B M I n O B E S I T Y BMI is commonly used to diagnose overweight and obesity, often in conjunction with measurement of waist circumference. Leading guidelines, such as those produced by the American Association for Clinical Endocrinology (AACE),the UK National Institute for Health and Care Excellence (NICE),[2] and the European Association for the Study of Obesity (EASO),consider a BMI of 30 kg/m2 to be the threshold for obesity, and describe 3 classes of obesity, rising in severity from low-risk/class 1 (between 30.0 and 34.9 kg/m2), through moderate-risk/class 2 (between 35.0 and 39.9 kg/m2), to high-risk/class 3 (≥40.0 kg/m2). Lower BMI thresholds may be recommended for black African, African-Caribbean, and Asian (particularly South Asian) populations in order to trigger action to reduce the risk for comorbid conditions. For example, in the NICE guidelines, a BMI of 23.0 kg/m2 in these groups indicates increased risk for type 2 diabetes mellitus (T2DM), and 27.5 kg/m2 indicates a high risk. Obesity is a global epidemic and its prevalence more than doubled between 1980 and 2014. In 2014, more than 1.9 billion adults (≥18 years), which is 39% of all adults, had overweight. More than 600 million had obesity, representing 13% of all adults. The fundamental cause of obesity and overweight is an imbalance between calories consumed and expended. Changes in dietary and physical-activity patterns worldwide have led to the increase in obesity and overweight.Obesity is a serious chronic condition that is associated with multiple comorbidities and decreased life expectancy.An increase in BMI increases a person's risk for cardiovascular disease (CVD), and obesity is an independent risk factor for CVD.It also increases the risk for T2DM; fatty liver disease; musculoskeletal disorders, in particular osteoarthritis; and some cancers, including breast, colon, kidney, and pancreatic cancer.Higher BMIs are also associated with cognitive/mood disorders, obstructive sleep apnea, gallstones, and gastroesophageal reflux. Classes 2 and 3 obesity are associated with significantly higher all-cause mortality than class 1 obesity and normal weight.Other factors, such as waist circumference, also contribute to the increased risk for obesity-related disease. As well as fat accumulation, fat distribution is related to obesity-related mortality and morbidity. Central obesity, also known as the apple shape, confers a higher risk than general obesity for several chronic diseases.In recent years, there has been a broadening of focus from BMI alone, so that the management of obesity-related comorbidities is also a priority Physical-activity counseling is an integral part of obesity management, but would not be effective on its own. EASO guidelines recommend that pharmacological therapy is considered in patients who are overweight or who have class 1 obesity if they also have comorbidities. Treatment guidelines recommend that the first stage in managing patients with obesity is to assess their views of their weight and the diagnosis, as well as the possible reasons for weight gain. Failure to engage patients and to convince them of the benefits of lifestyle interventions aimed at weight loss is likely to result in the lifestyle interventions being less effective. Therefore, this is an important first step. Eating patterns and physical-activity levels should be explored, as well any beliefs about diet, exercise, and weight gain that may be unhelpful to the patient. The physician should find out if the patient has already tried to lose weight and how successful these efforts were. They should assess the patient's confidence and willingness to engage in a weight-loss program. The health and other risks of obesity should be explained, as well as the benefits of weight loss and increasing physical-activity levels. The physician should be aware that a patient's feelings about obesity and other health problems, such as surprise or denial, may reduce their willingness or ability to change. For this reason, it may help to stress that obesity is a clinical condition with specific implications for health, rather than something that focuses on how a patient looks. It has reported a divergence in the perception of obesity between people with obesity and the clinicians treating them. For example, 65% of people with obesity consider obesity to be primarily a lifestyle disease and 44% think it is possible to have obesity and be healthy, compared with 88% and 4%, respectively, for clinicians. Barriers can be motivational, such as lack of willpower, emotional/personal, such as eating habits, or practical/systemic, such as medication costs or lack of support services. A comprehensive lifestyle intervention is a fundamental part of the management of obesity. This consists of lifestyle/behavioral training, a dietary calorie-reduction plan, and increased physical activity.When developing a weight-loss plan for a patient, the main requirement is that total energy intake is less than total energy expenditure.This will help address the imbalance of energy regulation that characterizes obesity. Obesity develops when the body's weight and energy regulatory mechanisms do not work properly, leading to an elevated body fat "set point," ie, the amount of fat the body wants to retain. The energy intake behavior of an individual is determined by whether he or she is at, above, or below the set point. Diets with a daily deficit of 600 kcal, leading to a 5% to 10% reduction in current body weight over 6 months, are considered to be realistic and have proven health benefits.Lower-calorie diets with an intake of 800 to 1600 kcal/day can be considered, but they are less nutritionally complete. Very low-calorie diets (<800 kcal/day) should not be routinely used to manage obesity. Evidence from systematic reviews suggests that, although initial weight loss is more rapid with very low-calorie diets, weight change after 1 year is not very different from comprehensive approaches. Physical activity is part of a comprehensive lifestyle intervention. Although it may have