Obesity

What is obesity?
What are the causes?
What are the symptoms?
What are the risks of obesity?
How is it diagnosed?
What is the treatment?

What is obesity?

Obesity is defined as a condition of excess bodyweight and fat. The size and number of fat cells increase in obese people. A person is said to be obese when the body weight is 20% or more above ideal body weight, which can be calculated by comparing his height and sex.

What are the causes?

Dietary and life style practices are directly related to obesity. The most important cause is the imbalance between the energy intake and output. Energy is obtained from the food one eats and is required to carry out the daily activities, and the body functions, which are going on even when one is sleeping. The extra energy which is not used by the body is stored as fat. Eating more than one need causes obesity because the excess energy supplied to the body gets converted into fat. On the expenditure side, if a person is physically less active then less energy is utilised and more is converted to fat.

Home, work and school are barriers to opportunities for active lifestyle. Children of obese parents are 10 times likely to be obese than those of non-obese parents. This is mostly environmental since the children and parents share the same dietary habits. Genes influence how the body burns calories or stores fat. In some rare cases, hormonal imbalance, such as overactivity of the adrenal glands or underactivity of the thyroid gland, can also cause obesity. Injury or inflammation of the hypothalamus can interfere with the appetite centre and thereby cause obesity.

What are the symptoms?

The signs of obesity include body fat and weight more than the ideal body weight.

What are the risks of obesity?

Obesity is a serious condition as it increases the risk of heart diseases, diabetes, joint pains, high blood pressure and some types of cancers such as colon, breast and uterine cancers. Obese people are also more prone to diseases and problems such as stroke, gall bladder disease, breathing problems (sleep apnoea syndrome), low back pain, swelling of the feet and ankles, imbalances and accidents. Obese people have a low self-esteem and they avoid company, which makes them insular and insecure.

How is it diagnosed?

Obesity is determined by measuring body weight and fat. There are different ways of calculating body fat. Body mass index (BMI) is one of the best methods used to measure body fat. BMI is calculated as the ratio of the weight in Kg and height in square metre. Guidelines define overweight as a BMI between 25 and 29.9 kg/square meter and obesity as a BMI greater than 30. The doctor may also suggest blood test for sugar, cholesterol, and triglycerides. In case insufficient thyroid functioning (hypothyroidism) is suspected, the doctor will ask for a thyroid stimulating hormone test.

What is the treatment?

The simplest and the most basic principle is to reduce food intake, especially the fat content, and increasing physical activity. Increasing physical activity alone is not an easy way to lose weight unless one combines it with a reduction of fat intake. Physical activity includes walking, jogging, swimming, cycling, aerobics or any other household activity such as cleaning, washing, climbing stairs etc. The sense of well-being and weight loss motivates an individual to make changes in his or her diet as well. The best way of keeping a good control on ones dietary intake is to keep a daily diary, and writing down whatever one eats as one eats. Avoid high oil content in the curries and do not use butter on chappatis, which may be tasty without the fat. The doctor or health care provider evaluates the daily diet and plans a diet providing calories enough to maintain the weight below the ideal body weight.

Increase your physical; activity and reduce the intake of food. Your initial goal of weight loss therapy should be to reduce the bodyweight by 10% from baseline. With success, further weight loss can be attempted. Weight loss should be 1-2 kg for 6 months. Reducing dietary fat alone without reducing calories is not sufficient for weight loss. Reducing dietary fat along with dietary carbohydrates can help reduce calories. Weight maintenance program should be priory after 6 months.

In order to maintain one’s weight, calories consumed should be equal to calories used. Energy balance is like a scale. When calories consumed are more than calories used, it results in weight gain. Let physical activity tip the scale in your favour. You can perform aerobic exercises 30 minutes a day thrice week. Avoid a sedentary lifestyle.

