This document discusses obesity, its prevalence, and management. It notes that obesity produces complications like hypertension, diabetes, and heart disease. The prevalence of obesity is increasing globally and is a leading risk factor for death. Obesity is defined as abnormal growth of adipose tissue due to enlarged fat cells or increased fat cell number. The document discusses factors contributing to obesity like diet, physical inactivity, and genetics. It also outlines methods for measuring obesity and classifications based on BMI. Prevention and treatment options for obesity like diet, exercise, and surgery are mentioned.

2. OBESITY AND ITSOBESITY AND ITS
MANAGEMENTMANAGEMENT
Maj Neamatullah AhmedMaj Neamatullah Ahmed
PBGMS,MPH,MCPSPBGMS,MPH,MCPS

3. INTRODUCTIONINTRODUCTION
It produces many complications
like hypertension, Diabetes
Mellitus, IHD,Stroke etc.

4. Deadly DiseasesDeadly Diseases
Causing Death of MillionsCausing Death of Millions
of People worldwideof People worldwide
 In 20th CenturyIn 20th Century
 Deadly infections,i.e.Deadly infections,i.e.
 CholeraCholera
 Small poxSmall pox
 TuberculosisTuberculosis
 TetanusTetanus
 MeaslesMeasles
 PneumoniaPneumonia
 Bird fluBird flu
 Other viral & bacterialOther viral & bacterial
infectionsinfections
 In 21In 21stst
CenturyCentury
 Hypertension-CVAHypertension-CVA
 Heart DiseasesHeart Diseases
 DiabetesDiabetes
 CancerCancer
 ObesityObesity
 Man made Disaster-Man made Disaster-
RTA, War etcRTA, War etc

5. Projected prevalence of obesity in adults by 2025

6. AIMAIM

7. My aim is to orient youMy aim is to orient you
about :about : Definition of obesityDefinition of obesity
 PrevalencePrevalence
 Reversible causes of weight gainReversible causes of weight gain
 Obesogenic environmentObesogenic environment
 Food value chartFood value chart
 Different exercise value chartDifferent exercise value chart
 Prevention strategies for obesityPrevention strategies for obesity
 Balanced DietBalanced Diet
 Therapeutic options for obesityTherapeutic options for obesity
 Surgical options for obesitySurgical options for obesity
 Danger FoodsDanger Foods
 Fitness PledgeFitness Pledge
 Prevention of obesityPrevention of obesity
 RecommendationsRecommendations

8. Abnormal growth of the
adipose tissue due to
enlargement of fat cell
size (hypertrophic) or
an increase of fat cell
no (hyper plastic) or
combination of both.

9. Desirable % Body FatDesirable % Body Fat
 Men: 8-25%Men: 8-25%
 Women 20-35%Women 20-35%

10. Prevalence ofPrevalence of
ObesityObesity

11. What is Prevalence?What is Prevalence?
New Obese / Incidence + Old ObeseNew Obese / Incidence + Old Obese
No of Total Obese PersonsNo of Total Obese Persons

12. Global epidemic ofGlobal epidemic of
obesityobesity
0
200
400
600
800
1000
1200
1400
1600
2000 2005
BMI>30
BMI>25
Overweight and Obesity are the 5Overweight and Obesity are the 5thth
leading risk of global deaths.leading risk of global deaths.
At least 3.4 million adults die each year as a result of beingAt least 3.4 million adults die each year as a result of being
overweight or obese.overweight or obese.

13. Obesity Trends* Among U.S.Obesity Trends* Among U.S.
AdultsAdults
BRFSS, 2005BRFSS, 2005
15%–19% 20%–24% 25%–29% ≥30%

14. India

15. Bangladesh
 Prevalence of obesity among girls & women aged
10 to 49 yrs
SlSl
nono
BMIBMI Prevalence (%)Prevalence (%)
1.1. > 25> 25 55
2.2. 18.5- 24.9918.5- 24.99 5959
3.3. < 25< 25 9595
4.4. < 18.5< 18.5 3535
Source: Bangladesh demographic & health data 2004
In 2010, among college students of Dhaka
City - Prevalence of obesity is 18%

16. United Kingdom
16% adults are obese by 199516% adults are obese by 1995
25% adults are obese by 201025% adults are obese by 2010
16% adults are obese by 199516% adults are obese by 1995
25% adults are obese by 201025% adults are obese by 2010

