ENLIGHT: A Quarterly Bariatric Support Group System


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70% of people above their ideal weight
suffer from at least 1 coexisting disease
condition. In Chennai, 51% of all people
above their ideal body weight suffer from at
least one co morbidity, associated with

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ENLIGHT: A Quarterly Bariatric Support Group System

  1. 1. Volume1 Issue1enlight 21 March 2013 Chennai . India QUARTERLY NEWSLETTERApollo launches its 1st Bariatric Center of Excellence in November 2012 contents inside: Chennai tops obesity survey 2 ”Enlight” support group 3 Success Stories 3 Battle on the Bulge 4 Must eat nutrients for winter 5 Control your mind 5 Metabolic Syndromes 6 Obstructive Sleep Apnea 7 Easy lifestyle routines 7 from the surgeon’s desk: Welcome to Apollo Bariatric Institutes. With alarming increase in prevalence of obesity and its consequences, we are at the brink of war with the most threatening lifestyle Dr. Rajkumar Palaniappan disease of this age. The aim of this newsletter initiative is to spread awareness about this looming issue and its management possibilities. We at our institute provide a holistic 2013 approach to the management of obesity and its metabolic consequences with focus on all aspects including nutritional management, counseling, wellness program and surgical management to combat any type of weight & its related syndromes.
  2. 2. what’s hot & what’s not: Indians seem to be more vulnerable to lifestyle changes. The culprit may be what is called the thrifty genotype. According to this theory, Indians, are genetically adapted obesity facts to scarcity in calories due to just one meal and rarely two meals a day and follow a “famine–feast cycle”. This was true until two decades ago when suddenly our country 2013 became richer and three meals became affordable. As a result, their bodies cant cope over-indulgence, and it takes only a small increase in daily calories for their metabolism to tip over into obesity and diabetes. This made Indian prone for alarming weight gain and its issues more rapid than other countries when added with sedentary lifestyle.Chennai tops national obesity survey amongst 11 metropolitan cities 70% of people above their ideal weightA C NielsonFor Johnson & Johnson Medical suffer from at least 1 coexisting disease condition. In Chennai, 51% of all people experts believe: above their ideal body weight suffer from at People fall prey to advertisements for least one co morbidity, associated with quack treatments than scientific treatments. obesity* but nearly 33% are unaware of existing conditions since they have never People fail to realize that Obesity is a consulted a doctor making it the most unsafe disease and it can be treated scientifically. of all locations for obesity. Average duration of suffering from any coexisting indication/ Psychologically the consumer is illness is 3 to 4 years with incidence of constantly feeling that they have hypertension 52%, heart diseases in 45%, type 2 Diabetes in 42%, sleep apnea in attempted to lose weight. 39%, heart burn in 38% and arthritis in Consumers feel that losing weight 35% of overweight patients. Other common illness include polycystic ovarian disease, means giving up food/ drinks and stop gout, liver diseases, menstural irregularities, living, hence they prefer the way they are. depression and thyroid deficiency in up to 20% individuals. There are several expenses associated India has been the focus of interest for with weight loss measure like costs relatedWHO in the recent years for the main What is more alarming is thatreasons, namely obesity. There have been significantly higher number of respondents to healthy eating, gym and travel costs,reports on obesity being endemic in India have never done anything nor intend to do medical costs for ailments, absenteeismwith south being more affected by this anything in future about their weight and co- from work. To add, are indirect costs oflifestyle disease. Recently a research to existing illness. 43% of obese individualsunderstand the current status and trends in have never done anything to tackle their “Missing out on the essence of life”.the management of obesity in Chennai and problem of obesity. In spite of being awaresouth India was conducted by A.C. Nielsen of several weight loss options, we find People look for shortcuts and especiallyfor Johnson & Johnson, Medical. limited takers for those options. While 82% those which are economical. Such options believe that obesity is caused due to eating, don’t give a sustained weight loss solution A survey conducted in 11 metropolitan we find only 25% practicing dieting. Whencities across the nation revealed Chennai asked about reasons for not doing anything and after a failure they are resistantemerging as the obesity capital. 38% of currently, paucity of time (46%), towards trying anything new.Chennai’s population was found to be comfortable / happy the way I am (27%),above its ideal weight of which 12% are need a quick solution to the problem and Consumers may idolize film/ sportsobese and 3% are morbidly obese. 