Certain medicines are also available for weight reduction. There are two main types of weight reducing drugs: one class decreases appetite while the other prevents dietary fat from being absorbed by the body. These drugs should be taken only with doctor's advice, as there are a lot of side effects related with their use. Surgery to cure obesity should be undertaken as the last resort for people who are very obese, have tried all the other options available and have medical problems. The main surgical option is to have your stomach banded or stapled so that it cannot accommodate more food. Why not eat less voluntarily?

Weight loss

What is intentional weight loss?
What do the terms overweight or obese signify?
How to determine what is desirable?
Who should lose weight?
How to lose weight?
Few tips to bring about weight loss
What are the types of weight-loss programmes?
Are weight loss drugs safe?

What is intentional weight loss?

Intentional weight loss is the process of consciously making and executing a plan to decrease total body weight. This usually entails the reduction of total body fat. Ideally, dieting should be done by eating a nutritionally balanced low-calorie diet and increasing physical activity.

What do the terms overweight or obese signify?

The terms ‘overweight’ or ‘obese’ are used to describe excess body weight. Overweight typically refers to weight 10% above the expected body weight for height and build. Obese refers to being 20% over the target. The greater the excess, the more significant the health risk.

How to determine what is desirable?

There are chart and tables that are used to determine what one’s target weight should be. They vary according to gender, height, age, and bone structure. A simpler and more useful piece of information is Body Mass Index (BMI). The BMI is calculated by dividing your weight (in kilograms) by the square of one’s height (in meters). To fall within the ‘healthy range’ on the BMI, the result should be within 20 and 25. Results, both, lesser and greater than these values are associated with significant health risks.

Who should lose weight?

Adults can benefit from weight loss if they are moderately to severely overweight. Adults who are overweight and have weight-related medical problems or a family history of such problems can benefit from weight loss. Some weight-related health problems include diabetes, heart disease, high blood pressure, high cholesterol levels, or high blood sugar levels. Even a small weight loss of 10 to 20 pounds can improve one’s health. One does not need to lose weight if one’s weight is within the healthy range on the weight-for-height chart.

How to lose weight?

Intentional weight loss is a deliberate attempt to lose weight. Although there are many programmes to help lose weight, the only proven long-term and safe method is to burn more calories than are ingested. This is achieved either by reducing the caloric intake (eat less food or healthier food) or by increasing the energy expenditure (exercise more). Often, behaviour modification techniques like eating smaller portions are also used to help control eating habits. Once the weight is lost, these habits can be modified slightly for weight maintenance.

One pound of fat contains approximately 3,500 calories, so to lose one pound a week, a person should consume approximately 3,500 fewer calories per week. This can be done by reducing the daily intake by 500 calories per day (500 x 7 days will provide a deficit of 3,500 calories per week). To lose 2 pounds per week, a deficit of 1,000 calories per day is required. If this seems impossible, physical activity also contributes significantly to weight loss. The deficit of 500 to 1,000 calories can come from a combination of increased physical activity and reduced intake on a daily basis. Therefore, one does not need to experience significant food deprivation. The lowest intake per day recommended for females is 1,200 calories, unless they are in a medically-supervised, very low-calorie regimen which may have a daily level of 500 to 800 calories per day. The lowest level recommended for males is 1,500 calories per day. A very low-calorie diet can also be used by males if they are in a medically-supervised programme.

A key to weight maintenance and weight loss is to increase daily activity - things like taking the stairs, rather than the elevator or walking rather than driving when possible make a real difference.