17. United States
68% Americans are overweight and68% Americans are overweight and
33.8% Americans are obese33.8% Americans are obese
68% Americans are overweight and68% Americans are overweight and
33.8% Americans are obese33.8% Americans are obese

18. China

19. Potential reversible causes ofPotential reversible causes of
weight gainweight gain
 Endocrine FactorsEndocrine Factors
HypothyroidismHypothyroidism
Cushing’s SyndromeCushing’s Syndrome
Hypothalamic Tumors / injuryHypothalamic Tumors / injury
InsulinomaInsulinoma
 Drug TreatmentsDrug Treatments
Tricyclic antidepressantTricyclic antidepressant
SulphonylureasSulphonylureas
Oestrogen-containing contraceptive pillOestrogen-containing contraceptive pill
CorticosteroidsCorticosteroids
Sodium valproateSodium valproate
ß-blockersß-blockers
NSAIDSNSAIDS
 Pathological Eating BehaviourPathological Eating Behaviour
Binge eatingBinge eating
Nocturnal eating/BulimiaNocturnal eating/Bulimia
 Alcohol consumptionAlcohol consumption Davidson/22ndDavidson/22nd

20. Reasons for the increase prevalence ofReasons for the increase prevalence of
obesity-The ‘Obesogenic’ Environmentobesity-The ‘Obesogenic’ Environment
 Increasing energy intakeIncreasing energy intake
↑↑Portion sizesPortion sizes
↑↑Snacking and loss of regular mealsSnacking and loss of regular meals
↑↑Energy-dense food (mainly fat)Energy-dense food (mainly fat)
↑↑AffluenceAffluence
Late night sleepLate night sleep
 Decreasing energy expenditureDecreasing energy expenditure
↑↑Car ownershipCar ownership
↓↓Walking to school/workWalking to school/work
↑↑Automation; ↓manual labourAutomation; ↓manual labour
↓↓Sports in schoolsSports in schools
↑↑Time spent on video games and watching TVTime spent on video games and watching TV
↑↑Central heating( Air ConditioningCentral heating( Air Conditioning))

22. BAGEL
20 Years Ago
Today
140 calories
3-inch diameter How many calories
are in this bagel?

23. BAGEL
20 Years Ago Today
140 calories
3-inch diameter
350 calories
6-inch diameter
Calorie Difference: 210 calories

24. Maintaining a Healthy Weight is a Balancing Act
Calories In = Calories Out
How long will you have to rake leaves in order to
burn the extra 210 calories?*
*Based on 130-pound person

25. Calories In = Calories Out
If you rake the leaves for 50 minutes you will burn
the extra 210 calories.*
*Based on 130-pound person

26. CHEESEBURGER
20 Years Ago
Today
333 calories
How many calories are in today’s
cheeseburger?

27. CHEESEBURGER
20 Years Ago Today
590 calories
333 calories
Calorie Difference: 257 calories

28. Maintaining a Healthy Weight is a Balancing Act
Calories In = Calories Out
How long will you have to lift weights in order to
burn the extra 257 calories?*
*Based on 130-pound person

29. Calories In = Calories Out
If you lift weights for 1 hour and 30
minutes,
you will burn approximately 257 calories.*
*Based on 130-pound person

30. Calories In = Calories Out
If you ride a bike for 1 hour and 25 minutes,
you will burn approximately 500 calories.*
*Based on 160-pound person

31. EpidemiologyEpidemiology
SexSex
AgeAge
Physical InactivityPhysical Inactivity Genetic FactorsGenetic Factors
Socio-economic StatusSocio-economic Status
Eating HabitEating Habit
Psychological
Factors
Psychological
Factors

32. Obesity can occur at any age
If obesity develops in childhood, it is likely
to be followed by obesity in adult life

33. Women are more prone to obesity than men
Woman’s BMI increases with successive pregnancies.

34. Genetic factors also plays an important role

35. Genetic Mechanism of Obesity

37. Obesity is more
common and prevalent
in the affluent society
than that of other
classes.

39. The use of steroids, oral contraceptive pills,
pain killers, Anti-hypertensives & insulin is
commonly followed by obesity

40. The composition of diet, the periodicity with
which it is eaten and the amount of energy
derived from it are all relevant with obesity

