By-Ankur

SinghalBatch-08

G.R.M.C. Gwalior

HEALTH THREATS OF SEDENTARY LIFESTYLE

OutlineWhat are “sedentary lifestyles?”

Epidemiology pertaining to us and the world.

Overview of Health Consequences Hypokinetic diseases

The Evidence Sedentary Lifestyle is an Independent Risk

Factor for Cardiovascular Disease & Mortality

What Can Be Done?

What are sedentary lifestyles?

Any lifestyle that has

- insufficient physical activity or exercise

+ =

EPIDEMIOLOGY: The INDIAN SCENARIO

It’s Crazy to be Lazy…“Physical inactivity contributes substantially to the global burden of disease, death and disability.”

WHO: ~ 2 million deaths per year can be attributed to sedentary life style due to increased co-morbidities.

India is, in our own eyes, still a country of poverty, hunger and malnutrition. India is one of the capitals of diabetes and cardiovascular diseases.Accordig to NFHS, The overall prevalence of subjects >23 kg/m2 was 50.8% and central obesity was 52.6%. The overall prevalence of sedentary behavior was 59.3% among women and 58.5% among men. Both sedentary behavior and mild activity showed a significantly increasing trend in women after the age of 35–44 years. In men, such a trend was observed above the age of 45 years.

But today, obesity in children and adults is a reality that poses a double jeopardy to the government and health experts - on the one hand, they have to tackle the malice of malnutrition and on the other, they have to fight obesity among children.

The prevalence of overweight rose from 2% to 17.1% in rural india due to changing life style of the rural dwellers as it was found to be a contributory factor for the rising rates of obesity and associated metabolic diseases, such as diabetes according to NFHS survey being conducted in 1989 and 2009 respectively.

The prevalence of overweight in 14 to 17 years old school children has increased significantly from 10% in 2006-2007 to 12% in 2009, while those underweight decreased in Delhi. Affluence clearly impacts body weight.

States of India ranked in order of %age of people who are overwt. or obese, based on data from the 2007 National Family Health Survey

The European Youth Heart StudyResults:3.29 times increased Risk!Independent of weight status!!

Kuopio Ischemic Heart Disease Risk Factor StudyIncreased risk of “Metabolic Syndrome”

Strong predictor of cardiovascular mortalityStudy conclusion:

Sedentary lifestyle is actually a “feature” of MS

The Health and Retirement Study

Overview of health consequences

EFFECTS

Of A Sedentary Lifestyle

- Weight Gain- Obesity

Heart DiseaseJoint PainDiabetes

Weakened Immune System

Plethora of Ds.BAD

Hypokinetic diseases are conditions that occur from a sedentary lifestyle. Examples could include

AnxietyCardiovascular diseaseMortality in elderly men by 30% and double the risk in elderly women

Deep vein thrombosisDepressionDiabetes

Colon cancerHigh blood pressureObesityOsteoporosisLipid disordersKidney stones

Respiratory disease

Coronary heart disease

Gallbladder disease

Hormonal abnormalities and pregnancy complications

Hyperuricemiaand gout

Ischemic stroke

Type 2 Diabetes

Osteoarthritis

Cancer (breast, endometrial,colon, prostate)

Dyslipidemia

DepressionSleep apnoa

Co-morbidities associated with obesity

The problem of sedentary lifestyle: The Diabesity

Obesity in type-2 diabetic patients is a very common phenomenon and often termed as "Diabesity." Diabetes, obesity, hypertension, dyslipidemia are grouped under one name "Metabolic syndrome." The rising prevalence of these lifestyle disorders in India is of concern as singly or in combination, which act as major risk factors for coronary artery diseases (CAD).

Increased predisposition to diabetes and premature CAD in Indians has been attributed to the "Asian Indian Phenotype" characterized by less of generalized obesity measured by BMI and greater central body obesity as shown by greater WC and WHR.

Many Indians fit into the category of metabolically obese, normal weight individuals. The body fat percentage of an Indian is significantly higher than a western counterpart with similar BMI and blood glucose level. It has been hypothesized that excess body fat and low muscle mass may explain the high prevalence of hyperinsulinemia and the high risk of type-2 diabetes in Asian Indians

WHY????????

Sedentary Careers or Jobs

Many jobs require you to sit behind a computer all day which promotes you to live a sedentary lifestyle.

You sometimes get home late and have no time to cook so you buy fast food on the way home.

You lack physical activity and don’t eat healthy.

But this is all your decision because you can always get a different job or use your free time to be active and eat healthy.

WHAT CAN BE DONE: Well it’s quite obvious now to tackle any of

these large group of co-morbidities , a multi-disciplinary approach is required in order to shift the curve towards the better of this slowly rising epidemic…..

Focus for Change

Individual attitudesBelief in abilities

Micro environmentConduciveness of activity at

work & homeMacro environment

Socioeconomic culture & environment

A multidisciplinary approach to tackle health risks of sedentary lifestyle

How to Avoid Death (Or At Least Postpone It)Daily walksTake the stairsGardeningCycling, swimming, sportsYou get the idea…

THE EVIDENCE FOR EXERCISE…

Positive Health Effects of exercise and evidences of its effectiveness: Cardiovascular diseaseOverweight & obesityDiabetesCancerMusculoskeletal healthPsychological well-being

Reduction of CVD Risk

Greatest benefit of physical activity

Inactive people have 2x risk vs active

Prevents stroke

Improves CVD associated

risk factors

Sedentary Lifestyle and Cardiovascular Fitness

Most reliable index of physical activity Define “Cardiorespiratory Fitness”

Decrease in Cardiorespiratory Fitness Powerful Predictor

Cardiovascular Disease

Mortality

Type II Diabetes Mellitus

Overweight & Obesity“Ex-Ur-Size!”

