health threats of sedentary lifestyle and its management.
HEALTH THREATS OF
are “sedentary lifestyles?”
pertaining to us and the
of Health Consequences
Lifestyle is an Independent Risk
Factor for Cardiovascular Disease & Mortality
Can Be Done?
What are sedentary
Any lifestyle that has
- insufficient physical activity or exercise
EPIDEMIOLOGY: The INDIAN SCENARIO
It’s Crazy to be Lazy…
“Physical inactivity contributes substantially
to the global burden of disease, death and disability.”
~ 2 million deaths per
year can be attributed to
sedentary life style due to
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.
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
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
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
The European Youth Heart Study
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
Sedentary lifestyle is actually a “feature” of MS
The Health and Retirement Study
Of A Sedentary Lifestyle
- Weight Gain
Weakened Immune System
Plethora of Ds.BAD
Hypokinetic diseases are conditions
that occur from a sedentary lifestyle.
Cardiovascular disease blood pressure
Mortality in elderly
men by 30% and double Osteoporosis
the risk in elderly women
Deep vein thrombosis
Co-morbidities associated with obesity
Coronary heart disease
Type 2 Diabetes
Cancer (breast, endometrial,
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).
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.
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
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
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.
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…..
Focus for Change
work & home
of activity at
A multidisciplinary approach to tackle health risks of sedentary lifestyle
How to Avoid Death
(Or At Least Postpone It)
Take the stairs
Cycling, swimming, sports
You get the idea…
Positive Health Effects of
exercise and evidences of its
Overweight & obesity
Reduction of CVD Risk
Greatest benefit of physical activity
Inactive people have 2x risk vs active
Improves CVD associated
Sedentary Lifestyle and
Most reliable index of physical activity
Define “Cardiorespiratory Fitness”
Decrease in Cardiorespiratory Fitness
Type II Diabetes Mellitus
Overweight & Obesity
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!!
developing country like us
Usual onset after age 40
Emerging in children…
Evidence: 30% lower risk in
Regular physical activity
Strength and flexibility
Reduces age decline
Reduces risk of falls & hip fractures
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
Decreases cardiovascular risk factors
Independent of weight loss
Physical activity is an independent predictor of mortality…
Leanness ≠ invincible
Indications for Drug Therapy in
Failure of diet and exercise alone
Significant obesity related comorbidities even if
BMI < 30 (ie 25-30).
No contraindications to drug therapy lest
Medical conditions that may be adversely affected
by the obesity drug
Weight loss with obesity
medicines is modest
Obesity medicines are
not a substitute for diet
Weight loss is often not
maintained after drug
Most obesity medicines
are not covered by
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
Recommends bariatric surgery for obese people:
BMI > 40 without co morbidities
BMI >35 with 1 or more co morbidities.
BMI of 30 to 35 with significant or serious co morbidities.
When less invasive methods of weight loss have failed and the patient is at
high risk for Obesity-associated morbidity and mortality.
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
5. INTRA GASTRIC BALLOON
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
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.
2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH
3. IMPLANTABLE GASTRIC STIMULATION
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
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.
Reduce TV and Computer Use
Schedule your time for physical activity
Run like Usain Bolt
Take the stairs
Don’t take your vehicle.
IT’S NOT THAT FAR