41. Eating tooEating too
little?little?
OrOr
too much?too much?

42. Improper diet
Malnutrition
bmi>25 bmi<18.5
(Overweight) (Underweight)

43. Physical inactivity may cause obesity,
which in turn restrict activity

44. Types ofTypes of
ObesityObesity
 Apple Shape obesityApple Shape obesity
 Pear Shaped ObesityPear Shaped Obesity

46. Partners in Global Health Education
1. How to use this
module
2. Learning
outcomes
3. Definition
4. Classification
5. Section 1 quiz
6. Global burden of
obesity
7. Section 2 quiz
8. Pathogenesis
9. Section 3 quiz
10. Effects of obesity
11. Section 4 quiz
12. Childhood obesity
13. Section 5 quiz
14. Management of
obesity
15. Section 6 quiz
16. Summary
17. Information
sources
tio n1
Note: Although overweight is identified by a BMI of ? 25.0 kg/m2, the risks of
obesity-associated diseases, such as diabetes, hypertension and dyslipidaemia,
increase from a BMI of about 21.0 kg/m2.
Increased as follows:≥30.0Obesity, further classified as:
– Very severe
– Severe
– Moderate
Increased
Not increased
Risk of co-morbidity
≥40.0– Class III
35.0 - 39.9– Class II
30.0 - 34.9– Class I
25.0 - 29.9Overweight or pre-obese
18.5 - 24.9Normal
BMI (kg/m2)Classification
Source: Adapted from WHO 1997
WHO classification of obesity

47. Different Techniques to Measure ObesityDifferent Techniques to Measure Obesity
Body Mass Index (BMI-Kg/m2)
Waist-Hip Ratio ( WHR)
Waist Circumference
Skin fold thickness
Broca Index : Height in cm – 100= Body weight in KG

49. Body Mass IndexBody Mass Index
The new vital sign!The new vital sign!
 Correlated with total body fat contentCorrelated with total body fat content
 Not accurate in muscular individualsNot accurate in muscular individuals
 Initial assessment and monitoringInitial assessment and monitoring
 BMIBMI
 weight in lbs/(height in inches)weight in lbs/(height in inches)22
x 703x 703
 ExampleExample
 5’6” 248lb female5’6” 248lb female
 248lbs / (66inches)248lbs / (66inches)22
x 703 = 40x 703 = 40

50. BMI ChartBMI Chart

51. Disadvantages of BMIDisadvantages of BMI
(a)
1.72
metre
Ht 1.72
metre
84
Kg
Wt 84
Kg
28.4 BMI 28.4
(b)
These men have the same
height, weight and BMI,
but have different percent
body fat
BMI calculated as follows:
BMI = 84 = 84 = 28.4 kg/ m2
(1.72)2
2.96
Which of theseWhich of these
men is atmen is at
risk of illrisk of ill
health andhealth and
why?why?
Although BMI is equally high in both men, in (a) it is due to
lean body mass whereas in (b) it is due to body fat. This
shows that, used alone, a high BMI is not diagnostic of
obesity. BMI also varies with age and sex in those <18 years.
These are some of the disadvantages
of using BMI to assess health risks.

52. Answer to QuestionAnswer to Question
 BMI =BMI = 87.387.3 kgkg == 28.28.55 kg/m2kg/m2
 (1.(1.7575 m)2m)2
 HHis BMI lies in the “overweight range” (25 –is BMI lies in the “overweight range” (25 –
29.9 kg/m229.9 kg/m2))
 The likely reason for the increased BMI inThe likely reason for the increased BMI in
an athlete is an increase in lean musclean athlete is an increase in lean muscle
massmass
  BMI does not distinguish between leanBMI does not distinguish between lean
body massbody mass ((accumulation of muscle massaccumulation of muscle mass))
and body fat. Hence, this athlete is wronglyand body fat. Hence, this athlete is wrongly

53. Waist Circumference
Android obesity or
“apple-shaped”
Higher risk for morbidity
and mortality
High Risk Men >102 cm
(>40 in)
Women > 88 cm (>35 in)