only modest effects on weight loss, it will bring other benefits, such as a reduction in the risk for T2DM and CVD.Physical activity also helps to preserve fat-free mass during weight loss and promote weight maintenance. People who have had obesity but have lost weight may need to do 60 to 90 minutes of activity per day to avoid regaining weight. Weight loss is difficult to achieve for most patients with obesity because a desire to restrict caloric intake is counteracted by biological responses to weight loss. The reduction in energy expenditure and increase in appetite that occur after weight loss are associated with changes in several hormones. Some of the hormonal changes result in altered physiology that leads to weight gain, whereas other changes lead to improvements in hormonal systems as the patient gets closer to a healthy weight. Weight-loss medications aim to reinforce the patient's efforts to change eating behaviors and produce an energy deficit.Most promote weight loss through their effects on appetite -- increasing satiety and decreasing hunger. It is possible that satiety signaling and inhibitory control are weaker in people who are prone to obesity. Many treatment guidelines recommend that weight-loss medication is considered for patients with a BMI ≥30 kg/m2 or a BMI ≥27 kg/m2 if they also have 1 or more comorbidities and a history of failure to lose weight.The inclusion of comorbidities in the criteria reinforces the benefits of weight loss for people with obesity-related disease. ORLISTAT Unlike most weight-loss medications, orlistat is a reversible gastric and pancreatic lipase inhibitor that blocks absorption of 30% of ingested fat from a 30% fat diet when taken at the recommended dosage (120 mg 3 times per day). It is approved for use in adults and adolescents, is considered one of the safest drugs in its category, and is available in most countries around the world. However, it has well-documented GI adverse events, such as fecal leakage, which limit its popularity. NALTREXONE/BUPROPION This is a sustained-release combination of an opioid receptor antagonist (naltrexone) and a noradrenaline reuptake inhibitor (bupropion). Naltrexone has a minimal weight-loss effect on its own,but it acts synergistically with bupropion to stimulate central melanocortin pathways and antagonize inhibitory feedback loops that limit weight reduction. This leads to improved energy expenditure and a reduction in appetite.The maximum total daily dose is 32 mg naltrexone/360 mg bupropion.Naltrexone/bupropion is associated with increased BP, so it should be avoided in patients whose hypertension is not controlled, and BP should be monitored in the initial phase of therapy. The most common adverse events are nausea, headache, vomiting, anxiety, and insomnia. The risk for GI events can be minimized by gradual titration. Other anti obesity drug is Liraglutide but this and Naltrexone are not available n approved in India by FDA .Only Bupropion is available but at present is used in smoking cessation n in depression.
NICE POST. YOGA HAS ROLE IN CONROLLING OBESITY.
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nice . Yoga as form of obese therapy can be advised
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Dear Friends, Today's discussion is… impact of OBESITY on ASTHMA Obesity was defined as a body mass index (BMI) greater than 30 Studies show that obesity is a risk factor for asthma. There is a positive correlation between baseline body mass index and the subsequent development of asthma. factors which explain this association… (1)Obesity is capable of reducing pulmonary compliance, lung volumes, and the diameter of peripheral airways. (2)Obesity affects the volume of blood in the lungs and so leads to ventilation-perfusion mismatch. (3)The increase in the adipose tissue in obese subjects leads to a rise in the serum concentrations of several cytokines, the soluble fractions of their receptors, and chemokines. (4)Many of these mediators are synthesized and secreted by cells from adipose tissue and receive the generic name of adipokines, including IL-6, IL-10, eotaxin, tumor necrosis factor-alpha, transforming growth factors-beta1, C-reactive protein, leptin, and adiponectin. (5) Comorbidities associated with Obesity like Diabetes, OSAS and Gastroesophageal reflux aggravates the Asthma further. Most studies point out that obesity is capable of increasing the prevalence and incidence of asthma, The treatment of obese asthmatics must include a weight control program. Studies suggest weight loss improves the course of Asthma I hope this piece of information will be HELPFUL Thanks Dr K N Poddar
Dr. K N Poddar16 Likes12 Answers - Login to View the image
Friends today I am discussing about Avery disgusting problem said to be obesity. What is obesity? Obesity is an epidemic condition puts people at a higher risk for serious diseases, such as type 2 diabetes, heart disease, and cancer. Obesity is defined as having a body mass index (BMI) of 30 or more. BMI is a calculation that takes a person’s weight and height into account. However, BMI does have some limitations. According to the CDC, “Factors such as age, sex, ethnicity, and muscle mass can influence the relationship between BMI and body fat. Also, BMI doesn’t distinguish between excess fat, muscle, or bone mass, nor does it provide any indication of the distribution of fat among individuals.” What causes obesity? Eating more calories than you burn in daily activity and exercise (on a long-term basis) causes obesity. Over time, these extra calories add up and cause you to gain weight. Common specific causes of obesity include: eating a poor diet of foods high in fats and calories having a sedentary (inactive) lifestyle not sleeping enough, which can lead to hormonal changes that make you feel hungrier and crave certain high-calorie foods genetics, which can affect how your body processes food into energy and how fat is stored growing older, which can lead to less muscle mass and a slower metabolic rate, making it easier to gain weight pregnancy (weight gained during pregnancy can be difficult to lose and may eventually lead to obesity) Certain medical conditions may also lead to weight gain. These include: polycystic ovary syndrome (PCOS): a condition that causes an imbalance of female reproductive hormones Prader-Willi syndrome: a rare condition that an individual is born with which causes excessive hunger Cushing syndrome: a condition caused by having an excessive amount of the hormone cortisol in your system hypothyroidism (underactive thyroid): a condition in which the thyroid gland doesn’t produce enough of certain important hormones osteoarthritis (and other conditions that cause pain that may lead to inactivity) Who is at risk for obesity? A complex mix of genetic, environmental, and psychological factors can increase a person’s risk for obesity. Genetics Some people possess genetic factors that make it difficult for them to lose weight. Environment and community Your environment at home, at school, and in your community, can all influence how and what you eat and how active you are. Maybe you haven’t learned to cook healthy meals or don’t think you can afford healthier foods. If your neighborhood is unsafe, maybe you haven’t found a good place to play, walk, or run. Psychological and other factors Depression can sometimes lead to weight gain, as people turn to food for emotional comfort. Certain antidepressants can also increase risk of weight gain. It’s a good thing to quit smoking, but quitting can also lead to weight gain. For that reason, it’s important to focus on diet and exercise while you’re quitting. Medications such as steroids or birth control pills can also put you at greater risk for weight gain. How is obesity diagnosed? Obesity is defined as having a BMI of 30 or more. Body mass index is a rough calculation of a person’s weight in relation to their height. Other more accurate measures of body fat and body fat distribution include skinfold thickness, waist-to-hip comparisons, and screening tests such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) scans. Your doctor may also order certain tests to help diagnose obesity as well as obesity-related health risks. These may include blood tests to examine cholesterol and glucose levels, liver function tests, diabetes screen, thyroid tests, and heart tests, such as an electrocardiogram. A measurement of the fat around your waist is also a good predictor of risk for obesity-related diseases. What are complications of obesity? Obesity leads to much more than simple weight gain. Having a high ratio of body fat to muscle puts strain on your bones as well as your internal organs. It also increases inflammation in the body, which is thought to be a cause of cancer. Obesity is also a major cause of type 2 diabetes. Obesity has been linked to a number of health complications, some of which are life-threatening: type 2 diabetes heart disease high blood pressure certain cancers (breast, colon, and endometrial) stroke gallbladder disease fatty liver disease high cholesterol sleep apnea and other breathing problems arthritis infertility How is obesity treated? If you’re obese and haven’t been able to lose weight on your own, medical help is available. Start with your family physician who may be able to refer you to a weight specialist in your area. Lifestyle and behavior changes Your healthcare team can educate you on better food choices and help develop a healthy eating plan that works for you. A structured exercise program and increased daily activity — up to 300 minutes a week — will help build up your strength, endurance, and metabolism. Counseling or support groups may also identify unhealthy triggers and help you cope with any anxiety, depression, or emotional eating issues. Medical weight loss Your doctor may also prescribe certain prescription weight loss medications in addition to healthy eating and exercise plans. Medications are usually prescribed only if other methods of weight loss haven’t worked and if you have a BMI of 27 or more in addition to obesity-related health issues. Prescription weight loss medications either prevent the absorption of fat or suppress appetite. These drugs can have unpleasant side effects. For example, the drug orlistat (Xenical) can lead to oily and frequent bowel movements, bowel urgency, and gas. Your doctor will monitor you closely while you’re taking these medications. Weight loss surgery Weight loss surgery (commonly called “bariatric surgery”) requires a commitment from patients that they will change their lifestyle. These types of surgery work by limiting how much food you can comfortably eat or by preventing your body from absorbing food and calories. Sometimes they do both. Weight loss surgery isn’t a quick fix. It’s a major surgery and can have serious risks. After surgery, patients will need to change how they eat and how much they eat or risk getting sick. Candidates for weight loss surgery will have a BMI of 40 or more, or have a BMI of 35 to 39.9 along with serious obesity-related health problems. Patients will often have to lose weight prior to undergoing surgery. Additionally, they will normally undergo counseling to ensure that they’re both emotionally prepared for this surgery and willing to make the necessary lifestyle changes that it will require. There’s been a dramatic increase in obesity and in obesity-related diseases. This is the reason why communities, states, and the federal government are putting an emphasis on healthy food choices and activities to help turn the tide on obesity. How can you prevent obesity? Help prevent weight gain by making good lifestyle choices. Aim for moderate exercise (walking, swimming, biking) for 20 to 30 minutes every day. Eat well by choosing nutritious foods like fruits, vegetables, whole grains, and lean protein. Eat high-fat, high-calorie foods in moderation. Common and effective homeopathic remedies for weight loss Antimonium crudum. Argentum nitricum. Calcarea carbonica. Coffea cruda. Capsicum. Other homoeopathic medicines can also be given on the basis of totality of symptoms.