6% of there are no quick fix methods (21%) were personalities but friends, spouse, relativestotal obese population in top 11 cities is on the most significant responses for theirthe verge of being morbidly obese with their weight and co-morbid issues. However play a key role in persuading people toBMI in the range of 35 – 37.5 of which 23% among overweight and obese the urge/ undertake any weight loss measures.are from Chennai. More so 40% of morbidly need to lose weight is missing.obese across these 11 locations have theirBMI >50, of which the highest contribution is The expenses from consumers point ofagain from Chennai at 17%. Obesity is more view may seem minimal but its all aboutprevalent in women (16%) as compared to what they “remember”. Right from food,men (13%) and prevalence increases with living, travel whatever they must have spentage with significantly more with the age towards weight loss they do not correlategroup over 31 years. anything as an expense on the treatment of obesity. Hope of being successful, Overweight individuals feel that the top motivation, cost & their current health statusthree causes for prevalence of obesity* in are refraining morbidly obese from losingChennai are –Irregular eating habits (62%), weight. Most consumers try inexpensiveeating oily or fatty food (53%) and lack of options , and less than 1% patients arephysical activity or sedentary lifestyle aggressively follow some scientific treatment(43%). Basically begins as a problem, grows and that is why more than 99% are failures.into an emotional burden and then Chennai fast needs to wake up to obesitytranscends into a disease state. and its deadly consequences.
  3. 3. “ENLIGHT” Bariatric support group initiative for obese individualsTo aid in patient’s fight management, pre and post- surgical This highly beneficial session is planned patients, support is absolutely critical to once every quarter and the next session isagainst obesity and long-term sustained weight loss and slated on June 8th. Regardless of whether ametabolic syndromes.. maintenance. Support group meeting patient is in the process of considering attendance directly increases the chances of bariatric surgery, just prior to the surgery or We recognize that obesity is a short and long term patient success post post-surgery, they are welcome to attend thedebilitating disease of mind, body and spirit bariatric surgery. sessions and are highly encouraged to bringand must be addressed holistically to their loved ones along as well. The successachieve long-term success. Patients post- We at Apollo Hospitals has taken this of this surgery also hinges on the supportsurgery realize that surgery will not seriously and started a quarterly support the patient receives at home, which is whymiraculously eliminate the emotional or group system named “ENLIGHT”. We educating the family is a priority for us.psychological trauma that morbid obesity conducted our first support group meetinghad inflicted on them for years. They are on the 8th of March and was attended byalso in the process of developing an entirelynew way of looking at food as well as their 20 patients (8 pre-op and 12 post-op). Our support groups are in place to assist patients “enlight” features:bariatric surgery experience, both on a with addressing more immediate and long- Know about obesity & co-morbiditiespersonal and professional basis. term questions and needs including the most Understand types of bariatric Surgery beneficial diets, exercise regimens, body Support groups constitute an integral contouring options, dealing with lifestyle Nutrition and lifestyle master classespart of vision to provide safe, effective and changes that follow bariatric surgery, , Pre & Post operative patient interactionsefficacious care to the patient population. importance of adhering to the medicationResearch has consistently demonstrated that Sharing of experience with obesity regimen strictly, ways to bolster one’sall types of ongoing weight management emotional, mental, psychological and Quarterly meeting with Bariatric teamplans, including people on diet, medical spiritual health. what’s hot & what’s not: India has the second largest diabetic population in the world with seven crore people and equal urban (25.4%) and rural (25.2%) distribution of obesity among them. An co-morbidty facts estimated increase of more than 50% is predicted in the next 15 years making the count to around eleven crore and to become the diabetic capital of the world by 2030. 2013 India is also tipped to be having the second largest hypertensive population with 11 crore individuals and predicted to become the hypertensive capital by 2025 with an estimated disease population of 21 crore. At present 20% of all deaths in India are either obesity or metabolic disease related. VENUGOPAL is one happy man after losing 64 kg.. I’m a professional working with Ashok Leyland as Deputy manager. I was always on the plump side, slowly started adding weight in years due to work demands, irregular diet habits and sedentary lifestyle. I was weighing 140 kg in 2011 and was not even able to walk properly. My self esteem and confidence were low and was even suffering from depression which started affecting my performance at work. Though i was aware of Bariatric surgery, I was very worried to go under the knife. That is when i read about the scarless SILS technique of Bariatric surgery at Apollo Hospitals, Greams Road. I underwent surgery in March 2011 in spite of negative comments from relatives and friends. After the surgery i lost an amazing 64 kg in 8 months. Now I feel more healthier and more free, have better self-confidence, self-esteem and performance based promotion at work. In simple terms the surgery has turned my life upside down for the best. It’s been close to 2 years since surgery and i still stand at 76 kg. I am proud to have made one of the best decision in my life.