54. MEASURE MENT OF SKIN FOLD THICKNESS

55. Skin Thickness Measurement
Male : If more Than 40mm
Female : If more than 50
mm

57. Relative risks associated with obesity
Greatly increased (>3)Greatly increased (>3) Moderately increased (2-3)Moderately increased (2-3) Slightly increased (1-2)Slightly increased (1-2)
NIDDMNIDDM CHDCHD CANCERCANCER
breast cancer (in postbreast cancer (in post
menopausal women),menopausal women),
endometrial, colonendometrial, colon
Gallbladder diseaseGallbladder disease HypertensionHypertension Reproductive hormoneReproductive hormone
abnormalitiesabnormalities
DyslipidaemiaDyslipidaemia OsteoarthritisOsteoarthritis Polycystic ovaryPolycystic ovary
syndromesyndrome
Insulin ResistanceInsulin Resistance
BreathlessnessBreathlessness
Sleep apnoeaSleep apnoea
Hyperuricaemia andHyperuricaemia and
goutgout
Table 4.1 WHO TRS 894 Obesity: Preventing andTable 4.1 WHO TRS 894 Obesity: Preventing and
Managing the Global EpidemicManaging the Global Epidemic
Impaired fertilityImpaired fertility
Low back painLow back pain
Anaesthesia complicationsAnaesthesia complications
Fetal defects in maternalFetal defects in maternal
obesityobesity
CHDCHD
HypertensionHypertension
OsteoarthritisOsteoarthritis
Hyperuricaemia andHyperuricaemia and
goutgout
Table 4.1 WHO TRS 894 Obesity: Preventing andTable 4.1 WHO TRS 894 Obesity: Preventing and
Managing the Global EpidemicManaging the Global Epidemic

58. Diabetic Ulcer of FootDiabetic Ulcer of Foot

59. Foot ulcer in aFoot ulcer in a
traumatised diabetictraumatised diabetic
patientpatient

60. Squamous cellSquamous cell
carcinoma of fingercarcinoma of finger

61. Cosmetic disfiguration ofCosmetic disfiguration of
body inbody in
obesityobesity

63. Food value chartFood value chart
 Tea/Coffee:75/110 calTea/Coffee:75/110 cal
 Orange juice-1cup:40 calOrange juice-1cup:40 cal
 Tomato juice-1cup:80calTomato juice-1cup:80cal
 Cold Drinks-01 glass: 100 calCold Drinks-01 glass: 100 cal
 Banana-01(Sagar type):100 calBanana-01(Sagar type):100 cal
 Cake-01:70 calCake-01:70 cal
 Fruit cake-01:270 calFruit cake-01:270 cal
 MilkMilk-01cup/-01cup/1glass:1glass:80 cal/80 cal/150cal150cal
 Soup-01cup:100 calSoup-01cup:100 cal
 Dal-01cup:75 calDal-01cup:75 cal
 Ruti/chapati-2small:70 calRuti/chapati-2small:70 cal
 Paratha-01:150 calParatha-01:150 cal
 Vegetable-1/2cup:70 calVegetable-1/2cup:70 cal
 Toast 2piece:150 calToast 2piece:150 cal
K. ParkK. Park
 Rice-01cup: 170 calRice-01cup: 170 cal
 Salad-01cup: 56 calSalad-01cup: 56 cal
 Fish/Chicken-2piece:200 calFish/Chicken-2piece:200 cal
 Cooked veg 1cup:170 calCooked veg 1cup:170 cal
 Oil for cooking-3tsf:135 calOil for cooking-3tsf:135 cal
 Chira/muri-60gm:210 calChira/muri-60gm:210 cal
 Potato-01 medium:70 calPotato-01 medium:70 cal
 4 biscuit(15gm):75 cal4 biscuit(15gm):75 cal
 Mango-medium 01:100calMango-medium 01:100cal
 Boiled egg-01:90 calBoiled egg-01:90 cal
 Omelette / fried egg-01:160 calOmelette / fried egg-01:160 cal
 Samosa-01:200 calSamosa-01:200 cal
 Ice-cream-1 cup:400 calIce-cream-1 cup:400 cal
 Sandesh-2 nos:140 calSandesh-2 nos:140 cal
 Alcohol-7 cal/gmAlcohol-7 cal/gm
 Carbohydrate-4cal/gmCarbohydrate-4cal/gm
 Protein-4 cal/gmProtein-4 cal/gm
 Fat-9 cal/gmFat-9 cal/gm

64. Exercise Value ChartExercise Value Chart
For 77kg/170lb male : cal expenditure/ half an hourFor 77kg/170lb male : cal expenditure/ half an hour
 Lying/sitting idle: 51 calLying/sitting idle: 51 cal
 Standing idle : 57 calStanding idle : 57 cal
 Walking 2 miles:97 calWalking 2 miles:97 cal
 Running-11min/miles:315 calRunning-11min/miles:315 cal
 Cycling-5.5 miles/h:147 calCycling-5.5 miles/h:147 cal
 Boxing inside ring: 463 calBoxing inside ring: 463 cal
 Tennis:252 calTennis:252 cal
 Table tennis:156 calTable tennis:156 cal
 Voleyball:116 calVoleyball:116 cal
 Football:348 calFootball:348 cal
 Basketball:318 calBasketball:318 cal
 Swimming: 390 calSwimming: 390 cal
 Boating:102 calBoating:102 cal
 Sweeping floor/rakeSweeping floor/rake
leaves:138 calleaves:138 cal
 Gardenning:231 calGardenning:231 cal
 Ball-dance: 117 calBall-dance: 117 cal
 Disco dance: 237 calDisco dance: 237 cal