Dr. Rajesh Gupta7 Likes4 Answers - Login to View the image
FROM MOTHER TO BABY: 'SECONDHAND SUGARS' CAN PASS THROUGH BREAST MILK. March 2, 2017. ADD BREAST MILK TO THE LIST OF FOODS AND BEVERAGES THAT CONTAIN FRUCTOSE, A SWEETENER LINKED TO HEALTH ISSUES RANGING FROM OBESITY TO DIABETES. A NEW STUDY by researchers at the Keck School of Medicine of USC INDICATES a sugar called FRUCTOSE is PASSED from MOTHER TO INFANT THROUGH BREAST MILK. The proof-of-concept study involving 25 mothers and infants provides preliminary evidence that even fructose equivalent to the weight of a grain of rice in a FULL DAY'S SERVING OF BREAST MILK IS ASSOCIATED WITH INCREASED BODY WEIGHT, MUSCLE AND BONE MINERAL CONTENT. Found in fruit, processed food and soda, FRUCTOSE IS NOT A NATURAL COMPONENT OF BREAST MILK, which IS STILL CONSIDERED the GOLD STANDARD DIET FOR BABIES. The "SECONDHAND SUGAR" is DERIVED FROM a MOM'S DIET, said Michael Goran, lead author of the new study published in February in the journal Nutrients. EXPOSING INFANTS AND CHILDREN TO HIGHER AMOUNTS OF SUGAR during growth and development can PRODUCE PROBLEMS with COGNITIVE DEVELOPMENT and LEARNING as well as CREATE LIFELONG RISK FOR OBESITY, DIABETES, FATTY LIVER DISEASE AND HEART DISEASE, said Goran, founding director of the Childhood Obesity Research Center at the Keck School of Medicine. FRAPPUCCINOS, ENERGY DRINKS, CRANBERRY JUICE COCKTAILS AND FRUCTOSE are examples of SOURCES OF SECONDHAND SUGARS. Healthy, naturally occurring SUGARS IN BREAST MILK include LACTOSE, which is BENEFICIAL TO to INFANT GROWTH and DEVELOPMENT. "Lactose is the main source of carbohydrate energy and breast milk is very beneficial, but it's possible that you CAN LOSE some of that BENEFICIAL EFFECT DEPENDING ON MATERNAL DIET and how that may AFFECT the COMPOSITION OF BREAST MILK," Goran said. "OTHER STUDIES have SHOWN that FRUCTOSE and artificial sweeteners are particularly DAMAGING during CRITICAL PERIODS OF GROWTH AND DEVELOPMENT IN CHILDREN. We are beginning to see that any amount of FRUCTOSE IN BREAST MILK IS RISKY." GORAN and his colleagues DID NOT COLLECT MOTHERS' DIETARY DATA FOR THIS STUDY, SO they were UNABLE TO DETERMINE if the trace amounts of fructose found in BREAST MILK is POSITIVELY ASSOCIATED WITH HABITUAL CONSUMPTION OF FRUCTOSE-RICH FOODS AND DRINKS. "WE KNOW VERY LITTLE ABOUT WHY SOME CHILDREN EVENTUALLY BECOME OVERWEIGHT OR OBESE," Goran said. "IT'S IMPORTANT that we study WHAT may be TAKING PLACE in the earliest times OF THEIR DEVELOPMENT to determine WHETHER ANYTHING COULD BE DONE JUST AFTER BIRTH TO LOWER THEIR RISKS." HOW MUCH IS TOO MUCH? The FIRST YEAR OF LIFE is a CRITICAL PERIOD for BUILDING BRAIN NETWORKS AND for cementing the foundation for the METABOLIC SYSTEM. MINUTE AMOUNTS of FRUCTOSE may have DETRIMENTAL EFFECTS on infant metabolism, said Tanya Alderete, co-author of the study and a postdoctoral research scholar at the Keck School of Medicine. INGESTION OF FRUCTOSE COULD COACH PRE-FAT STORAGE CELLS TO BECOME FAT CELLS, RAISING the BABY'S RISK of one day becoming overweight or obese. "EARLY LIFE IS A PERIOD OF RAPID DEVELOPMENT and EARLY NUTRITION is STRONGLY LINKED TO LONG-TERM HEALTH OUTCOMES," Alderete said. "We know that the DECISION TO BREASTFEED OR BOTTLE FEED may have IMPACTS ON LATER HEALTH. RESULTS from this work SUGGEST that the COMPOSITION OF BREAST MILK MAY BE ANOTHER IMPORTANT FACTOR TO CONSIDER in regard to infant health." Looking at the study data, Alderete said the AVERAGE BREASTFEEDING 1-MONTH-OLD BABY could CONSUME JUST 10 MILLIGRAMS (about a grain of rice) of FRUCTOSE FROM BREAST MILK A DAY, YET he would see ADVERSE CHANGES in body composition during growth. A SINGLE MICROGRAM OF FRUCTOSE PER MILLILITER of BREAST MILK —that's 1,000 times lower than the amount of lactose found in breast milk—is ASSOCIATED WITH A 5 to 10 PERCENT INCREASE IN BODY WEIGHT AND BODY FAT FOR INFANTS AT SIX MONTHS OF AGE, Goran said. STILL, Alderete EMPHASIZED that BREASTFEEDING IS THE IDEAL form of infant nutrition AND MOTHERS SHOULD CONTINUE TO BREASTFEED FOR AS LONG AS POSSIBLE OR UP TO ONE YEAR. BABY FAT TWENTY-FIVE MOTHERS BROUGHT their INFANTS to the Oklahoma Health Sciences Center WHEN the babies were 1 MONTH OLD and AGAIN when they were 6 MONTHS OLD. The MOTHERS FASTED for at least THREE HOURS prior to the visit. The INFANTS were FED BREAST MILK, CONSUMED LESS THAN 8 OUNCES of FORMULA A WEEK and had NO SOLID FOODS, according to their mothers. RESEARCHERS TOOK a BREAST MILK SAMPLE FROM EACH MOM and SCANNED IT FOR sugars such as LACTOSE, GLUCOSE and FRUCTOSE. They MEASURED each BABY'S FAT MASS, MUSCLE MASS and BONE MASS. INFANT GROWTH was NOT RELATED TO MOTHERS' PRE-PREGNANCY BODY MASS INDEX, a measure of body fat, or to any of the other breast milk components, scientists found. The researchers ADJUSTED their RESULTS FOR the SEX of the infant AND the BABY'S WEIGHT AT 1 MONTH. Researchers at the Childhood Obesity Research Center at USC are looking at HOW MATERNAL FOOD INTAKE AFFECTS FRUCTOSE LEVELS in breast milk as well as HOW SPECIFIC ELEMENTS in breast milk can ALTER a BABY'S DEVELOPING GUT BACTERIA, which neutralizes toxic byproducts of digestion. This "GUT MICROBIOME" IMPACTS INFANT GROWTH AND METABOLISM. Based on early study results, Goran OFFERS some ADVICE TO PREGNANT WOMEN AND NEW MOTHERS. "NEW MOMS CAN PREVENT PASSING SECONDHAND SUGARS TO THEIR CHILDREN BY EATING AND DRINKING LESS SUGARS WHILE PREGNANT OR BREASTFEEDING," Goran said. "CAREGIVERS CAN SHIELD babies and children from HARMFUL EFFECTS OF SUGARS BY carefully CHOOSING INFANT FORMULA, baby foods and snacks WITHOUT ADDED SUGARS OR SWEETENERS.." £££££££££££££££££££££££££££££££££££££££££££££ PROVIDED BY: University of Southern California. _______________________________________ CREDIT: CC0 Public Domain. =====================+=======================