  4. 4. what’s hot & what’s not: Bariatric Surgery: Battle on the BulgeBMI facts Dr.Rajkumar Palaniappan Gastric bypass, which combines restrictive and malabsorptive surgery 2013 Bariatric Surgeon techniques, is the most frequently performed Bariatric surgery is a surgical bariatric procedure and is the GOLD procedure wherein the size of the stomach is standard in Bariatric surgery. In this curtailed and / or intestines are bypassed procedure, stapling creates a small (15 to leading to reduced consumption of calories 20 cc) stomach pouch. The remainder of the and thus aiding in weight loss. Over the last stomach is not removed, but is completely BMI = Weight in kg decade, weight loss surgery has been stapled and divided from the lower stomach. Height in m2 continually refined to improve results and The small intestine is then divided just minimize risks. Today, bariatric surgeons beyond the duodenum and a connectionAs per IFSO-APC guidelines, BMI for have access to a substantial body of clinical with the new, smaller stomach pouch isIndians is reduced by 2.5 due to the data that supports the use of surgery as a constructed (see picture). The length ofoccurrence of potentially life safe and effective weight loss treatment either segment of the intestine can bethreatening co-morbidities at an early when other methods have failed. increased to produce lower or higher levelsBMI. Less lean body mass, morebody fat and central obesity are of malabsorption. An analysis of clinical People who fall in the Grade III studies reported an average excess weightpostulated to be the reasons. category of obesity stand most eligible, loss of 70 – 80 % over a period of 2-3 patients in Grade II obesity with one or years. It is shown to help resolve type 2 more co-morbidities may also opt for diabetes, high blood pressure, and Underweight < 18.4 bariatric surgery. Bariatric surgery leads to obstructive sleep apnea, and to help drastic weight loss, in a significantly smaller improve high cholesterol with success rates Normal 18.5 - 22.4 time frame. As it is exclusively done by more than 80%. laparoscopy, recovery is faster with less Overweight 22.5 - 27.4 post-operative complications. It also requires The bariatric procedure can successfully less effort to lose weight. More importantly start patients on the road to recovery from Obesity I 27.5 - 32.4 bariatric surgery significantly increases the clinically severe obesity, but surgery alone life span of an obese individual will not ensure long-term success. Most simultaneously ridding of co-morbidities. The patients lose more than half of their excess Obesity II 32.5 - 37.4 choice of surgery depends on patients BMI weight in the first year and continue to lose & co-morbidities. weight after this point. Successful habits Obesity III > 37.5 include eating three small, well-balanced Surgical procedures promote weight meals, and a maximum of one snack a day. loss by two different ways: Patients tend to gain weight back if they start 1. By decreasing food intake eating larger portions, graze, consume high (restriction) by surgeries that limit the fat or "junk" foods, or drink high-calorie amount of food the stomach can hold by beverages. A program of regular exercise is closing off or removing parts of the stomach. very important for promoting and NOTE: The majority of patients report early maintaining weight loss. Patients who satiety and, and hunger is lost from 30 – 70 exercise 45 minutes at least three times per % depending on the procedure. The most week lose an average of 18% more excess popular in India and commonly used weight than patients who do not exercise. restrictive procedure is sleeve gastrectomy (see picture). During this procedure a thin vertical sleeve of stomach like a hockey stick techniques: is created using a stapling device. This sleeve will typically hold between 80-100 Conventional Laparoscopy ml. The excised portion of the stomach is Surgery is done through three or more removed. In clinical studies across India, tiny keyholes through the abdomen. patient lost an average of 60 – 70% of their excess weight. It is also shown to help Single Incision Laparoscopic Surgery resolve high blood pressure and obstructive sleep apnea, and to help improve type 2 Surgery is done through a single hole diabetes and hyperlipidemia. However long in the belly button and there wont be term durability is not proved due to paucity any visible scar in the abdomen. of data and being a new procedure. 