ADDITIONAL MATERIAL ON LIFESTYLE DISEASES

OBESITY
"Living life to the fullest without enjoying it is like a man who eats anything and is suffering from obesity."

Introduction
Increased consumption of more energydense, nutrient-poor, low fibre diet with high levels of sugar and saturated fats, combined with reduced physical activity, have led to obesity rates that have risen more than three-fold since 1980 in many countries.
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Introduction
The health consequences range from increased risk of premature death, to serious chronic conditions that reduce the overall quality of life. Of special concern is the increasing incidence of child obesity.

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Introduction
This epidemic is not restricted to industrialized societies; rather is often faster in developing countries than in the developed world. Coexisting with under-nutrition, obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socio-economic groups.
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 Economic growth, modernization, urbanization and globalization of food markets are just some of the forces thought to underlie the epidemic.
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Disease Burden
Obesity has reached epidemic proportions globally
> than 1 billion adults overweight - at least 300 million - clinically obese

Is a major contributor to the global burden of chronic disease and disability.

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 The importance of central obesity is clear in populations (e.g. Asian) who tend to have relatively low BMIs but high levels of abdominal fat, and are particularly prone to NIDDM, hypertension and coronary heart disease (CHD). An Indian Study recently revealed that almost 20% of adults who were not overweight or obese still had central obesity, putting them at a greater risk of developing these associated diseases (Gopalan 1998)
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Classification of obesity as per fat distribution

Android (or abdominal or central, males) -Collection of fat mostly in the abdomen (above the waist) -apple-shaped

-Associated with insulin resistance DM and

heart disease Gynoid (below the waist, females) - Collection of fat on hips and buttocks -pear-shaped
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-Associated with mechanical problems

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WAIST HIP RATIO

Obesity = WHR > 1(Men) & >0.85 (Women)

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Indicates abdominal fat accumulation

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ADVERSE HEALTH CONSEQUENCES

- Type II DM - Hypertension - Dyslipidemia - cardiovascular disease. referred as syndrome X, Insulin resistance syndrome or the metabolic syndrome

SURGICAL PROBLEMS
cholelithiasis varicose veins osteoarthritis lowbackache abdominal herniae

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MINOR PROBLEMS
non healing ulcers flat feet plantar fasciitis

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Prevention

WHY?

BENEFITS OF 10% REDN IN WT

DIABETES REDUCES RISK BY 50% FALL OF 30-50% IN FASTING GLUCOSE FALL OF 15% IN GLYCOCYLATED HB. RHEOLOGY DECREASES BLOOD VISCOSITY BY 20% DECREASES RBC AGGREGATION BY 20%

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BENEFITS OF 10% REDN IN WT

Mortality 20-25% fall in total mortality 30-40% fall in diabetes related deaths 40-50% fall in obesity related Ca deaths Angina Reduced symptoms by 90% 33% increase in exercise tolerance
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BENEFITS OF 10% REDN IN WT

BLOOD PRESSURE FALL OF 10 MM HG SYSTOLIC PRESSURE FALL OF 20 MM HG DIASTOLIC PRESSURE LIPIDS FALL BY 10% IN TOTAL CHOLESTEROL FALL BY 15% IN LDL CHOLESTEROL FALL BY 30% IN TRIGLYCERIDES INCREASE BY 8% IN HDL CHOLESTEROL

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WHEN TO START ?
CHOOSE YOUR PARENTS!!! ANTENATAL CARE
WT GAIN GESTATIONAL DM

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GUIDANCE
AVOID SWEETENED BEVERAGE INTRO MILK INTAKE OF DAIRY PRODUCTS IS ASSOC WITH REDUCED RISK OF WT GAIN
LOW FAT MILK ( 2%) UPTO 2 Y LOW FAT MILK ( 1%) >2 Y

AVOID JUICES
NOT INTRODUCE IN DIET < 6M 4-6 OZ PERMITTED UPTO 1-6 Y 12 OZ PERMITTED > 6 Y

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GUIDANCE
ENCOURAGE OUTDOOR ACTIVITY 30 MIN OF STRUCTURED PHY ACTIVITY FOR TODDLER AND SEVERAL HOURS OF SPONTANEOUS ACTIVITY LAYDOWN TIME LT FOR MEDIA ENCOURAGEBOOKS, GAMES, COLOURBOOK, DIALOGUE ETC