Dr. Puranjoy Saha17 Likes14 Answers - Login to View the image
You can find here key changes in ADA guidelines. They are published in Diabetes Care once yearly in the month of January. GENERAL CHANGES The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the ADA has long been a leader in producing guidelines that capture the most current state of the field. To that end, the “Standards of Medical Care in Diabetes” now includes a dedicated section on Diabetes Technology, which contains preexisting material that was previously in other sections that has been consolidated, as well as new recommendations. SECTION 1. IMPROVING CARE AND PROMOTING HEALTH IN POPULATIONS Additional information was included on the financial costs of diabetes to individuals and society. Because telemedicine is a growing field that may increase access to care for patients with diabetes, discussion was added on its use to facilitate remote delivery of health-related services and clinical information. SECTION 2. CLASSIFICATION AND DIAGNOSIS OF DIABETES Based on new data, the criteria for the diagnosis of diabetes was changed to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from same sample). The section was reorganized to improve flow and reduce redundancy. Additional conditions were identified that may affect A1C test accuracy including the postpartum period. SECTION 3. PREVENTION OR DELAY OF TYPE 2 DIABETES This section was moved and is now located before the Lifestyle Management section to better reflect the progression of type 2 diabetes. The nutrition section was updated to highlight the importance of weight loss for those at high risk for developing type 2 diabetes who have overweight or obesity. Because smoking may increase the risk of type 2 diabetes, a section on tobacco use and cessation was added. SECTION 4. COMPREHENSIVE MEDICAL EVALUATION AND ASSESSMENT OF COMORBIDITIES On the basis of a new consensus report on diabetes and language, new text was added to guide health care professionals’ use of language to communicate about diabetes with people with diabetes and professional audiences in an informative, empowering, and educational style. A new figure from the ADA-European Association for the Study of Diabetes (EASD) consensus report about the diabetes care decision cycle was added to emphasize the need for ongoing assessment and shared decision making to achieve the goals of health care and avoid clinical inertia. A new recommendation was added to explicitly call out the importance of the diabetes care team and to list the professionals that make up the team. A recommendation was added to include the 10-year atherosclerotic cardiovascular disease (ASCVD) risk as part of overall risk assessment. The fatty liver disease section was revised to include updated text and a new recommendation regarding when to test for liver disease. SECTION 5. LIFESTYLE MANAGEMENT Evidence continues to suggest that there is NOT an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, more discussion was added about the importance of macronutrient distribution based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Additional considerations were added to the eating patterns, macronutrient distribution, and meal planning sections to better identify candidates for meal plans, specifically for low-carbohydrate eating patterns and people who are pregnant or lactating, who have or are at risk for disordered eating, who have renal disease, and who are taking sodium–glucose cotransporter 2 inhibitors. There is NOT a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized. A recommendation was modified to encourage people with diabetes to decrease consumption of both sugar sweetened and nonnutritive-sweetened beverages and use other alternatives, with an emphasis on water intake. The sodium consumption recommendation was modified to eliminate the further restriction that was potentially indicated for those with both diabetes and hypertension. Additional discussion was added to the physical activity section to include the benefit of a variety of leisure-time physical activities and flexibility and balance exercises. The discussion about e-cigarettes was expanded to include more on public perception and how their use to aide smoking cessation was not more effective than “usual care.” SECTION 6. GLYCEMIC TARGETS This section now begins with a discussion of A1C tests to highlight the centrality of A1C testing in glycemic management. To emphasize that the risks and benefits of glycemic targets can change