2. By causing food to be poorly Robotic Surgery digested and absorbed (malabsorption). Surgeon makes a direct connection from the Similar technique as conventional stomach to a lower segment of the small laparoscopy, with 3D vision, better intestine, bypassing the duodenum, and precision, control, safety, and less pain. some of the jejunum. NOTE: Vitamin and mineral rich high protein intake will be Endoluminal Surgery (to be launched) required for life to prevent the problem of For low BMI patients where surgery is nutritional deficiencies. Although results are more predictable and manageable, side performed through endoscope. effects persist for some patients.
  5. 5. control your mind Must eat low calorie nutrition for winterWhen we aim for our goals, we take Dr.Deepa Agarwalinto consideration many factors: do Bariatric Nutritionistwe have the necessary talent and Seasonal eating is a healthier bet! Asabilities to achieve them? Are we the winter’s chill sets in, we find ourselves reaching for cozy, comfort foods that equatemotivated enough? What obstacles do warm ovens with warm hearts. Winters canwe have in our way, and how do we be hard on health with most people stayingovercome them? indoors. With days getting shorter, outdoor exercise becomes difficult and peopleHowever, our perception of these engage in more passive activities likefactors can make a big difference to watching television and reading. Studiesthe way we achieve. Let’s assume that have suggested that there is an increase in aches and pains during the winter, alongour goal is weight loss. Perhaps we with an increase in functional impairmentare not motivated to eat right because associated with seasonal depression. An increase in appetite is also reported, with Tea and coffee produce warmth but shouldwe think, “The holidays are around the festive season leading to temptation to be consumed in moderation. Of course somethe corner, and I can start dieting indulge. comfort foods will always need to be eatenonce they’re over”. Or perhaps “I in strict moderation - for example puddings Nature has its own way of keeping the loaded up with custard or cream, cakes,have too much stress in my life right body warm. The heat can be generated biscuits, chocolate and crisps.now, and eating food that I enjoy is from within the body as well as from foodone of the few pleasures I can get.” that raises the body’s temperature to help it Eat healthy during winters and include cope. The body needs to burn more calories foods thatll keep you snug and steady atSuch thoughts can slow us down, or to keep warm and hence there is a need to the same time. Exercise can also give you aprevent us from achieving our goals; eat judiciously. Certain foods have a more similar mental high to eating comfort food. Ifbut, by controlling our minds, we can warming effect than others. you can, wrap up warm and go for a brisk walk outside every day.work toward overcoming these Apart from the traditional Indian wholenegative thoughts and procrastination. grain cereals besides wheat and rice,So, try replacing them with positive include bajra, oats, maize or corn. Millets what’s hot & what’s not: can be used to make hot porridge. Wholethoughts. For instance, the holiday pulses and legumes like beans, soyabean nutrition facts 2013example can be turned into, “I know and lentils can be used in soups and stews. Winter is an excellent time to incorporatethe holidays are coming, so let me use ginger, garlic, cinnamon, turmeric andthis as an opportunity to test my cloves into one’s daily diet. In addition toability to control my eating habits”. their warming effect, they contain phytonutrients, anti-microbial and anti- Calling all almond lovers! A new studyWe can also try to look at the positive published in the American Journal of inflammatory properties that help fightside of stress as well: “I realize I’m infections and disease. Garlic has special Clinical Nutrition found that almonds decongestant, antibiotic and antifungal have 20% fewer calories thanfeeling stressed, so maybe I could try properties to fight coughs, colds and originally thought. The results foundtalking to someone about the issue to sinusitis. Ginger increases peripheral that one-ounce serving of almonds hassee if they can help. I want to get circulation. Almonds, walnuts, peanuts, 129 calories as opposed to 160 that’s black and white sesame seeds and flax currently listed. Interestingly, it haspleasure from more aspects of my life seeds are nutrition-packed for cold days. nothing to do with the composition -than just eating!”