Professional Documents
Culture Documents
3 rd year
Introduction:
Lifestyle such as hypertension, diabetes cardiovascular
diseases, behavioural problems, high cholesterol, obesity,
are becoming the major public health problems.
These are called lifestyle disorder because they are limited
to people who adopt unhealthy and inappropriate lifestyles.
According to the National Family Health Survey, 13 percent
of women and 9 percent of men in India are overweight or
obese. Obesity increases the chance of other lifestyle
disorders.
Death rate due to ischemic heart disease in India is
165.8 per 100,000 population. Around 116.4 per 100,
000 people in India die due to cerebro-vascular
diseases. Cardiovascular disease is the leading cause of
death among males as well as females.
Lifestyle disorders are due to choices that people make
in their life. The good news is that most of the lifestyle
disorders are preventable and many are even
reversible.
Management of lifestyle disorder
The management of lifestyle disorder usually involves
a shift from unhealthy lifestyle to a healthy one.
Few basic changes include quitting smoking, avoiding
alcohol, having a balanced diet that includes fresh
vegetables and fruits, regular physical activity and
leading a stress-free life.
An expert consultation, early diagnosis, change in
lifestyle and medication specific to the underlying
diseases are very important in lifestyle disorders.
Definition:
Generalized accumulation of excess fat in the body.
There is excessive weight gain in the body.
10% to 20% above ideal or optimal weight is termed
obesity
It is one of the most important public health problem
Ideal or desirable body weight
Desirable range corresponds closely to the range of
quetelet’s index(QI) also known as body mass index
(BMI)
BMI = weight in kg/ height in m2
20 - 24.9 = desirable range
25 – 29.9 = overweight
˃30 = obese
˃40 = very obese
Types of obesity:
Based on fat distribution:
Upper body obesity
Men – nape of neck, shoulders, and abdomen
women – waist , chest and arms
High waist hip ratio
Fat cells may be normal in number but are larger
Greater risk of heart disease and diabetes
Lower body obesity
hips and thighs
No risk for diabetes
Finds difficulty in losing weight
Fat cells greater in number but of normal size
Based on onset:
Recent obesity(adult onset):
failure to adjust eating habits with age
Quite responsive to treatment
Long term obesity or developmental obesity(juvenile
onset):
Early infancy and between 5 to 7 years of age.
Overweight at age 7 should be managed by a very
modest restriction of energy intake in order to achieve
a normal weight for height at age 12 years
If not managed and child becomes adult then this type
of obesity tends to be very resistant to treatement.
Reactive obesity:
Weight gain following a traumatic emotional
experience
May appear at any time of life
Over eating to escape from problems
Treatment involves psychological approach
Obesity secondary to another condition:
Metabolic disorders( hypothyroidism and praeder willi
syndrome)
Etiology:
1)Excessive calorie consumption
Excessive intake of food
Not only the quantity of food but also the quality of
food(i.e. its calorie equivalent)
For example 100g of cucumber provides 16kcal but
the same amount of roasted groundnut provide
600kcal
Other examples : bread, butter, cheese and sweets
Excess calorie accumulates as adipose tissues.
2.Reduced energy output
less physical work and lack of exercise.
When physical activities are reduced food
consumption must be reduced.
but consumption pattern remains unchanged while
activities are reduced.
This results in obesity.
3.Hormonal imbalance
Constitutes less than 5%.
Dysfunction of thyroid, pituitary or suprarenals
Insulin
Female sex hormones(after pregnancy, after removal of
ovaries or uterus or at menopause).
Influence appetite
4.Heredity
The role of heredity is not well understood.
Dietetic habits of the family rather than hereditary
factors are always responsible for obesity.
Children imitate their parent’s dietary pattern.
Eating to much or eating fattening foods are handed
over as food habits from generation to generation.
Predisposing factors:
Age and sex:
Prevalence of obesity increases with age.
Most common after the age of 35.
In every geographical region, in the age group 40-60
years, the prevalence is higher among women than
among men.
Sedentary habits:
Television viewing
Less physical activities
Spending more hours in sitting
Socioeconomic status:
Obesity is more in affluent societies
Also in families with low educational level
smoking:
Smokers weigh a little less than non smokers
On cessation there is a tendency to increase weight.