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DIET
ELEMINATE FAT
FAT UP TO 30% OF TOTAL ENERGY SATURATED FAT 10% PUFA 10 % AVOID DESSERTS, PASTRY ETC SUBSTITUTE AVOID FRYING, GRILLING, FAT SPRAY

DIETARY FIBER 25-30 GM /DAY

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DIET
REFINED SUGAR TO 10% OF TOTAL ENERGY FOODS RICH IN STARCH SALT 5-6 GMS/DAY ALCOHOL IN MODERATE QTY

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STIMULUS CONTROL
DELAY EATING FOR 2-3 MIN SLOW PACE OF EATING YOU EAT MORE IF YOU HAVE MORE CHOICES PUTTING DOWN CUTLERY BETWEEN BITES CHEW STOCK VEG/ FRUITS ADVERTISEMENTS

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STIMULUS CONTROL
EAT SITTING DOWN ONLY AT DESIGNATED PLACE LEAVE TABLE AS SOON AS EATING IS OVER DONOT COMBINE EATING WITH READING/ TV DONOT PUT BOWL OF SNACKS ON TABLE WHILE WATCHING TV

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STIMULUS CONTROL
IN RESTRAUNTS LAY A LIMIT TO ONE ROLL OF BREAD PLAN FOR PARTIES PLAN MEALS AND SNACKS DELAYS SNACKS FOR 10 MIN USE SMALLER PLATE DIVIDE INTO PORTIONS
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STIMULUS CONTROL
SHOP WITH FULL STOMACH LAYDOWN SHOPPING LIMITS STORE OUT OF SIGHT STOCK VEG AND FRUITS

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POSITIVE SELF TALK

MAINTAIN DIET RECORD CELEBRATE ACHIEVEMENT PLAN REWARD

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BEHAVIOUR MODIFICATION
ACQUIRE KNOWLEDGE INFLUENCE FAMILY ASK OHTERS TO MONITOR SUBSTITUTE SNACKING WITH OTHER ACTIVITY EXECESSIVE PORTION SIZE ACCEPTED AS NORM AVOID ENERGY DENSE DIET
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BEHAVIOUR MODIFICATION
ACQUIRE SOCIAL SKILLS
LAY DOWN LIMITS SAY NO

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THE PLATE MODEL

Rice Bread Pulses

Vegetables Fruits

Meat Eggs Fish

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TOBACCO AND CANCER

20 % OF ALL CANCERS 80 % OF LUNG CANCERS REDUCES 8 YEARS OF LIFE EXPECTANCY 50 % OF THOSE WHO STARTED SMOKING IN TEENAGE ARE LIKELY TO DIE OF CANCER SITES AFFECTED ARE
LUNGS, ORAL, NASOPHARYNX, LARYNX, OESOPHAGUS, STOMACH, BLADDER, PANCREAS, KIDNEY

ALCOHOL
RESPONSIBLE FOR 3% OF ALL CANCER DEATH ASSOCIATED WITH RISK OF OESOPHAGEAL, LIVER, RECTAL CANCERS BEER RELATED TO CANCER OF LARGE INTESTINE SYNERGISTIC AFFECT ON TOBACCO

CAUTION
SEVEN SIGN TO WARN YOU OF POSSIBILITY OF CANCER CHANGE IN BOWEL/ BLADDER PATTERN A SORE THAT DOESNOT HEAL UNUSUAL BLEEDING DISCHARGE THINKENING OR LUMP IN BREAST INDIGESTION/ DIFFICULTY IN SWALLOWING OBVIOUS CHANGE IN SIZE OF A MOLE NAGGING COUGH OR HOARSENESS

