This document discusses chronic non-communicable diseases (NCDs) and lifestyle diseases in India. It notes that NCDs contribute to 62% of disease burden and 52% of deaths in India. Urbanization and industrialization are changing lifestyle behaviors like diet and physical activity that increase risk factors for NCDs. Obesity is a common expression of unhealthy diet and lack of physical activity, and its prevalence is increasing globally and in India. The document discusses causes, types, quantification, and health hazards of obesity as well as strategies for its prevention and treatment through diet and lifestyle modification.
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes
At the end of this session, the student shall be able to
What is gerontology and it’s branches?
Describe the growing burden of geriatric age group.
Classify and Enumerate the Health problems of the aged.
What are the lifestyle factors which helps the aged?
Describe the health status of the aged in India.
Describe the Schemes & Policy for Older Person in India
Explain the Implication of the ageing population in India
How are these diseases prevented in the elderly?
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes
At the end of this session, the student shall be able to
What is gerontology and it’s branches?
Describe the growing burden of geriatric age group.
Classify and Enumerate the Health problems of the aged.
What are the lifestyle factors which helps the aged?
Describe the health status of the aged in India.
Describe the Schemes & Policy for Older Person in India
Explain the Implication of the ageing population in India
How are these diseases prevented in the elderly?
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
This powerpoint covers the following subtopics:
What is obesity?
Pathogenesis
Burden
Epidemiology of obesity
Assessment of obesity
Consequences of obesity
Prevention and Control
Types of families |NUCLEAR FAMILY|JOINT FAMILY|THREE GENERATION FAMILY |Functions of the family |FAMILY IN HEALTH AND DISEASE |SOCIAL AND CULTURAL FACTORS| COMMUNITY MEDICINE
Title: Navigating Obesity: Understanding, Impact, Solutions
In this presentation, we unravel obesity's complexity, exploring its subcategories and the significance of Body Mass Index. Key facts underscore its global urgency. We dissect causes, from genetics to sedentary lifestyles, and outline health risks like cardiovascular issues and diabetes. We address the challenge of "double burden of malnutrition." Solutions include balanced diets, activity, stress management, and professional guidance. Real-life success stories inspire, and a Q&A session fosters engagement. Our aim: empower individuals to grasp obesity's nuances, mitigate its impacts, and embrace healthier living.
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
This powerpoint covers the following subtopics:
What is obesity?
Pathogenesis
Burden
Epidemiology of obesity
Assessment of obesity
Consequences of obesity
Prevention and Control
Types of families |NUCLEAR FAMILY|JOINT FAMILY|THREE GENERATION FAMILY |Functions of the family |FAMILY IN HEALTH AND DISEASE |SOCIAL AND CULTURAL FACTORS| COMMUNITY MEDICINE
Title: Navigating Obesity: Understanding, Impact, Solutions
In this presentation, we unravel obesity's complexity, exploring its subcategories and the significance of Body Mass Index. Key facts underscore its global urgency. We dissect causes, from genetics to sedentary lifestyles, and outline health risks like cardiovascular issues and diabetes. We address the challenge of "double burden of malnutrition." Solutions include balanced diets, activity, stress management, and professional guidance. Real-life success stories inspire, and a Q&A session fosters engagement. Our aim: empower individuals to grasp obesity's nuances, mitigate its impacts, and embrace healthier living.
Overweight And Obesity : Proven Health Risks, We All Should KnowSanjiv Haribhakti
Overweight and obesity are defined as abnormal or excessive fat accumulation in the body that presents a risk to health. Obesity will have a negative effect on health, leading to reduced life expectancy and/or increased health problems. According to WHO, Obesity is one of the most serious public health problems of the 21st century. For more info visit :- http://gisurgery.info/player_presentation.php?id=133
Voppt by dr seema kohli obesity and overweight-rev1Dr Seema Kohli
Obesity and overweight pose a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer.
The key causes are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity.
The Burden of diabetes in India is an alarming topic. Diabetes is a chronic disease also called "a touch of sugar". India has an estimated about 77 million people with diabetes and second most affected country in the world. International Diabetes Federation (IDF) forecasted by 2045 India will become 134 million of people with Type 1 diabetes. Diabetes pyramid of prevention - Low risk, Moderate Risk, High Risk, Very High Risk, Undiagnosed and Diabetes are the stages of the pyramid.
International Diabetes Federation has reported that the prevalence of Diabetes in adults in India is around 7.1%. In Urban areas is around 9%.