It can be curbed by diet adjustment and exercise
Obesity: A gateway of diseases:
Obesity is an important risk factor for many diseases.
Cardiovascular diseases:
Hypertension
Coronary heart disease
Congestive heart failure
Stroke
Cardiovascular disease is the main cause of increased
mortality among obese people
Non – insulin dependant diabetes mellitus (NIDM):
Another important contributor to morbidity and mortality
in obese people
Creates insulin resistance
Gall stones ( bile is supersaturated with cholesterol).
Men: cancers of colon, rectum and prostrate
Women : menstrual problems, cancers of breast, ovary,
endometrium and cervix
Osteoarthritis of weight bearing joints (especially of back,
hips and knees)
Gout
Sleep apnea
Treatment of obesity:
Principle of treatment:
decreasing energy intake and increasing energy output
Components of treatment:
1)Diet
2)Exercise:
exercise alone is not an effective method for achieving weight loss.
But along with diet it results in greater weight loss
Activities should be gradually increased in a healthful manner
Maximum rate of work of the average non – athlete is about 6kcal/min over 1
h
The average resting metabolism is about 1 kcal/min
So the person engaged in 1 hour jogging used 360 kcal whereas the one who
remained at rest used 60 kcal
This is the upper limit of the increase in energy expenditure
In extremely obese individuals, in older adults and in
those obese who are afflicted with any cardiovascular
disease exercises must be mild
Extremely obese individuals need close supervision
because problems in dissipating heat, tachycardia,
hyperventilation, elevated blood pressure and
dyspnoea can occur
3.drugs:
In secondary obesity the treatment of underlying cause is
effective in reducing weight. e.g. : thyroid extract in
hypothyroidism
In primary obesity appetite reducing drugs such as
fenfluramine etc are used but has the following limitations:
Meant only for the short term
Maintaining lower body weight only when on drug
Not effective after six months because the patient regains
appetite due to tolerance to drugs and the dosage too
cannot be increased due to toxicity
4.surgery:
Only applicable in severely obese patients.
It is not an alternative to dieting but a method for
trying to enforce dieting
Associated with many complications
Dietetic management:
Dietetic management is by balanced reducing diet
which includes low calorie foods
Aims at maintaining and restoring good nutrition
along with gradual restriction in body weight
About 20 kcal/kg of ideal body weight is prescribed for
a sedentary worker and 25kcal/kg for a moderately
active worker
Principles of a reducing diet:
1. The total calorie intake should be within the range of 800 –
1500 kcal/ day. never go outside of this
2. Rate of weight loss should be 0.5 – 1.0 kg/ week
3. The reducing diet must provide essential nutrients
4. The diet must provide satiety value or a sense of satisfaction or
well-being to the patient
5. Fats should be restricted since they are concentrated source of
energy
6. Vegetable oils (except coconut and palm) van de included in
adequate amounts for supply of essential fatty acids
7. Bulk producing carbohydrates like green vegetables are liberally
prescribed.
8. Starches with a high carbohydrate content like potatoes are
restricted
9. Protein intake should be adequate to avoid unnecessary
loss of lean tissue
10. 1g of protein /kg ideal weight is essential to meet the
protein requirements.
11.Restriction of sodium as common salt is helpful in a weight
reducing diet. excess sodium causes retention of fluid.
12. Fluids can be taken liberally if salt is restricted.
13.Nonveg items are rich in fat so must be included only in
small quantities.
Restricted foods Permitted foods
Sweets, sugar chocolates, All green leafy
jaggery , jam, honey, cakes, vegetables, other
pastries, puddings, fried
items vegetables, fruits,
Roots like potato, tapioca,
vegetables soup,
yam, banana, whole milk, unsweetened lime juice
dried fruits, papad, Prescribed amount of
chutney, pickles, nuts cereals and pulses
creams, coconuts, fatty
foods and oils, alcoholic
drinks and soft drinks
•With all theses guidelines a reducing diet can be planned
Diabetic coma
Diagnosis of DM
Blood examination
Fasting blood glucose
Post prandial blood glucose
Oral glucose tolerance test
Glycosylated haemoglobin
Urine examination
Glucosuria
ketonuria
Diagnosis Fasting Random OGT HbA1C
glucose glucose