Few tips to bring about weight loss as well as ensuring good health:


Eat plenty of vegetables, fruits, and grain products like wheat.
Increase the consumption of complex carbohydrates like whole wheat, millet (jowar) and barley (bajra)

Restrict refined products such as flour (maida) and its products such as bread, noodles, macaronis and pastas in regular diet

Restrict fat and cholesterol rich foods. Only non-vegetarian foods (like eggs and dairy products) are good sources of cholesterol, however saturated fatty acids present in butter, ghee, vanaspati and coconut get metabolised to cholesterol in our body

Reduce the amount of sugars consumed

Consume raw fruits and vegetables in form of salads and raitas in every meal. These provide adequate vitamins, minerals and fibre. Fibre is essential as it aids in digestion, has an effective role in managing obesity and cardiovascular problems

Limit salt intake

Have small portions of food at a time

Do not skip meals

Have regular meal timings

Do not eat while cooking and watching television

Drink plenty of water (6-8 glasses) in a day

Exercise regularly. Do brisk walking at least for 20-40 minutes in a day
The best exercises that are sustainable and safe to loose weight are aerobic exercises. Aerobic exercises usually involve vigorous exercises sustained over a period of several minutes and their effect is to increase the efficiency of the lungs, heart and blood circulation, which are collectively known as the aerobic system. Short and sharp bursts of activity which rely on the body's reserves of oxygen do not produce a similar improvement. Exercises should increase strength and mobility and also aid relaxation. You can choose walking, swimming, bicycling as per your fitness level and increase gradually. You should plan on 20-minute sessions at least 3 times per week. Gradual changes in eating habits will help encourage a permanent lifestyle change. A slow weight loss of 1 or 2 pounds a week, until the desirable body weight is reached, is best.

What are the types of weight-loss programmes?

To lose weight one should also be aware of the different types of programmes available and the important parts of a good programme. The three types of weight-loss programmes include: do-it-yourself programmes, non-clinical programmes, and clinical programmes.


Do-it-yourself programmes
Any effort to lose weight by oneself or with a group of like-minded others through support groups, worksite or community-based programmes fits in the "do-it-yourself" category. Individuals using a do-it-yourself programme rely on their own judgment, group support, and products such as diet books for advice.


Non-clinical programmes
These programmes may or may not be commercially operated, such as through a privately-owned, weight-loss chain. They often use books and pamphlets that are prepared by health-care providers. These programmes use counsellors (who usually are not health-care providers and may or may not have training) to provide services. Some programmes require participants to use the programmes's food or supplements.


Clinical programmes
This type of programme may or may not be commercially owned. Services are provided in a health-care setting, such as a hospital, by licensed health professionals, such as physicians, nurses, dietitians, and psychologists. Clinical programmes may offer services such as nutrition education, medical care, behaviour change therapy, and physical activity. Clinical programmes may also use other weight-loss methods, such as very low-calorie diets, prescription weight-loss drugs, and surgery, to treat severely overweight patients.
Are weight loss drugs safe?

Prescribed weight-loss drugs should be used only if one is likely to have health problems caused by weight. One should not use drugs to improve one’s appearance. Prescribed weight-loss drugs, when combined with a healthy diet and regular physical activity, may help some obese adults lose weight. However, before these medications can be widely recommended, more research is needed to determine their long-term safety and effectiveness. Whatever the results, prescription weight-loss drugs should be used only as part of an overall programme that includes long-term changes in the eating and physical activity habits.

Low Blood Pressure

Written by: DoctorNDTV Team


What is low blood pressure?
What are the symptoms of low BP?
What are the causes of low blood pressure?
How is low BP diagnosed?
How can low blood pressure be treated?

What is low blood pressure?

Normal blood pressure is 120/80 mm hg where 120 is the systolic pressure and 80 is the diastolic pressure. Low blood pressure is an abnormal condition where a person's blood pressure is much lower than usual, which can cause symptoms such as dizziness or lightheadedness. When the blood pressure is too low, there is inadequate blood flow to the heart, brain, and other vital organs. A blood pressure level that is borderline low for one person may be normal for another. The most important factor is how the blood pressure changes from the normal condition. Most normal blood pressures fall in the range of 90/60 mm Hg to 130/80 mm Hg, but a significant change, even as little as 20 mm Hg, can cause problems for some people.

What are the symptoms of low BP?

Symptoms of low BP may include:


Tiredness

General weakness

Light-headedness and fainting

Blurred vision

Dizziness

Palpitations

Confusion

Nausea

Temporary loss of consciousness.
What are the causes of low blood pressure?