The crude prevalence of diabetes and pre-diabetes among adults were 5.1 and 13.5%, respectively, while the prevalence of pre-diabetes in youth aged 10–17 years was 5.1%. Intervention reduced fasting blood glucose levels of pre-diabetic adults by 11%.
Primordial prevention was provided to the whole population in the form of mass- scale diabetes awareness programs. This part of the program used VHWs to increase awareness and to screen all subjects in the community.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
Ncd gaps in ncd & obesity
1. Chronic Non-Communicable
Diseases (NCD) and Conditions
&
Lifestyle Diseases
Dr. Jeevan Yadav
Professor,
Community Medicine,
D. Y. Patil Medical College, Kolhapur
2. National Burden
• Advancing epidemics of LIFESTYLE Diseases are
– propelled by demographic, economic and social factors,
– of which urbanisation, industrialisation, and
globalisation, are the main determinants.
• The Indian economy is
– growing at approx. 7% per year.
– With increasing life expectancy,
– the proportion of the population older than 35 years is
expected to rise from 28% in 1981 to 42% in 2021.
3. National Burden
– NCDs contribute to 62% of total disease (Morbidity) burden,
52% of deaths (Mortality) are associated,
while 43% (Disability) DALYs lost due to NCDs in India.
– Urbanisation and industrialisation are changing the patterns of
living in ways that increase behavioural and biological risk factor
levels in the population.
• For these social reasons,
– the lifestyle epidemic is not simply restricted to NCDs in our
country;
– related to sexual lifestyle and have resulted in HIV - AIDS
epidemic that has reached concerning proportions.
5. Gaps in natural H/o NCD
• There are many gaps in our knowledge about the
natural H/o chronic NCDs
• These gaps cause difficulties in aetiological
investigations and research .
• These are
• 1) Absence of a known agent –
• 2) Multiple Risk factors than single cause-
• 3) Long latent period-
• 4) Indefinite onset-
6. • 1). Absence of a known agent -
• There is much to learn about causes of chronic
diseases.
• Whereas in some chronic diseases the cause is
known (e.g., silica in silicosis, asbestos in
mesothelioma),
• For many chronic diseases causative agent is
not known.
• The absence of a known agent makes both
diagnosis and specific prevention difficult.
7. • 2) Multiple Risk factors than single cause-
• Chronic diseases appear to result from
cumulative effects of multiple risk factors.
• These factors may be both environmental and
behavioural, constitutional.
• Epidemiology has contributed massively in the
identification of risk factors of chronic diseases.
• Many more are yet to be identified and
evaluated.
8. • 3) Long latent period-
• A further obstacle in natural history of chronic disease is
the long latent (or incubation) period between the first
exposure to "suspected cause" and the eventual
development of disease (e.g., cervical cancer).
• This makes it difficult to link suspected causes (antecedent
events) with outcomes, e.g., the possible relation between
oral contraceptives and the occurrence of cervical cancer.
• Now it is increasingly evident that the factors favoring the
development of chronic disease are often present early in
life, preceding the appearance of chronic disease by many
years.
• e.g. include-hypertension. diabetes, stroke, etc.
9. • 4) Indefinite onset-
• Most chronic diseases are slow in onset and
development, the distinction between diseased and
non-diseased states may be difficult to establish
(e.g., diabetes and hypertension).
• In many chronic diseases (e.g. cancer) the underlying
pathological processes are well established long before
the disease manifests itself.
• By the time the patient seeks medical advice, the
damage already caused may be irreversible or
difficult to treat.
11. Obesity
• Is one of the commonest expressions of
– unhealthy diet, often combined with
– lack of physical activity.
• Indeed, we are amidst an epidemic of obesity.
• Over past 2 decades there has been a dramatic rise in
prevalence of obesity throughout the world.
• It is estimated by the WHO that globally,
– over 1 billion (16%) adults are overweight and
– 300 million (5%) are obese.
12. • The highest rise in the number of obese is noted in the countries
with fast growing economies especially of South East Asia.
• As many as 250 million people in the third world countries suffer
from obesity.
• In India the prevalence of obesity is-
– 12.6% in women and 9.3% in men .
– In other words, > 100 million individuals are obese in India.