65. Prevention StrategiesPrevention Strategies
for Obesityfor Obesity
 Changes in eating behaviour :Changes in eating behaviour : Food selection,Food selection, Portion sizePortion size
controlcontrol,,
avoidance of snacking,avoidance of snacking, regular meals to encourage satietyregular meals to encourage satiety andand
substitution of sugar with artificial sweeteners.substitution of sugar with artificial sweeteners.
 Regular eating pattern:Regular eating pattern: Not to skip any mealNot to skip any meal-which will-which will↑ satiety↑ satiety
 ExerciseExercise should be incorporated in the daily routine .should be incorporated in the daily routine .
 Promoting healthy eating in schools.Promoting healthy eating in schools.
 Enhancing walking and cycling options for commuters.Enhancing walking and cycling options for commuters.
 Creation of public places to encourage physical activity andCreation of public places to encourage physical activity and
fitnessfitness
 RenderingRendering health educationhealth education about the benefit of having standardabout the benefit of having standard
weight to the people.weight to the people.
 Lifestyle modification.Lifestyle modification.

66. Therapeautic OptionsTherapeautic Options
for Obesityfor Obesity
40 Surgery 35
30 Drugs 27
Supervised low-calorie diet
↑exercise
Eating behaviour modification
25Treat cardiovascular risk factors 25
BMI cut-offs in absence ofBMI cut-offs in absence of
comorbiditycomorbidity
BMI cut-offsBMI cut-offs
In presence of comorbidityIn presence of comorbidity

67. APPETITE SUPPRESSANT
THERMOGENIC
FAT ABSORPTION
INHIBATOR

68. DrugDrug
TherapyTherapy Fat absorption InhibitorFat absorption Inhibitor
 Orlistat(Orlistat(Slimfast-120mgSlimfast-120mg))
1 cap with each main1 cap with each main
mealmeal
 Loose stool,oilyLoose stool,oily
spotting,faecalspotting,faecal
urgency,flatus,vit -urgency,flatus,vit -
malabsorptionmalabsorption
 Wt lossWt loss~3kg/6months~3kg/6months
 Appetite SupressantAppetite Supressant
 Sibutramine(Sibutramine(Obenil-Obenil-
5mg5mg) 5/10/15 mg once) 5/10/15 mg once
daily with / without fooddaily with / without food
 Dry mouth,constipation,Dry mouth,constipation,
insomnia,insomnia,↑HR,HTN↑HR,HTN
 Wt loss : 3-5kg/6 monthsWt loss : 3-5kg/6 months

69.  JAW WIRING
 GASTIC BYPASS
 GASTROPLASTY
 GASTRIC BALLOON
 FAT SUCTION
SURGICAL TREATMENT

73. Types OfTypes Of
ExerciseExercise
 Aerobic ExerciseAerobic Exercise : running, swimming,: running, swimming,
walking etc.walking etc.
 Anaerobic ExerciseAnaerobic Exercise : Weight lifting,: Weight lifting,
sketing ,Yoga, exercise with dumble etc.sketing ,Yoga, exercise with dumble etc.

74. Shape UpShape Up

75. Find out more at http://www.Powerhealths.com
1. Running burns calories hence it’s a great
way to lose extra weight.
2. Running is a great cardio-vascular
exercise that will keep our heart strong
and healthy. Jogging reduces the risk of
heart attack by strengthening the heart
and lowering blood pressure.
Facts about Running:

76. Find out more at http://www.Powerhealths.com
3. Running if done regularly,
according to Mayo Clinic, can
ease symptoms of depression
and anxiety.

77. Find out more at http://www.Powerhealths.com
4. A study research performed in
Japan, Nihon Fukushi University
in Handa showed that jogging
increase mental sharpness.
5. Running improves coordination
and makes us more alert.

78. Find out more at http://www.Powerhealths.com
6. Running makes us happier.
While running the body
released a hormone known as
endorphins that create a
sense of euphoria.