. They are rich in heart-healthy fats, fiber, rather, the way we metabolize it. magnesium and vitamin E. Honey and Recipe to Try: jaggery are natural substitutes for sugar and Honey and Fennel Glazed Almonds: have warming effects. Dark green leafy Preparation: Preheat oven to 300°F. vegetables like Mustard greens and Melt unsalted butter (2 tbsp) in a amaranth greens (bathua) are good sources large skillet on medium heat. Stir in of iron and folate and help maintain good honey (3tsp), water (1 tbsp), salt (1 haemoglobin levels. Vitamin C loaded foods 1/4th tsp) and ginger (1/4th tsp) .  like carrots, pumpkin, turnips, cabbage, Stir in almonds ( 2 cups) and fennel tomatoes, oranges, guava, lime and amla ( 1tsp), and remove from heat. help fight infections like the common cold Spread almonds onto foil, and bake and flu. Lean meats, fish, and poultry are 25 to 35 minutes, stirring once, until high biological value protein foods and are almonds are golden (cut one open to associated with increased heat production test). Transfer almonds on foil to a and higher thermogenesis. Hot soup, masala rack, cool completely and serve. tea, green tea, and hot water with Nutrients: Calories:205, Fat:2.6g, condiments help keep the body hydrated Protein:6g, Carb:11g, Fiber:4g and maintain body temperature.
  6. 6. Metabolic syndromes: Killer diseases that complicate obesity Terms like metabolic syndrome, InsulinDr.Boochandran Resistance Syndrome, Syndrome X are usedConsultant Endocrinologist for a group of conditions predisposing to diabesity Metabolic Syndrome is a combination Type 2 DM and Atherosclerotic Vascularof medical condition and disorder, when Diabesity, a new terminology coined Disease.occurring together invokes the risk of for patents suffering from Obesity andDiabetes and Cardiac Disease. According "Metabolic syndrome" dates back to at Diabetes is today’s most blatantlyto the International Diabetes Federation least the late 1950s, but came into common(IDF) – the definition of Metabolic visible – yet most neglected public usage in the late 1970s to describe variousSyndrome is Central Obesity (Waist associations of risk factors with diabetes, health problem. The link betweencircumference with ethnicity specific values) that had been noted as early as the 1920s. obesity and diabetes is firmlyand any of the following: established and threaten the health, • The Marseilles physician Dr. Jean Vague,• Raised triglycerides > 150 mg/dl in 1947, made the interesting observation well-being and economic welfare of• Reduced HDL < 40 mg/dl that upper body obesity appeared to virtually every country. Since organ• Raised BP Systolic BP >130 mm Hg predispose to diabetes, atherosclerosis, Diastolic BP > 85 mm Hg gout, and calculi. damage is inevitable if not controlled,• Raised Fasting Glucose >100 mg /dl • In 1977, Haller used the term "metabolic early multi modality treatment should syndrome" for associations of obesity,If BMI > 30 kg /m2, waist circumference be considered, especially in India diabetes mellitus, hyperlipoprotinemia,need not be measured. High sensitivity C- hyperuricemia and steatosis hepattis when which is tipped to become the obesityreactive protein has been developed and describing the additive effects of risk and diabetic capital by 2025.used as a marker to predict Coronary factors on atherosclerosis.Vascular Disease in Metabolic Syndrome. In a recent population based study from Chennai, the metabolic syndrome prevalence what’s hot & what’s not: was 18.3% by ATPIII criteria. In Northern India, the prevalence (ATPIII) was 35% in an metabolic facts industrial population and 24.9% in a community based study. Metabolic Syndrome causes higher incidence of cardiovascular disease than patients with diabetes. 