• We are truly in the midst of an obesity epidemic, which has
serious health ramifications
13. Epidemiological Determinants of Obesity
1) Obesogenic Environment :
• Today the shared environmental factors like-
– affluent lifestyle, rich food, sedentary home environment,
– vanishing old family traditions (with regards to eating,
exercise and outdoor activities),
– the ‘couch - potato’ culture etc. substantially contribute to
obesity.
• This environment is moulded towards a very favourable milieu
for obesity.
14. • Aggressive advertising, marketing and universal
accessibility of chips, wafers and colas have made them
not only a household item but also must for any outing or
birthday party!
• These are some of the reasons of urban obesity.
• Subconsciously we are imparting the same ‘unhealthy’
eating - behaviour to the children, ensuring that the next
generation too falls in the same vicious cycle of no return.
15. 2) Age : The incidence of obesity increases with age till about 60 yrs.
• The vulnerability is maximum in the middle age (around 40 years
of age), owing to certain hormonal changes, affluence and a
more sedentary lifestyle at this age.
3) Gender : Females are more likely to be obese as compared to
males, owing to inherent hormonal differences.
4) Ethnicity : There are large unexplained variations in the prevalence
of obesity in the people from different ethnic groups.
16. 5) Education levels : Indian setting, people with a higher education
level, are more likely to be obese, as compared to less educated.
• It is because the educated are likely to be more affluent.
• In the west, however, the educated might be in a better state of
health, as they are more aware and concerned about health
issues.
6) Income : The effect of income too is varied, in India and in the
West. Just like education, those with higher income are more
likely to be obese in India, but not so in the West.
17. 7) Marital status :
• Those who are married are more likely to be obese as
compared to those who are not.
8) Parity :
• Women with higher parity are more likely to be obese.
an average the woman gains 1kg weight with each pregnancy
18. 9) Diet : A diet rich in fats, refined sugar & carbohydrates
predisposes to obesity.
• Excessive consumption of
– sweets, cold drinks,
– fried food, baked items,
– pickles and chutneys, fast foods, alcohol etc.
– is responsible for obesity.
• Consumption of as little as 100 extra calories per day would
increase the weight of an individual by 4 kg in one year.
19. 10) Smoking : Is mostly clubbed with tea/coffee/cold
drink/alcohol/etc. gives more calories.
(Smoking per se reduces the likelihood of obesity, by virtue of nicotine being an
anorexic agent). But this positive effect of smoking can by no means
be endorsed for its promotion.
11) Physical Inactivity : High physical activity is a vital component
that keeps accumulation of fat and obesity under check.
• One who is undertaking minimal activity and is leading a
sedentary life is at a risk of obesity.
20. 12) Alcohol :
• Alcohol provides 7kcal per gm, which is almost double the
calorie content of carbohydrates or proteins (4kcal). Such a
high calorific value in itself is a risk factor for obesity
• The snacks consumed along with an alcoholic drink are
invariably nutritionally rich (fried, fatty and oily), which add
many more calories and predisposing the individual to
obesity.
21. Causes of Obesity
• Obesity results from
– an excess of dietary energy intake as compared to
energy expenditure and
– thus both an increase in intake and a decrease in
energy expenditure will lead to excess calories
being stored as fat and, ultimately to obesity.
1) Increased energy intake :
– due to lifestyle changes and affluence as seen in
urban areas seems to be fuelling the obesity
epidemic.
22. 2) Passive overeating :
– The term passive overeating is applied to the
practice of eating without a biological need, and
not expending the calories thus gained.
– Such a situation is commonly seen in the urban
setting today where one relishes French fries,
wafers and other high calorie snacks while
watching TV or using a computer.
23. 3) Binge eating :
• It is the practice of overindulging in eating in a short time.
• This might occur in a party, on a weekend or with drinks.
• In binge eating occasions become rather frequent;
it certainly is a cause of obesity.
4) Decreased energy expenditure :
• There is a rapid decline in energy expenditure
• i.e. in manual labour resulting from vehicle ownership,
availability of labour - saving devices,
• shunning outdoor sports and watching television and
computer use for long hours.
• These factors contribute to obesity.
24. 5) Metabolic factors :
• In some individuals endocrine disorders such as Cushing’s
syndrome and hypothyroidism, Prader – Willi syndrome etc.
are the cause of obesity.
6) Genetic factors :
• Obesity tends to run in families.
• Obesogenic genes are under study, which alter the metabolism
or alter response to obesity limiting hormones like Leptins etc.
7) Fetal programming :
• The Barker’s hypothesis proposes that under nutrition during
pregnancy may increase the susceptibility of that individual to
obesity in adulthood.