Low blood pressure may be caused by drugs such as the following

Medications used for surgery

Anti-anxiety agents

Treatment for high blood pressure

Diuretics

Heart medicines

Some antidepressants

Narcotic analgesics

Alcohol
Other causes of low blood pressure include the following:


Dehydration

Heart failure

Heart attack

Changes in heart rhythm (arrhythmias)

Fainting

Anaphylaxis (a life-threatening allergic response)

Shock (from severe infection, stroke, anaphylaxis, major trauma, or heart attack)

Advanced diabetes
Another common type of low blood pressure is orthostatic hypotension, which results from a sudden change in body position, usually from lying down to an upright position.

How is low BP diagnosed?

Blood pressure is measured using two numbers - the systolic first (the pressure in the arteries when the heart contracts and pushes the blood round the body) and then the diastolic (the pressure in the arteries when the heart relaxes and fills with blood between two heart beats).
Blood pressure is measured using an inflatable cuff. This is positioned around the upper arm. The cuff is inflated and the doctor or nurse listens to the artery just below the cuff as the air is then released. When they can hear the heart beat, they will record the systolic pressure. When the sound disappears, they will record the diastolic pressure. Sometimes an automatic blood pressure recording machine is used.
Blood pressure may be measured while lying down and then while standing. Blood pressure has to be checked regularly.

How can low blood pressure be treated?

Low blood pressure may or may not require treatment. The treatment of low blood pressure is directed toward the underlying cause. Checking whether you are drinking enough and are not dehydrated may be important. If an underlying disorder, such as a heart condition is suspected then it may be advisable to go to hospital for tests and treatment. If medications are suspected of causing hypotension the doctor will probably advise a change of drug or dosage. Bed rest and assistance with daily activities are needed until the condition improves

Knee pain

Written by: DoctorNDTV Team


What are the functions of the knee?
What injuries can cause knee pain?
What diseases and conditions can cause knee pain?


What are the functions of the knee?

The knee joint has three parts. The thigh bone (femur) meets the large shin bone (tibia) forming the main knee joint. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third joint, called the patellofemoral joint.

A joint capsule surrounds the knee joint with ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments). These ligaments provide stability and strength to the knee joint.

The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. The meniscus acts as a smooth surface for the joint to move on. Fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons, surround the knee joint. Below the kneecap, there is a large tendon (patellar tendon) that attaches to the front of the tibia bone. The large muscles of the thigh move the knee. The knee also rotates slightly under guidance of specific muscles of the thigh. The knee functions to allow movement of the leg and is critical to normal walking and is a weight-bearing joint.

What injuries can cause knee pain?

An injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors that make the knee one of the most commonly injured joints.


Ligament Injury

Trauma can cause injury to the ligaments on the inner portion of the knee, the outer portion of the knee or within the knee. Injuries to these areas are noticed as immediate pain, but are sometimes difficult to localise. A collateral ligament injury is often associated with local tenderness over the area of the ligament involved. A ligament injury to the knee is usually painful at rest and may be swollen and warm. The pain can worsen by bending the knee, putting weight on the knee or walking. The severity of the injury can vary from mild (minor stretching or tearing of the ligament fibres, such as a low grade sprain) to severe (complete tear of the ligament fibres). Patients can have more than one area injured in a single traumatic event.

Ligament injuries are initially treated with ice packs and immobilisation, with rest and elevation. It is generally initially recommended to avoid bearing weight on the injured joint and crutches may be required for walking. Some patients are placed in splints or braces to immobilise the joint to decrease pain and promote healing. Arthroscopic or open surgery may be necessary to repair severe injuries.