Dramatic increase in prevalence over last 20 years (Remember last week?)

Energy intake>>>total energy expenditure Physical activity weight loss

Decreases risks of obesity

Health benefits independent of weight loss!!

DiabetesIncreasing prevalence in

developing country like usUsual onset after age 40Emerging in children…Evidence: 30% lower risk

in activeModerate and vigorous

activity levels

Cancer

Physical activity Colon cancer riskBreast cancer Prostate cancer?

Musculoskeletal Health

Regular physical activity Reduces age decline Strength and flexibility Reduces risk of falls & hip fractures

Weight-bearing activities Prevents osteoporosis

Psychological Well-Being

Physical activity Reduces symptoms of depression, and

possibly stress, & anxiety Positive self image and self-esteem Increases social interaction Builds social skills among children Improves quality of life

Summary

Physical activity: Many benefits… Decreases cardiovascular risk factors Independent of weight loss Physical activity is an independent predictor of mortality… Leanness ≠ invincible

So overview is

Pharmacotherapy for the Treatment of Obesity

“BUT DOC, ISN’T THERE A PILL I CAN TAKE?”

Drugs:Drugs: Sibutramine(withdrawn)Sibutramine(withdrawn) Phentermine(amphetamine)Phentermine(amphetamine) Amfepramone(congener of ethcathinone)Amfepramone(congener of ethcathinone) OrlistatOrlistat MetforminMetformin ExenatideExenatide BupropionBupropion FluoxetineFluoxetine MixedMixed RimonabantRimonabant

Indications for Drug Therapy in Obesity

Failure of diet and exercise alone

Significant obesity related comorbidities even if BMI < 30 (ie 25-30).

No contraindications to drug therapy lest Medication interactions

Medical conditions that may be adversely affected by the obesity drug

Summary Weight loss with

obesity medicines is modest

Obesity medicines are not a substitute for diet and exercise

Weight loss is often not maintained after drug is discontinued

Most obesity medicines are not covered by insurance

DrugDrug Wt lossWt loss

SibutraminSibutraminee

4-5 kg4-5 kg

PhenterminPhenterminee

3-4 kg3-4 kg

OrlistatOrlistat 2-3 kg2-3 kg

MetforminMetformin 2 kg2 kg

ExenatideExenatide 2-3 kg2-3 kg

BupropionBupropion 2-3 kg2-3 kg

FluoxetineFluoxetine MixedMixed

TopamaxTopamax 6-7 kg6-7 kg

RimonabanRimonabantt

6-7 kg6-7 kg

CLASSIFICATION OF BARIATRIC SURGERY:

1. PREDOMINANTLY RESTRICTIVE PROCEDURES

2. PREDOMINANTLY MALABSORBTIVE PROCEDURES

3. MIXED OR COMBINATION PROCEDURES

Bariatric surgery procedures can be categorized into operations utilizing 3

methods to produce weight loss: gastric restriction, mal absorption, or a

combination of the two.

SURGICAL THERAPY:

Recommends bariatric surgery for obese people:

BMI > 40 without co morbidities BMI >35 with 1 or more co morbidities. or BMI of 30 to 35 with significant or serious co morbidities.

or

When less invasive methods of weight loss have failed and the patient is at high risk for Obesity-associated morbidity and mortality.

Procedures that are solely restrictive by creating a small gastric pouch & a degree of outlet obstruction leading to delayed gastric emptying. The goal is to reduce oral intake by limiting gastric volume, produce early satiety, and leave the alimentary canal in continuity, minimizing the risks of metabolic complications

1.VERTICAL BANDED GASTROPLASTY

2.ADJUSTABLE GASTRIC BANDING

3. SLEEVE GASTRECTOMY

4.GASTRIC PLICATION

5. INTRA GASTRIC BALLOON

RESTRICTIVE PROCEDURES:

Malabsorption is achieved by creating a short gut syndrome and/or by accomplishing distal mixing of bile and pancreatic juice with ingested nutrients thereby reducing absorption.. Some purely malabsorptive operations are no longer recommended due to their potential hazard to cause serious nutritional deficiencies.

1. BILIOPANCREATIC DIVERSION2. THE JEJUNAL-ILEAL BYPASS

(no longer performed)3. ENDOLUMINAL SLEEVE

MALABSORPTIVE PROCEDURES

MIXED PROCEDURES:

1. GASTRIC BYPASS ROUX-EN-Y ( RYGBP). Most commonly performed procedure these days. Done laparoscopically.

2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH

3. IMPLANTABLE GASTRIC STIMULATION

The following procedures combine restrictive and malabsorptive approaches. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

Patient Criteria for surgery

1. A Body Mass Index (BMI) ≥ 40 or a BMI ≥ 35 with obesity related co-morbid conditions.

2. Age – 16 to 65 yrs.

3. Screening for mental or behavioral disorders that may interfere with post-operative outcomes

(e.g. eating disorders, depression, and substance abuse).

4. Counselling and advise to stop using tobacco products & alcohol, 4 weeks prior to surgery.

5. No absolute contraindication to major abdominal surgery

6. Obesity of long standing. Should have completed a weight loss program is recommended but

not required.

eg: dieting, nutritional counseling, an exercise program and commercial/hospital.

7.To adhere to post-surgical attention to lifestyle, an exercise program and dietary changes and

post-surgical follow-up with applicable professionals (e.g. nutritionist, psychiatrist, exercise ,

physical therapist, support group participation, on regular basis.

Lift WeightsPlay cricket Run like Usain Bolt

Ideas Reduce TV and Computer Use

Schedule your time for physical activity

Take the stairs

WALKDon’t take your vehicle.IT’S NOT THAT FARSERIOUSLY