25. • Critical Periods for Weight Gain
– Weight gained during certain critical periods, usually
lead to an increased number of fat cells and makes
obesity difficult to treat.
– It is important to be on guard during these critical
periods, with an aim of preventing almost irreversible
weight gain
• These periods include :
– Age range of 12 to 18 months •
– Age range of 12 to 16 years •
– Gain of 60% (or more) of his ideal weight by an adult •
– Weight gain during pregnancy •
26. Quantifying Obesity
1) Body Mass Index (BMI) :
• Overweight is usually determined by the Body Mass
Index (BMI), which is a relationship of the person’s
weight to his height.
• BMI is computed by taking the body weight in kilograms and dividing it by
the square of the height in meters.
• Body Mass Index (BMI) = Weight (Kg) / [Height (m)]2
• BMI does not measure the body fat but relates well
with the degree of obesity.
27. 2) Waist circumference :
• Measurement of the waist circumference is a practical method to assess
obesity, esp. the degree of abdominal adiposity and the cardiovascular
disease risk.
• Waist is measured at mid point of lower border of rib cage
and iliac crest (at the level of umbilicus).
• A measure of less than or equal to 90 cm for men and 80
cm for women is considered healthy.
3) Waist - Hip Ratio (WHR) :
• It is another measure of abdominal adiposity and the cardiovascular
disease risk of the individual.
• A ratio of < 0.9 for men and < 0.8 for women is considered
normal.
28.
29. Types of obesity
Gynoid / ‘Pear shaped’ :
• The fat is evenly distributed (globally distributed).
Android/‘Apple shaped’ :
• In this type of obesity, the fat is centrally distributed or deposited
preferentially in the abdominal region.
• This expresses the peritoneal (visceral) distribution of fat in the
individual.
• This type of obesity is commonly seen in men of the South East
Asian region, including India.
• Such distribution is higher risk factor for coronary artery disease as
compared to the global distribution of fat in the body.
• Higher waist circumference or higher WHR is a indicator of visceral
(peritoneal) deposition of fat.
30. Hazards of obesity
• Obesity is associated with higher risk of mortality &
morbidity.
• The life expectancy of a morbidly obese individual is
about a decade lower than one with normal BMI.
• Most overweight and obese individuals exhibit
certain symptoms like
– difficulty in walking,
– heavy breathing while walking,
– joint pains, snoring, morning headaches and
– shortness of breath.
31. • Some specific clinical consequences of obesity :
• Metabolic & Degenerative :
– Diabetes type 2 (50 to 100 times more common in obese),
– hyperlipidaemia, ischaemic heart disease, hypertension (5 to 6 times
commoner),
– stroke (2.5 to 6 times commoner),
– gall stones, breast and colon cancer,
– infertility (men and women),gout and
– polycystic ovary syndrome are seen more often in obese.
• Physical :
– Osteoarthritis, chronic back pain,
– respiratory problems, limited mobility,
– higher accidents, sleep apnoea and skin problems.
• Psychological :
– Depression, low self - esteem, social isolation,
– poor employment status, impaired relationships and discrimination.
32. Prevention of Obesity
• “Most obese people- won’t enter treatment,
most who do- won’t lose weight and
most who lose weight- regain it” ~ Stukard
• The quotation by Stukard , clearly summarizes,
the importance of prevention of obesity over
treatment.
• Prevention is the only viable long term
strategy for many reasons.
34. • 1. Universal Prevention :
• As the name suggests, universal preventive measures are
meant for all the individuals in the community, irrespective
of their weight status.
• Theses measures include
– healthy lifestyle practices,
– like consuming a prudent and healthy diet,
– low consumption of fat and refined carbohydrates.
– Active physical activity and
– shunning sedentary lifestyle also forms a part of this strategy.
• Health and nutritional education is also imparted to
everyone in order to create awareness amongst masses for
prevention of obesity.
35. • 2. Selective Prevention :
• High risk individuals are targeted.
• These include-
– affluent people especially adolescents,
– pregnant women, middle aged people and
– those with rich sedentary lifestyle consuming high energy food (fats)
– those under psychological stress,
– those with a hormonal disorder,
– family history of obesity or on certain drugs like Lithium, Sodium
valproate, hormones etc.
– are also at a high risk of obesity.
• 3. Indicated Prevention :
• Indicated Prevention or the Secondary preventive measures are to
be taken for those with existing problems of overweight and
obesity.