2013 Congestive Heart Disease is 50% more common in patients with metabolic syndrome, 37% have premature artery disease at age 45, particularly in woman.Its prevalence increases with age and is higher in men than in women in south India. Almost 1% of children born in India are found to be suffering from “Inborn Metabolic Syndrome”. • In 1988, in his Banting lecture, Dr. Gerald The pathophysiology is extremely M. Reaven proposed insulin resistance as complex and only partially understood. The the underlying factor and named the important factors predisposing to Metabolic constellation of abnormalities Syndrome Syndrome are Obesity, genetics, endocrine X. Reaven did not include abdominal disorders such as PCOS, sedentary lifestyle. obesity, which has also been A number of inflammatory markers are hypothesized as the underlying factor, as elevated such as C-reactive protein, part of the condition. fibrinogen, interleukin-6, TNFα and others. In a study done in 2010, by Vinayaka With appropriate cardiac Mission University, Salem, South India, 1568 rehabilitation, change in lifestyle (Eg. Diet, patients with Metabolic Syndrome were physical activity, weight reduction, if needed studied. Waist circumference, dyslipidemia medications), the prevalence of the and GTT were assessed and it was found Syndrome can be reduced. However in that 33% of males and 27% of females were country like ours, people seek medical found to have Metabolic Syndrome. It was attention only very late when the symptoms also found that it was more prevalent in men had already become irreversible. than in women. Compared to the European population, Asian Indians have a lower BMI Since metabolic syndrome with obesity but had a greater waist to hip circumference accounts for more than 20% of all causes of ratio. death n India, IDF through its Asia Pacific Chapter (APC) has postulated guidelines to In another recent study, done in Urban consider Bariatric surgery as an effective India by Hinduja Hospital Mumbai, a total option. The point statement issued in 2011 of 548 subjects were screened in a cardiac states that Bariatric/GI metabolic surgery evaluation camp and it was found that SHOULD be considered for the treatment of Metabolic Syndrome was present in 19.72% T2DM or metabolic syndrome for patients of population, 79% had a Body Mass Index who are inadequately controlled by lifestyle of more than 23. Raised triglycerides & low alternations and medical treatment for HDL were found more in males than in candidates with BMI≥30 and MAY be females. Incidence of metabolic syndrome considered as a non- primary alternative to increased with increase in BMI. treat candidates with BMI ≥ 27.5.
  7. 7. Obesity and Snoring: Potential life threatening Obstructive Sleep Apnea Forty-five per cent of normal adults 3. Long soft palate and/or uvula. TheyDr.Narasimhan snore at least occasionally, and 25 per cent narrow the opening from the nose into theConsultant Pulmonologist are habitual snorers. The problem is more throat. As it dangles, it acts as a noisy SNORING is a symptom of a serious frequent in males and overweight persons, flutter valve during relaxed breathing.disorder called sleep apnea. Sleep apnea is and usually grows worse with age. They 4. Obstructed nasal airways. A stuffy orcharacterised by repeated collapse of the may wake up frequently at night resulting in blocked nose requires extra effort to pullupper airway during sleep with consequent sleepiness and fatigue during the day. This air through. This creates an exaggeratedcessation of breathing. A person who snores could also result in serious medical problems vacuum and pulls together the floppyis often an object of ridicule and causes like hypertension and in some cases even tissues of the throat, and snoring results.sleepless nights for others. This problem is cause sudden death.worse when one is a frequent traveller. A common question is whether OSA is The main cause is an obstruction to the a genuine problem and if there is a cure. free flow of air through the passages at the OSA can be cured. Equipments like BIPAP snoring facts: back of the mouth and nose. This area, (Bilevel positive airway pressure) and CIPAP where the tongue and upper throat meet the (Continuous positive airway pressure) help Many do not realize that a person is soft palate and uvula, is collapsible. Snoring keep the airways open and in some cases breathing only when he is snoring. The occurs when these structures strike each surgery can solve the problem. But a sudden cessation