A Simple Guide to Obesity

A Simple Guide to Obesity
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What is obesity?
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Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.

What causes obesity?
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Many factors contributes to obesity:

Genetic factors
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Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.

Environmental factors
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The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food.
It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.

2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body.
Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.

3.lack of exercise -
Exercise helps to burn up calories.
People who tend to have a sedentary life without exercise tends to be overweight

4.Certain medications:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.

Psychological factors
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Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger.
Others overeat as a way of dealing with stress or depression.

Rare illnesses:
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Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems can lead to overeating.
These conditions are believed to be responsible for only about one percent of all obesity cases.

What is the criteria for diagnosis of Obesity?
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The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.

BMI = Your Weight (kg)
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Height (metres) x Height (metres)

The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.
BMI (kg/m2) (for adults):
Risk of Heart Disease and Diabetes

27.5 and above
High Risk

23.0 - 27.4
Moderate Risk

18.5 - 22.9
Low Risk (healthy range)

Less than 18.5
Risk of nutritional deficiency diseases and osteoporosis

Knowing your BMI will motivate you to lower your weight.

What are the Complications from obesity?
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Health hazards
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Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:
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1.High blood pressure

2.High blood cholesterol

3.Diabetes

4.Coronary heart disease

5.Stroke

6.Gallbladder disease

7.Liver disease

8.Degenerative joint disease

9.Cancer (colon, uterine, breast and other cancers).

10.Gout,caused by high levels of uric acid in the blood from the high purine
proteins consumed.

11.Sleep apnoea

Emotional effects:
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1.Feelings of rejection, shame, or depression

2.Feeling undesirable compared with a slim person.

3.Some face prejudice or discrimination.

4.Some may be seen as lazy or lacking in self-control.

Treatment of Obesity will follow in A Simple Guide to Obesity Part 2

A Simple Guide to Stroke 2

A Simple Guide to Stroke 2
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What is the treatment of Stroke?
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Stroke is an emergency.

Purpose of treatment is to:

1. preserve life

2. limit the amount of brain damage

3. lessen the extent of disability and deformity

4. prevent recurrence of a stroke.

Admission to hospital is necessary to determine

1. the cause of the stroke

2. the extent of damage to the brain using MRI of the brain

3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).

4. whether Surgery is necessary to stop bleeding or remove a blood clot

5. risk factors for stroke are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of stroke:
1. A clear airway must be maintained

2. Sufficient fluid and electrolyte intake must be maintained

3. Adequate nutrition in the form of glucose, proteins and calories must be given

4. Adequate nursing care is provided to prevent bed sores etc

5. Proper medicines are given

Once the stroke is stable:
The stroke patient is started on a rehabilitation programme.

This will include
a.exercises to strenthen his muscles,

b.speech training for patients with dysphasia (difficulty in talking)

c.training on how to carry out his daily activities.

d.advice about his diet

Immediate care improves the chance of a complete recovery.

How to care for a Stroke Patients?
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A stroke can be very devastating and depressing for a patient.

He will feel that part of his body and brain function is incapacitated.

Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:

Please do:
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1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

8.encourage the person to look at, touch, and move his affected limbs.

Do not:
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1.ignore him or treat him like a child .

2.encourage the person to do things using the good side only.

3.pull on the affected arm or leg as it can be extremely painful.

4.interrupt or speak up for him.

5.make discouraging remarks.

6.allow the person to squeeze rubber balls as this may tighten his hand muscles.

7.let him be depressed

8.let him develop bed sores. Try to turn his body regularly.

In order to help the person be as independent as possible, there are
special aids(such as tripod walking cane) and
appliances(wheelchairs) which can be used to help him with his daily activities.

There are also special clothes and shoes which uses velcro instead of buttons or zips.

Make the home a safe place with non-slipmats and grab bars

How to Prevent Stroke?
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Prevention of a stroke is the same as the prevention of a heart attack as both involve the avoiding the blockage or bleeding of a major artery to the brain or heart.

1.Control the Blood Pressure
Have your blood pressure checked at least once a year from the age of 40 years.
If there is high blood pressure, lifelong treatment with monthly checkups will keep it under control.

2.Control the Diabetes
Check for diabetes starting from the age of 40 years.
If there are risk factors for diabetes, screening should start earlier.
If there is diabetes, take the medicine or injections regularly.
Monitor the sugar levels daily.
Control the diet.
Check with the doctor regularly.

