Indians
  14. 14. WHY????????
  15. 15. Sedentary Careers or Jobs     Many jobs require you to sit behind a computer all day which promotes you to live a sedentary lifestyle. You sometimes get home late and have no time to cook so you buy fast food on the way home. You lack physical activity and don’t eat healthy. But this is all your decision because you can always get a different job or use your free time to be active and eat healthy.
  16. 16. WHAT CAN BE DONE:  Well it’s quite obvious now to tackle any of these large group of co-morbidities , a multi-disciplinary approach is required in order to shift the curve towards the better of this slowly rising epidemic…..
  17. 17. Focus for Change Individual Belief Micro attitudes in abilities environment Conduciveness work & home Macro of activity at environment Socioeconomic environment culture &
  18. 18. A multidisciplinary approach to tackle health risks of sedentary lifestyle
  19. 19. How to Avoid Death (Or At Least Postpone It) Daily walks Take the stairs Gardening Cycling, swimming, sports You get the idea…
  20. 20. THE EVIDENCE FOR EXERCISE…
  21. 21. Positive Health Effects of exercise and evidences of its effectiveness: Cardiovascular disease Overweight & obesity Diabetes Cancer Musculoskeletal health Psychological well-being
  22. 22. Reduction of CVD Risk  Greatest benefit of physical activity  Inactive people have 2x risk vs active  Prevents stroke  Improves CVD associated risk factors
  23. 23. Sedentary Lifestyle and Cardiovascular Fitness  Most reliable index of physical activity   Define “Cardiorespiratory Fitness” Decrease in Cardiorespiratory Fitness  Powerful Predictor  Cardiovascular Disease  Mortality  Type II Diabetes Mellitus
  24. 24. Overweight & Obesity “Ex-Ur-Size!”  Dramatic increase in prevalence over last 20 years (Remember last week?)  Energy intake>>>total energy expenditure  Physical activity → weight loss   Decreases risks of obesity Health benefits independent of weight loss!!
  25. 25. Diabetes Increasing prevalence in developing country like us Usual onset after age 40 Emerging in children… Evidence: 30% lower risk in active Moderate and vigorous activity levels
  26. 26. Cancer Physical Colon activity ↓ cancer risk Breast cancer Prostate cancer?
  27. 27. Musculoskeletal Health  Regular physical activity   Strength and flexibility   Reduces age decline Reduces risk of falls & hip fractures Weight-bearing activities  Prevents osteoporosis
  28. 28. Psychological Well-Being  Physical activity  Reduces symptoms of depression, and possibly stress, & anxiety  Positive self image and self-esteem  Increases social interaction  Builds social skills among children  Improves quality of life
  29. 29. Summary  Physical activity:  Many benefits…  Decreases cardiovascular risk factors  Independent of weight loss  Physical activity is an independent predictor of mortality…  Leanness ≠ invincible
  30. 30. So overview is
  31. 31. Pharmacotherapy for the Treatment of Obesity “BUT DOC, ISN’T THERE A PILL I CAN TAKE?”
  32. 32. Drugs:  Sibutramine(withdrawn)  Phentermine(amphetamine)  Amfepramone(congener of ethcathinone)  Orlistat  Metformin  Exenatide  Bupropion  Fluoxetine  Mixed  Rimonabant
  33. 33. Indications for Drug Therapy in Obesity  Failure of diet and exercise alone  Significant obesity related comorbidities even if BMI < 30 (ie 25-30).  No contraindications to drug therapy lest  Medication interactions  Medical conditions that may be adversely affected by the obesity drug
  34. 34. Summary  Weight loss with obesity medicines is modest Drug Sibutramine Wt loss 4-5 kg  Obesity medicines are not a substitute for diet and exercise Phentermine Orlistat 3-4 kg 2-3 kg Metformin Exenatide 2 kg 2-3 kg Bupropion Fluoxetine 2-3 kg Mixed Topamax Rimonabant 6-7 kg 6-7 kg   Weight loss is often not maintained after drug is discontinued Most obesity medicines are not covered by insurance
  35. 35. SURGICAL THERAPY: CLASSIFICATION OF BARIATRIC SURGERY: Bariatric surgery procedures can be categorized into operations utilizing 3 methods to produce weight loss: gastric restriction, mal absorption, or a combination of the two. 1. PREDOMINANTLY RESTRICTIVE PROCEDURES 2. PREDOMINANTLY MALABSORBTIVE PROCEDURES 3. MIXED OR COMBINATION PROCEDURES
  36. 36. Recommends bariatric surgery for obese people: BMI > 40 without co morbidities BMI >35 with 1 or more co morbidities. or BMI of 30 to 35 with significant or serious co morbidities. or When less invasive methods of weight loss have failed and the patient is at high risk for Obesity-associated morbidity and mortality.
  37. 37. RESTRICTIVE PROCEDURES: Procedures that are solely restrictive by creating a small gastric pouch & a degree of outlet obstruction leading to delayed gastric emptying. The goal is to reduce oral intake by limiting gastric volume, produce early satiety, and leave the alimentary canal in continuity, minimizing the risks of metabolic complications 1.VERTICAL BANDED GASTROPLASTY 2.ADJUSTABLE GASTRIC BANDING 3. SLEEVE GASTRECTOMY 4.GASTRIC PLICATION 5. INTRA GASTRIC BALLOON
  38. 38. MALABSORPTIVE PROCEDURES Malabsorption is achieved by creating a short gut syndrome and/or by accomplishing distal mixing of bile and pancreatic juice with ingested nutrients thereby reducing absorption.. Some purely malabsorptive operations are no longer recommended due to their potential hazard to cause serious nutritional deficiencies. 1. BILIOPANCREATIC DIVERSION 2. THE JEJUNAL-ILEAL BYPASS (no longer performed) 3. ENDOLUMINAL SLEEVE
  39. 39. MIXED PROCEDURES: The following procedures combine restrictive and malabsorptive approaches. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. GASTRIC BYPASS ROUX-EN-Y ( RYGBP). Most commonly performed procedure these days. Done laparoscopically. 1. 2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH 3. IMPLANTABLE GASTRIC STIMULATION
  40. 40. Patient Criteria for surgery 1. A Body Mass Index (BMI) ≥ 40 or a BMI ≥ 35 with obesity related co-morbid conditions. 2. Age – 16 to 65 yrs. 3. Screening for mental or behavioral disorders that may interfere with post-operative outcomes (e.g. eating disorders, depression, and substance abuse). 4. Counselling and advise to stop using tobacco products & alcohol, 4 weeks prior to surgery. 5. No absolute contraindication to major abdominal surgery 6. Obesity of long standing. Should have completed a weight loss program is recommended but not required. eg: dieting, nutritional counseling, an exercise program and commercial/hospital. 7.To adhere to post-surgical attention to lifestyle, an exercise program and dietary changes and post-surgical follow-up with applicable professionals (e.g. nutritionist, psychiatrist, exercise , physical therapist, support group participation, on regular basis.
  41. 41. Ideas  Reduce TV and Computer Use  Schedule your time for physical activity Play cricket Lift Weights Run like Usain Bolt
  42. 42. Take the stairs WALK Don’t take your vehicle. IT’S NOT THAT FAR SERIOUSLY

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