79. Food Guide Pyramid for aFood Guide Pyramid for a
balanced dietbalanced diet

80. Measurement OfMeasurement Of
ServingsServingsBread,Cereal,Rice ,PastaBread,Cereal,Rice ,Pasta
& Vegetable& Vegetable
& Fruit& Fruit
 2 slice Bread/0.5 cup Rice=12 slice Bread/0.5 cup Rice=1
Serving70 Cal(6-11Serving70 Cal(6-11
servings:420-770Cal)servings:420-770Cal)
 1 cup leaves/0.5 cup other1 cup leaves/0.5 cup other
vegetables/0.75 cupvegetables/0.75 cup
vegetable soup=1 Serving28vegetable soup=1 Serving28
Cal(3-5 servings:84-140Cal)Cal(3-5 servings:84-140Cal)
 1 apple/1 banana/1 mango/11 apple/1 banana/1 mango/1
orange/0.5 cup fruit juice=1orange/0.5 cup fruit juice=1
Serving100Cal(2-4Serving100Cal(2-4
serving:200-400Cal)serving:200-400Cal)
Milk,yogurt,cheese &Milk,yogurt,cheese &
Meat,poultry,fish,eggs,dry beans,nutsgroupMeat,poultry,fish,eggs,dry beans,nutsgroup
&Fats,oils,sweets&Fats,oils,sweets
 2 cup milk/yogurt=12 cup milk/yogurt=1
Serving160Cal(2-3Serving160Cal(2-3
servings:320-480Cal)servings:320-480Cal)
 30 gm fish/meat=130 gm fish/meat=1
Serving100Cal(2-3Serving100Cal(2-3
servings:200-300Cal)servings:200-300Cal)
 Fats ,Oils ,Sweets should beFats ,Oils ,Sweets should be
used sparingly.Oil=1used sparingly.Oil=1
tsf(5gm)=1 Serving=45 Caltsf(5gm)=1 Serving=45 Cal
 1224-2090 Cal +1224-2090 Cal +
Fat/Oil/SweetFat/Oil/Sweet

81. Composition ofComposition of
Balanced DietBalanced Diet
 Protein : 10-15%Protein : 10-15%
 Fat : 15-30%Fat : 15-30%
 Carbohydrate : Rest of the foodCarbohydrate : Rest of the food

83. Be Fit but not Fat.Be Fit but not Fat.
 If you are fit you are a hit.If you are fit you are a hit.

84. Fitness PledgeFitness Pledge
 My body is the only place I have to live.My body is the only place I have to live.
 I am proud to be gifted this wonderful creation.I am proud to be gifted this wonderful creation.
 I shall always strive to keep it healthy and fit.I shall always strive to keep it healthy and fit.
 I shall give all my body systems respect and treatI shall give all my body systems respect and treat
them with courtesy.them with courtesy.
 To my body and my health , I pledge my care andTo my body and my health , I pledge my care and
consideration.consideration.
 In body’s well-being and fitness - lies my happiness.In body’s well-being and fitness - lies my happiness.

85. Balanced Lifestyle
Energy
Intake
Energy
Expenditure

86. RECOMMENDATIONS
- -
Energy
Expenditure+ +
Energy
Intake
Obesity
Dietary Recommendations(Take
everything u like but with less
amount, Avoid starvation
Dieting-Free fatty acids)
Physical Activity (5
days in a week)
Behavior Modification
Psychological
Intervention(Strong mental

87. ??

88. Interaction with others atInteraction with others at
meetings like this, is one ofmeetings like this, is one of
thethe best waysbest ways to be updatedto be updated

90. ReferencesReferences
 www.powerhealth.comwww.powerhealth.com
 www.pubmed.comwww.pubmed.com
 Murtagh’s general practice 5Murtagh’s general practice 5thth
EditionEdition
 Davidson’s principles & practice of Medicine, 22Davidson’s principles & practice of Medicine, 22ndnd
EditionEdition
 Current Medical Diagnosis & Treatment-2015Current Medical Diagnosis & Treatment-2015
 Park’s Textbook of Preventive & Social Medicine-23Park’s Textbook of Preventive & Social Medicine-23rdrd
EditionEdition
 Kumar & Clark’s Clinical Medicine -8Kumar & Clark’s Clinical Medicine -8thth
EditionEdition

92. “ See each patient as if
He is your first patient,
He is your last patient’
He is your only patient.”
“It does not matter how
much you do ( for others ) but
is a matter that - how much
LOVE you put into doing that.”
Mother Teressa

93. This presentation is available at :