of snoring followed by other and vibrate during breathing. People detailed ENT examination and a sleep study who snore may suffer from: are mandatory before surgery. BIPAP and heavy snoring occurs because of the signal 1. Poor muscle tone in the tongue and CPAP are to be used on a long-term basis. If to brain from oxygen-starved organs. This throat. This happen during deep sleep. the patient is suffering from obesity as well, 2. Excessive bulkiness of throat tissue in Bariatric surgery mostly cures OSA. Even results in fragmented and daytime sleep. obese individuals. Children with large people using PAP for decades get relieved tonsils and adenoids often snore. of symptoms after weight loss surgery. 7 0 what’s hot & what’s not: Nicolas V Christou studied the hypothesis that bariatric surgery reduces long-term mortality in morbidly obese % 5 yr MORTALITY surgery facts patients. Bariatric surgery resulted in significant reduction 6.17 in mean percent excess weight loss (67.1%, P < 0.001). 2013 They had significant risk reductions for developing cancer, 0.68 cardiovascular, endocrine, infectious, psychiatric, and mental disorders compared with controls which translates to a reduction in the relative risk of death by 89%. Control BariatricsEasy daily lifestyle routines to lose excess weight become more mobile. If you move around be active after supper, thus burn moreMs. Krithvi ShyamClinical Psychologist enough, you can reduce the risk of all calories before going to bed and thus stay lifestyle diseases and burn up to 750 more slimmer. They will be up early and There has been a misconception among calories per day without even dieting or continue with breakfast during the peakpublic that dieting is enough to lose weight. hitting the gym. It requires you to rethink all metabolic activity. This helps them be moreAnd people are literally advised to starve in your habits and find new, more active ways fit and active and help them burn more. Thethe name of dieting. Dieting alone cant help to get through the day, making your own above lifestyle changes can add up toyou lose weight for long. It is not the healthy cup of tea than asking your maid or office burning of 1500 calories apart from anway to lose weight too. Unfortunately boy, or going for thrice a week shopping insensible loss of 500 calories, accountingslimming center use artificial fat dissolving instead of once a week bundled purchase. for the expenditure of 2000 calories intaketechniques that are temporary and diet Other major issue is the timing of meals. Our in a healthy Indian diet. This is simply howcharts with far less-than-required calorie body will have the least calorie-spending you go from being couch potatoes to muffin-intake that are unhealthy. You might lose rate between 8 pm and 6 am. If the person top blasting fitness freaks.weight for the first few months, but further has an erratic meal timing, body either willloss will be arrested because the body be depleted of calories due to long gapreduces burning its calories. Add exercise to between meals, or because of you feedingit, you will lose energy and get tired early. in with more calories during the time of leastYour performance at work will also be metabolic rate, your body tend to store mostcompromised. Life style changes are the real of the calories than spending it. Also therehealthy way to keep check at your weight will not be much of activity after you mealloss program. Add responsible eating and late in the night, which will not allow you toexercises, you will lose weight the right way, spend the calories taken in. If you canthe healthy way. regularize your meals to the time when your body is at its peak metabolism potential, ie 7 Increase your daily physical activity am, 12 pm, 7 pm, you will burn up to 500routine. Incorporate standing and walking calorie more than before without evenactivities as a part of you home and work moving a muscle. Morning people tend toactivities. The first and foremost change is to eat early, and give themselves a chance to
  8. 8. editor: secretariat:Dr. Rajkumar Palaniappan Bariatric Institute Apollo Hospitalsco-editors: 21 Greams LaneDr. Boochandran Chennai 600006Dr. Deepa Agarwal India contacts: tel: +91 44 42041788 mob: +91 7299952999 fax: +91 44 28294429 email: bariatrics@email.com website: www.apollohospitals.com