as diabetes progresses and patients age, a recommendation was added to reevaluate glycemic targets over time. The section was modified to align with the living Standards updates made in April 2018 regarding the consensus definition of hypoglycemia. SECTION 7. DIABETES TECHNOLOGY This new section includes new recommendations, the self-monitoring of blood glucose section formerly included in Section 6 “Glycemic Targets,” and a discussion of insulin delivery devices, blood glucose meters, continuous glucose monitors (real-time and intermittently scanned, and automated insulin delivery devices. The recommendation to use self-monitoring of blood glucose in people who are not using insulin was changed to acknowledge that routine glucose monitoring is of limited additional clinical benefit in this population. SECTION 8. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES A recommendation was modified to acknowledge the benefits of tracking weight, activity, etc., in the context of achieving and maintaining a healthy weight. A brief section was added on medical devices for weight loss, which are not currently recommended due to limited data in people with diabetes. The recommendations for metabolic surgery were modified to align with recent guidelines, citing the importance of considering comorbidities beyond diabetes when contemplating the appropriateness of metabolic surgery for a given patient. SECTION 9. PHARMACOLOGIC APPROACHES TO GLYCEMIC TREATMENT The section on the pharmacologic treatment of type 2 diabetes was significantly changed to align, as per the living Standards update in October 2018, with the ADA-EASD consensus report on this topic. This includes consideration of key patient factors: (a) important comorbidities such as ASCVD, CKD, and HF, (b) hypoglycemia risk, (c) effects on body weight, (d) side effects, (e) costs, and (f) patient preferences. To align with the ADA-EASD consensus report, the approach to injectable medication therapy was revised. A recommendation that, for most patients who need the greater efficacy of an injectable medication, a GLP-1 agonist should be the first choice, ahead of insulin. A new section was added on insulin injection technique, emphasizing the importance of technique for appropriate insulin dosing and the avoidance of complications (lipodystrophy, etc.). The section on non-insulin pharmacologic treatments for DM1 was abbreviated, as these are not generally recommended. SECTION 10. CARDIOVASCULAR DISEASE AND RISK MANAGEMENT For the first time, this section is endorsed by the American College of Cardiology. Additional text was added to acknowledge heart failure as an important type of cardiovascular disease in people with diabetes for consideration when determining optimal diabetes care. The blood pressure recommendations were modified to emphasize the importance of individualization of targets based on cardiovascular risk. A discussion of the appropriate use of the ASCVD risk calculator was included, and recommendations were modified to include assessment of 10-year ASCVD risk as part of overall risk assessment and in determining optimal treatment approaches. The recommendation and text regarding the use of aspirin in primary prevention was updated with new data. For alignment with the ADA-EASD consensus report, two recommendations were added for the use of medications that have proven cardiovascular benefit in people with ASCVD, with and without heart failure. SECTION 11. MICROVASCULAR COMPLICATIONS AND FOOT CARE To align with the ADA-EASD consensus report, a recommendation was added for people with type 2 diabetes and chronic kidney disease to consider agents with proven benefit with regard to renal outcomes. The recommendation on the use of telemedicine in retinal screening was modified to acknowledge the utility of this approach, so long as appropriate referrals are made for a comprehensive eye examination. Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. The gastroparesis section includes a discussion of a few additional treatment modalities. The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone. SECTION 12. OLDER ADULTS A new section and recommendation on lifestyle management was added to address the unique nutritional and physical activity needs and considerations for older adults. Within the pharmacologic therapy discussion, de-intensification of insulin regimes was introduced to help simplify insulin regimen to match individual’s self-management abilities. SECTION 13. CHILDREN AND ADOLESCENTS Introductory language was added to the beginning of this section reminding the reader that the epidemiology, pathophysiology, developmental considerations, and response to therapy in pediatric-onset diabetes are different from adult diabetes, and that there are also differences in recommended care for children and adolescents with type 1 as opposed to type 2 diabetes. A recommendation was added to emphasize the need for disordered eating screening in youth with type 1 diabetes beginning at 10–12 years of age. Based on new evidence, a recommendation was added discouraging e-cigarette use in youth. The discussion of type 2 diabetes in children and adolescents was