36. How to Reduce Weight?
• Nearly 2500 years ago, Socrates had very aptly
said :
• ‘Eat only when hungry and drink only when
thirsty, and never to leave the table with a
feeling of satiety’.
• The aim should be to maintain --
BMI below 25 kg/m2 (preferably below 23.5) and
waist circumference below 90 and 80 cm in adult men
& women respectively,
by a prudent combination of diet and physical activity
and avoid weight gain in adulthood.
37. • Being overweight, a high BMI is probably first indication of fact that our
diet is off - course and needs correction.
• If ignored at this stage other more sinister lifestyle diseases might soon
follow.
• Many modalities for treatment/prevention of obesity are available.
• (a) The dietary therapy (commonly known as ‘dieting’) remains the
most practical and effective measure.
• Other measures are :
– (b) Behaviour therapy
– (c) Drug therapy
– (d) Surgical intervention
– (e) Genetic approach.
• Presently we concentrate only on the dietary therapy.
38. • Reducing weight through dietary therapy (dieting) :
• The first step to adopt a healthy lifestyle is to get educated on
nutritional and health aspects.
• Understanding the nutritive values of Indian foods is perhaps a good
beginning.
• One must learn about calorie content of different foods, food
composition (fats, carbohydrates and proteins), nutrition labels, types
of foods to buy and details on cooking procedures.
• Correct dieting technique involves instructions on how to make safe,
sensible and gradual change in eating patterns.
• Moderate reduction in calorie intake is essential to achieve a slow but
steady weight loss.
• This strategy also helps in maintaining this weight loss.
39. • There are four areas to be considered in the use
of dieting and nutritional education in treating
obesity.
• 1) Ascertain the activity status :
– sedentary, moderate or hard •worker.
– Assess the present BMI and the desired BMI (20 to 25
kg/m2).
– This would indicate the weight (in Kg) to be reduced.
• 2) Set a practical time frame for weight reduction.
– It has to been achieved at a rate of around 1 to 1.5 kg
per month.
40. • 3) Assess the daily calorie intake from fats,
proteins and •carbohydrates.
– The weight to be reduced is then translated to the
calorie restriction.
– These calories are distributed between carbohydrates,
protein and fat so as to cut down calories preferably
from fats and carbohydrates (in that order).
– This also helps balance all nutrients.
• 4) Suitable substitutions should be made.
– The frequency with •which the foods are to be eaten
and the situation in which the food is ingested is also
to be looked into.
• An example is illustrated in Box - 4.
46. Fad diets and their role in weight reduction :
• Fad diets stress either absence or presence of
particular foods or combination of foods. These
are commonly aimed at weight reduction.
• A fad diet is a set of menus advocated generally
by people, who have little or no knowledge of
nutrition or on the basis of inadequate evidence
by nutritionist as well.
• Even though such diets fail to meet the healthy
diet specifications, they turn out to be beneficial
for a short duration.
47. • They are so different from customary foods and are so
unpleasant to follow that they are used for a short
duration, generally not long enough to cause deficiency.
• People taking up fad diets skip from one such diet to
other, which again saves them from deficiency states.
• The secret of the short - lived success of such diets is
that, weight is rapidly lost, but is regained little later,
once the former eating habits are resumed.
48. Commercial ‘Weight Reducing’ Diets
• Either the sheer number of obese and weight conscious people is so large or there
is such a glamorization of good physique that today dieting is not only
‘commercialized’ but dieting and ‘slimming centres’ have
attained industrial proportions.
• Visiting a well - known slimming centre is
considered a prestige symbol for the affluent.
• Popular diets have become increasingly prevalent and controversial.
• More than 1000 diet books are now available, with many popular ones departing
substantially from mainstream medical advice.
• Public interest is being fuelled by cover stories of
popular magazines and televised debates.
• Out of the thousands of structured commercial diets, probably the more
popular ones are the Atkins diet, Ornish diet, Weight watchers
diet and the Zone diet.
49. Study Exercises
• Long Questions :
• (1) Describe the epidemiology of obesity. How would you advice a
middle aged man of 90 kg and 170 cms tall to reduce weight?
• (2) Discuss the principles of a healthy diet in context of lifestyle
diseases.
• Short Notes :
• (1) Fad diets
• (2) Food pyramid
• (3) BMI
• (4) Benefits of weight loss
• (5) Dietary fiber
• (6) Gaps in natural history of NCD