Plzz guide. What is the problem nd what should b further treatment ?

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.

Friends today I am discusing about Fatty Liver problem . A number of health problems today are caused by an unhealthy lifestyle. One such condition is a fatty liver or collection of fat in the liver. The buildup of fats in the liver is known as Fatty Liver. The liver processes everything that you eat or drink and filters harmful substances from the blood. If too much fat has accumulated in the liver, this process gets interfered with. These fat cells cause inflammation of the liver tissues which in time can lead to scarring and liver fibrosis. On its own, a fatty liver is relatively harmless, but when it reaches this stage, it can be life threatening. The reasons for Fatty Liver can be alcoholism, incorrect diet, obesity, diabetes, or even excess use of medication. If ignored or left untreated, many liver diseases will lead to permanent and irreversible damage to the liver and can be a significant threat to your health. But, there is no standard form of treatment for a fatty liver. If diagnosed in its early stages, treating the underlying cause can stop the progression of the disease and even resolve it. Homeopathy addresses the underlying causes of a disease and hence is an ideal form of treatment for a fatty liver. It can reduce the symptoms of this disease, improve liver functioning and even reverse the condition if treatment is started early. The Homeopathic medicines, which are made of natural substances, are given to patients after studying the unique symptoms experienced by each individual. Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. Homoeopathy is very proficient in managing all the symptoms of Fatty liver disease and furthermore plays a vital role in preventing relapse of the condition. Some of the most common homeopathic medicines for fatty liver are Chelidonium: This is often used to treat a fatty liver accompanied by right upper abdominal pain. In such cases, the liver may be enlarged and the patient also usually suffers from constipation or experience nausea and vomiting. The patient will also probably suffer from excessive weakness and have a desire for hot food and drinks. Lycopodium: A fatty liver accompanied by acidity can be treated with this type of homeopathic medication. In such cases, the patient will also complain of bloating and belching with a burning sensation. These symptoms tend to worsen n the evening and the patient may have an intense craving for sweets and hot drinks. Phosphorus: This is used to treat cases of fatty acid which triggers regurgitation accompanied by sour belching. In some cases, the patient may also experience pain in the liver and excessive flatulence. Vomiting may also occur along with weakness while passing stool. Calcarea carb: Obese patients suffering from this condition can be treated with calcarea carb. These people often have a distended abdomen, are lactose intolerant and suffer from chronic constipation. They are also overly sensitive to cold air and sweat excessively from the head. Nux Vomica: homeopathic remedy for fatty liver with pain in abdomen after eating. Nux vomica is great for any abdominal problem including fatty liver caused by excessive consumption of alcohol. These patients often suffer from abdominal pain a few hours after eating with sour or bitter tasting belches. They may constantly feel the urge to pass stool but are unable to do so. Though homeopathic remedies have negligible side effects when taken in low dosages, they should never be self-prescribed. If you suffer from a fatty liver, consult a homeopathic doctor immediately who can diagnose it properly and treat you accordingly.

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.

Respected Doctors ,I want present a case in front of you All .47 years age executive in sugar industry. 60 kg weight ,5 feet 6 inches height ,Hindu .non vegetarian ,use to walk 3 km /day suffering from high BP & on amlodipine 5 mg ,suffering from hypocalcemia 25 hydroxy 6.nml on Cholecalciferol 60000 iu weekly for 8 week Prescribed by a professor of KGMU Lucknow ,is suffering from mild elevated serum bilirubin 1.6 & slightly up & down since one & half year .his USG normal. lipid profile normal, sugar normal ,Why serum bilirubin is elevated since 1&1/2 years .what is Dx & Rx .thanks to all .