significantly expanded, with new recommendations in a number of areas, including screening and diagnosis, lifestyle management, pharmacologic management, and transition of care to adult providers. New sections and/or recommendations for type 2 diabetes in children and adolescents were added for glycemic targets, metabolic surgery, nephropathy, neuropathy, retinopathy, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovary syndrome, cardiovascular disease, dyslipidemia, cardiac function testing, and psychosocial factors. SECTION 14. MANAGEMENT OF DIABETES IN PREGNANCY Women with preexisting diabetes are now recommended to have their care managed in a multidisciplinary clinic to improve diabetes and pregnancy outcomes. Greater emphasis has been placed on the use of insulin as the preferred medication for treating hyperglycemia in gestational diabetes mellitus as it does not cross the placenta to a measurable extent and how metformin and glyburide should not be used as first-line agents as both cross the placenta to the fetus. SECTION 15. DIABETES CARE IN THE HOSPITAL Because of their ability to improve hospital readmission rates and cost of care, a new recommendation was added calling for providers to consider consulting with a specialized diabetes or glucose management team where possible when caring for hospitalized patients with diabetes. SECTION 16. DIABETES ADVOCACY The “Insulin Access and Affordability Working Group: Conclusions and Recommendations” ADA statement was added to this section. Published in 2018, this statement compiled public information and convened a series of meetings with stakeholders throughout the insulin supply chain to learn how each entity affects the cost of insulin for the consumer, an important topic for the ADA and people living with diabetes.
Dr. Peerzada Ovais Ahmad6 Likes7 Answers - Login to View the image
Friends today I am discussing about a common problem obesity which can lead to so many problems. Obesity is a condition in which a person has excess body fat. More than just a number on a scale or the size of someone's body, obesity can increase a person's risk of diseases and health problems, including high blood pressure, diabetes and heart disease. It is a complex problem and a major public health concern, both in the United States and worldwide. Around the world, rates of obesity are on the rise: Since 1975, the worldwide obesity rate has nearly tripled, and there are now more than 650 million obese adults, according to estimates from the World Health Organization. Obesity is usually defined using a ratio of height to weight called body mass index (BMI), which often correlates with a person's level of body fat. According to the CDC, an adult with a BMI of 30 or higher is considered obese. However, some doctors and researchers suggest that using BMI alone may not be the best screening tool for obesity and a better approach may be to take into account a person's physical, mental and functional health. (Functional health refers to a person's ability to move around and go about their daily activities.) Causes At a fundamental level, obesity occurs when people regularly eat and drink more calories than they use. Besides a person's eating behavior, a number of factors can contribute to obesity, including a lack of physical activity, a lack of sleep, genetics and the use of certain medications that can cause weight gain or water retention, such as corticosteroids, antidepressants or some seizure medications. Modern culture and conveniences also, in part, contribute to obesity. Environmental factors that promote obesity include: Oversized food portions, busy work schedules with little time for an active lifestyle, limited access to healthy foods at supermarkets, easy access to fast food and lack of safe places for physical activity. Obesity may also be linked to the company a person keeps: It has been found to "spread" socially among friends. A 2011 study published in the American Journal of Public Health suggested that the reason for this social spread was because friends share similar environments and carry out activities together that may contribute to weight gain. Certain health conditions also can lead to weight gain, including: Hypothyroidism, an underactive thyroid gland that slows metabolism and causes fatigue and weakness. PCOS, or polycystic ovary syndrome, which affects up to 10 percent of women of childbearing age and can also lead to excess body hair and reproductive problems. Cushing's syndrome, which stems from an overproduction of the hormone cortisol by the adrenal glands and is characterized by weight gain in the upper body, face and neck. Prader-Willi syndrome, a rare genetic condition in which people never feel full, and so they want to eat constantly. Complications Obesity increases the risk of developing a number of potentially serious health problems, including: Coronary heart disease High blood pressure Stroke Type 2 diabetes Some cancers (breast, colon, endometrial, gallbladder, kidney, and liver) Sleep apnea High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides Gallstones Osteoarthritis Infertility or irregular periods Besides its physical