EXERCISE PREVENTS CANCERS

60 -120 MIN OF EXERCISE PER WEEK CAUSES 15 % REDUCTION IN INCIDENCE OF BREAST AND COLON CANCER

PLANT BASED DIET HELPS FIGHT CANCER

FEWER CALORIES MORE FIBRES LESS FAT MORE VITAMINS, MINERALS, PHYTOCHEMICALS AND ANTIOXIDANTS

CANCER OF WOMEN

FALLOPIAN TUBES

OVARY

ENDOMETRIUM

VAGINA

CERVIX

VULVA

PLANT BASED DIET GOALS

5 - 9 SERVINGS OF FRUIT VEGETABLES 3 - 7 WHOLE GRAINS

BREAST
1: 8 WOMEN GET BREAT CA < 39 Y 1:230 40-59Y 1:25 >60 Y 1:15

Breast Cancer Risk Factors

that cannot be changed

Age
GENDER Family History Reproductive History Genetic Factors Menstrual History

Parity
Radiation

WEIGHT

SMOKING

LACK OF PHYSICAL ACTIVITY

NOT BREAST FEEDING HORMONE REPLACEMENT THERAPY

Breast Cancer Risk Factors

HIGH FAT DIET

that can be changed

LATE CHILD BEARING

PROLONGED OCP USE

PREVENTION
20% LOWER RISK BY EATING 5 OR MORE SERVINGS VEGETABLES AND FRUITS PER DAY 30% LOWER RISK IF YOU DONT SMOKE 30-40% LOWER RISKIF YOU EAT A PLANT BASED DIET, MAINTAIN A HEALTHY WEIGHT AND EXERCISE REGULARLY

CANCER RISK CAN BE REDUCED 6070% BY

SENSIBLE FOOD CHOICES A HEALTHY WEIGHT PHYSICAL ACTIVITY NOT SMOKING

What is Physical Activity

Physical activity Bodily movement produced by skeletal muscles that results in an expenditure of energy Physical fitness A measure of a person's ability to perform physical activities that require endurance, strength, or flexibility.

Regular physical activity

A pattern of physical activity is regular if activities are performed in some order CDC,1997

Physical activity is something you do. Physical fitness is something you acquire, a characteristic or an attribute one can achieve by being physically active. And exercise is structured and tends to have fitness as its
goal" Anonymous

Spectrum of Physical Activity Health

and

Physically Fit

Physically disabled

Physically Active

LaPorte RE: Am J Epidemiol. 1984 Oct;120(4):507-17

Common Reasons Not To Exercise

I dont have the time I dont like to sweat Ill look silly It hurts I dont know what to do Its not important

Why Exercise ???

Do you know?
13.5 million people have coronary heart disease. 1.5 million people suffer from a heart attack in a given year. 250,000 people suffer from hip fractures each year. Over 60 million people (a third of the population) are overweight. 50 million people have high blood pressure.
(WHO, 2003)

Do you know that

Childhood obesity has reached epidemic proportions in most part of the world Children are eating more and exercising less. Time spent watching television or using computers This lack coupled with poor dietary habits has led to significant increases in the number of children with Type II diabetes and predisposition to hypertension, coronary artery disease and others

All of these can be Prevented by Regular Physical Activity !!!

How Physical Activity Impacts Health

Helps control weight. Reduces feelings of depression and anxiety. Helps build and maintain healthy bones, muscles, and joints. Reduces the risk of developing colon cancer. Helps reduce blood pressure in people who already have high blood pressure. Causes the development of new blood vessels in the heart and other muscles. Enlarges the arteries that supply blood to the heart.
WHO 2002

Health Risk of Physical Inactivity

Leading causes of disease and disability associated with physical inactivity
1. Coronary Heart Disease (CHD) 2. Stroke 3. Obesity 4. Type II Diabetes 5. Hypertension 6. Colorectal cancer 7. Stress and Anxiety 8. Osteo-arthritis 9. Osteoporosis 10. Low back pain

 Reduce the risk of the three leading causes of death: Heart Disease, stroke, and cancer Control or prevent development of Disease Enhance Mental Abilities Improve Sleeping Habits and Increase Energy Levels

What Can Exercise do for You?