Meniscus tears

The meniscus can be torn with the shearing forces of rotation that are applied to the knee during sharp, rapid motions. This is especially common in sports requiring reaction body movements. There is a higher incidence with aging and degeneration of the underlying cartilage. More than one tear can be present in an individual meniscus. The patient with a meniscal tear may have a rapid onset of a popping sensation with a certain activity or movement of the knee. Occasionally, it is associated with swelling and warmth in the knee. It is often associated with locking or unstable sensation in the knee joint. The meniscal tear can be diagnosed in one of three ways: arthroscopy, arthrography, or an MRI.


Tendinitis

Tendinitis is an inflammation of the tendon, which is often produced by a strain event, such as jumping. Tendinitis is diagnosed based on the presence of pain and tenderness localised to the tendon. It is treated with a combination of ice packs, immobilisation with a knee brace as needed, rest, and anti-inflammatory medications. In severe cases, surgery may be required. Surgical repair of the ruptured tendon is often necessary.


Fractures

With severe knee trauma, such as motor vehicle accidents, bone breakage (fracture) of any of the three bones of the knee can occur. Bone fractures within the knee joint can be serious and can require surgical repair as well as immobilisation with casting or other supports.
What diseases and conditions can cause knee pain?

Knee pain can also be caused due to diseases or conditions that involve the knee joint, the soft tissues and the bones surrounding the knee, or the nerves that supply sensation to the knee area.


Arthritis is the inflammation within a joint. The causes of knee joint inflammation range from non-inflammatory types of arthritis such as osteoarthritis, which is a degeneration of the cartilage of the knee, to inflammatory types of arthritis (rheumatoid arthritis or gout). Treatment of the various type of arthritis is directed towards the specific type of arthritis.

Chondromalacia refers to the softening of the cartilage under the kneecap (patella). It is a common cause of deep knee pain and stiffness in younger women and can be associated with pain and stiffness after prolonged sitting and climbing stairs or hills. While treatment with anti-inflammatory medications, ice packs, and rest can help, long-term relief is best achieved by strengthening exercises for the muscles of the front of the thigh.

Bursitis of the knee commonly occurs on the inside of the knee and the front of the kneecap. Bursitis is generally treated with ice packs, immobilisation, and anti-inflammatory medications and may require local injections of corticosteroids as well as exercise therapy to develop the musculature of the front of the thigh.

Infections of the bone or joint can rarely be a serious cause of knee pain. They do have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee.

Tumours involving the joint are extremely rare. They can cause problems with local pain.

The collateral ligament on the inside of the knee joint can become calcified and is referred to as Pellegrini-Stieda syndrome. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilisation and rest.

Cuts and wounds

Minor cuts, scratches and abrasions do not usually require medical attention. Abrasions, such as gravel or sand rash, may have dirt embedded in the wound and are likely to become infected.

A penetrating wound or a cut may be caused by sharp objects such as a knife, scissors, blade or nail. Although the surface cut may be small, such objects can penetrate deeply and harm internal organs. These objects may also carry dirt and germs deep inside, increasing the risk of infection.

First aid for cuts and wounds:
Wash your hands thoroughly before treating the wound.

Gently brush away any foreign object on the surface, such as gravel or sand.

Clean the wound and surrounding area, wiping away from the wound, using sterile swabs, warm and sterile water, and a mild antiseptic.

Pat dry the skin around the wound but do not wipe away blood clots.

Apply a sterile, non-adherent dressing, if necessary.

If the wound is dirty or caused by a rusty object, a tetanus toxoid injection may be needed.


First aid for stab wounds
Stop any bleeding by applying direct pressure.

Cut away or remove the clothing around the wound.

Carefully clean the wound if it is not bleeding and apply a sterile dressing.

If a limb is affected, raise it, unless you suspect a fracture.

Seek medical aid.


First aid for wounds with embedded object:
Do not attempt to remove the object. Apply a ring pad or pad around the wound and apply a clean dressing.

Apply pressure around the object to stop bleeding, but do not apply pressure on the object.

If a limb is affected, raise it, unless you suspect a fracture.

Seek medical aid urgently.