consequences, obesity may also take an emotional toll: Some people with obesity experience depression, feelings of social isolation, discrimination and an overall lower quality of life, according to the Mayo Clinic. Is obesity a disease? Whether or not obesity should be considered a "disease" (or an abnormal state) is a matter of debate. In 2013, the American Medical Association, the nation's largest group of physicians, voted to recognize obesity as a disease. The decision was meant to improve access to weight loss treatment, reduce the stigma of obesity and underscore the fact that obesity is not always a matter of self-control and willpower. But others argue that calling obesity a disease automatically categorizes a large portion of Americans as "sick," when they may not be. Instead, critics say obesity should be considered a risk factor for many diseases, but not a disease in and of itself. Treatment To achieve a healthy weight and adopt healthier eating habits, people may need to see several health professionals, including a dietitian, behavioral therapist, exercise physiologist and obesity expert, Working with a diverse team of health experts can help people make long-term changes in their eating and exercise habits and develop strategies to address any emotional and behavioral issues that may lead to weight gain and unhealthy lifestyle habits. Although there are lots of fad diets, such short-term dietary changes are not the best way to keep weight off permanently, Instead, people should aim to make long-term changes, such as eating healthy on a regular basis, and boosting daily physical activity. Behavior changes, such as understanding what stresses or situations may contribute to overeating and learning to modify these behaviors, are also important for achieving weight-loss goals. Even small amounts of weight loss — such as 5 to 10 percent of your total body weight — can have health benefits,These benefits include improvements in blood pressure, cholesterol levels and blood sugars. Keep a daily food diary, which can make people more aware of what foods they eat, when they eat them and how much they consume, as well as identify potentially unhealthy eating habits, such as eating when stressed or not hungry. Make small changes to your eating habits, such as eating more slowly, putting your fork down between bites and drinking more water, which can all help to reduce the number of calories people consume. Identify ways to incorporate healthy habits into your daily routine, such as taking a walk at lunchtime. Set specific but realistic goals for weight-loss and exercise, such as having a salad with dinner and walking for 15 minutes in the evening. Once you've lost weight, regular physical activity (60 to 90 minutes of moderate-intensity physical activity per day, on most days of the week) can help keep weight off. Homeopathic medicines for Obesity are Calcarea carbonica for weight reduction: This characteristic homeopathic medicine best the rundown of homeopathic weight reduction medicines. To be qualified to utilize this medicine to get in shape, the constitutional symptoms appeared by the patient are given most extreme significance. Natrum Mur: Natrum Mur, the Homeopathic medicine is likewise a proper remedy which is utilized to shed pounds. This medicine happens to be suggested when there happens to be an overabundance of fat for the most part in the thighs and buttocks when contrasted with different parts of the body. This medicine gives awesome results if the individual has put on overabundance weight because of since a long time ago proceeded with anxiety or sadness. The constitutional symptoms are constantly considered in the event of this medicine also. Lycopodium: It is a standout amongst the most helpful homeopathic solutions for fat misfortune. This is additionally utilized for the most part when the thighs and butt cheek regions have overabundance fat, much the same as the aforementioned medicine Natrum Mur. Yet, again the constitutional symptoms that are one of a kind to utilizing Lycopodium separate between these two. The patients who require Lycopodium are chronic sufferers of gastric inconveniences like tooting and blockage. They tend to long for sweet nourishments. Nux Vomica: Nux Vomica is suggested for people who have put on overabundance weight because of stationary propensities. The primary essential side effect in people requiring this medicine is that they are chronic sufferers of the most stubborn blockage. Such a man has a persistent desire to pass stool, yet just a little stool is shot out at once. Antimonium Crudum: This is for the most part a homeopathic medicine recommended for fat children keeping in mind the end goal to help them get more fit. A reasonable contender for this medicine is a child who has great crabbiness, exceptionally cross nature, and an abhorrence for be touched or be taken a gander at. These children likewise have a stamped abhorrence for icy showering. The significant indicator for utilizing this medicine to shed pounds is a longing for acidic things such as the pickles in the child.
Dr. Rajesh Gupta6 Likes7 Answers
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