Lift Depression and Help Manage Stress

Control Weight, improving self-image, appearance and health

FACT Sedentary lifestyle is a risk factor for CVD, according to the American Heart Association

Exercise & Cardiovascular Disease

Exercise reduces Blood Pressure

High blood pressure (above 140/90) is the main cause of Heart Attack and Stroke

Exercise prevents Atherosclerosis (clogged arteries)

Exercise reduces cholesterol plaques that clog arteries and can lead to stroke and heart attack
WHO 2002

Exercise and Cancer

The Basics Exercise helps to prevent obesity, a major risk factor for several types of cancer Exercise enhances immune function Exercise activates antioxidant enzymes that protect cells from free radical damage
WHO 2002

Exercise and Diabetes

Increase insulin sensitivity

Control blood glucose

Control Weight/Lower body fat Reduce risk of cardiovascular disease
WHO 2002

Exercise and Depression

Exercise can help prevent depression. In fact, recent studies have shown that exercise was found to be just as effective (despite a slower initial response) as antidepressant medication for treatment of depression.
Exercise reduces health problems , making you feel better Exercise helps you sleep better Exercise controls weight, enhancing self-esteem
WHO 2002

Exercise and Your Mind

Short-term benefits:
Boost alertness (possibly by triggering the release of epinephrine and nor epinephrine) Improve memory Improve intellectual function Spark creativity

Long-term benefits:
Exercise has been shown to slow and even reverse agerelated decline in mental function and loss of short-term memory
A report of Surgeon general, Physical Activity and health, 1996

Opportunities for Physical Activity

At work For transport In domestic duties In leisure time The majority of people do very little or no physical activity in any of these domains

Aerobic Activity
Definition Continuous movement that uses big muscle groups and is performed at an intensity that causes your heart, lungs, and vascular system to work harder than at rest Cardio respiratory Fitness is built through aerobic exercise Aerobic exercise conditions and strengthens our heart, respiratory system, muscles, and immune system
CDC physical activity report 1999

Types of Aerobic Exercise

Outdoor Activities
Walking Jogging/running Bicycling Swimming Basketball Soccer Jumping Rope

Indoor Activities
Treadmill machine Stair climbing machine Stationary bike Elliptical trainer Rowing machine Aerobics, boxing...

Frequency: 3-5 days per week

How Much and How Hard?

Aerobic exercise: a minimum if 3 days a week are necessary to reach most exercise goals and minimize health benefits Strength training: a minimum of 2 days per week Flexibility training: a minimum of 3-5 days per week Duration Aerobic: 20-60 minutes of continuous aerobic activity Strength: 1-3 sets of 8-12 repetitions Stretching: Stretch all muscle groups and hold positions for 10-30 seconds

 What time of day is best?

Timing Questions

Choose the most convenient time for your schedule Choose a regular time--the same time every day Timing may depend on the activity you choose

Can I eat before exercise?

It is best not to eat a meal for 2 hours beforehand Be sure to drink plenty of water before and during exercise

Should I exercise when Im sick?

No, especially if you have a fever

Exercise for people with special needs

People with disabilities are less likely to engage in regular moderate physical activity than people without disabilities, yet they have similar needs to promote their health and prevent unnecessary disease Exercise is for everyone!!!!!!! Individuals who have physical disabilities or chronic, disabling conditions such as arthritis can improve muscle stamina and strength with regular physical activity

Exercise for people with special needs

"You don't stop exercising because you grow old. You grow old because you stop exercising." Anonymous

People with disabilities should first consult a physician before beginning a program of physical activity to which they are unaccustomed Provide community-based programs to meet the needs of persons with disabilities. Ensure that environments and facilities conducive to being physically active are available and accessible to people with disabilities, such as offering safe, accessible, and attractive trails for bicycling, walking, and wheelchair activities.

Exercise for Women in developing countries

There has been several studies which have

shown that less emphasis is given to exercise especially in women The reasons are several and most important one is awareness. Women sports are not encouraged in most of developing countries There is stigma that women should not be involved in outdoor sports

Exercise is for everyone

There is need for awareness for physical fitness in developing countries Exercise is not only for men but for everyone With commitment, opportunities can be developed. Even shopping malls provide opportunities for fitness walking
CDC 1997

Health Risks of Physical Activity

Most musculo-skeletal injuries sustained during physical activity are likely to be preventable Injuries sustained during competitive sports have been shown to increase the risk of developing osteoarthritis Serious cardiac events can occur with physical exertion. The overall benefit of regular physical activity is lower all-cause mortality

Summary
Physical inactivity is one of the top 10 leading causes of death and disability in the developed world Exercise improves our body and minds Even moderate exercise has many health benefits It is important to set fitness goals that are realistic and meaningful for you It takes time to make fitness part of a lifestyle, and we will all have ups and downs in following our exercise programs
Exercise feels good!