2.Watch Your Diet
Reduce consumption of fat, high-cholesterol food, sugar and salt.
Take more fruit, vegetables and moderate servings of carbohydrates.
Eat more beancurd, dried peas, dried beans, fish and chicken instead of red meat.
Drink low-fat milk.
Avoid full cream milk.
Avoid alcohol.
Drink less coffee, tea and cola drinks.

3.Don't Smoke
Stop smoking immediately.
Don't start smoking if you are not a smoker.

4.Physical Activity
Regular exercise is good for you.
Do moderate intensity physical activity for 30 minutes such that you sweat and breathe deeply without getting breathless.
Examples include brisk walking, swimming, cycling.

6.Learn To Relax
Have adequate rest especially when you feel tense or tired.
Take up a hobby.
Do relaxation exercises such as yoga or deep breathing exercises.
Time management is important.

A Simple Guide to Diabetes Part 2

A Simple Guide to Diabetes Part 2
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What is the treatment of Diabetes?
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Control of Diabetes
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Diabetes is a chronic disease which cannot be cured.
It can be controlled to prevent the development of the above serious complications by :
Living a healthy lifestyle
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1.diet -

Reduce your intake of sugar and sweet food
Increase intake of more high fibre and wholegrain food like brown rice, wholemeal bread and oats
Take food with less fat content like lean meat, fish, skinless poultry and low fat milk
Have at least 2 servings of vegetables and 2 servings of fruits a day
Use healthier methods of cooking such as grilling and steaming rather than deep frying and use less salt and sauces
Take multiple (4-6) small meals a day that contains enough complex carbohydrates (e.g. rice), some lean meat or fish and vegetables.
Have regular meals and avoid skipping meals
Do not overeat

2.regular exercise-

This helps your body to use glucose more efficiently
Frequency: 3-5 days per week(daily if low intensity)
Intensity: 60-85% of maximum heart rate till the patient feels warm or sweats and breathes deeply but easily
Time: 20-60 mins each time
Type: aerobic exercises like walking, jogging, swimming, cycling

For those who have not been active for some time should start with walking first, then increase to more active exercises

3.weight control -

lose extra body weight by proper dieting and exercise
Aim for half kg loss per week
Aim for a BMI of 18.5-22.9kg/m2

Insulin works better in a lean healthy body.

4.Avoid smoking-

smoking increases all the risks associated with diabetes

5.Avoid stress -

by meditation, yoga, deep breathing exercises

Medication for Diabetes
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1.oral tablets:

a. Insulin secretagogues - drugs that increase insulin release from pancreas

eg. glibenclamide, repaglinide
Side effects: low blood sugar

b.Insulin sensitisers- drugs that make insulin work better especially in muscles and liver
eg.metformin
side effects: gastric discomfort, metallic taste in mouth
eg. rosiglitazone
side effect: water retention

c. Alpha-glucosidase blocker -slows digestion of carbohydrates in the intestine

eg. acarbose
side effect: stomach discomfort, bloating, diarrhea

If the oral medicines even in combination cannot bring down the blood sugar, the insulin injection may be required either alone or together with oral medication.

2.insulin injections

Insulin is destroyed in the stomach so it cannot be taken orally and has to be given as an injection.
Best place to inject the insulin is in the abdominal area where there is a lot of subcutaneous fat.
Avoid 2 fingers around the navel and below the rib cage where there is a rich nerve supply and therefore more painful.
Injection is usually done in the morning and evening.
Night injection controls the glucose when the patient sleep and avoid early morning high glucose.

a.Rapid and short acting insulin

eg. regular soluble insulin
onset 30-60min, peak 2-4 hrs, duration 6-8 hrs

b.intermediate and long acting insulin

eg. NPH insulin
onset 1-4 hrs, peak 8-12 hrs, duration 12-20hr

c.premixed or biphasic insulin

eg. NPH/regular 70/30
more convenient and less injections

Important hygience tips:

Use needles once only
Mix well by shaking bottle or injection pen 20 times
Store all unused insulin in fridge(will keep until expiry date).
Do not freeze insulin.
Insulin in use can be kept at room temprature away from sunlight and direct heat and must be discarded 4-6 weeks after use

Follow the instructions very carefully and keep detailed records of your treatment.

Home blood glucose monitoring
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1. monitor your progress with the help of your daily home blood glucose records.
Monitor;
a. before and after meals
b. before and after exercise
c. when feeling giddy to confirm low blood glucose
d. when sick and not eating well

Type 1 diabetes should be monitored 3-4 times a day

Type 2 non-insulin diabetes 1-2 times a day followed by 1 every 2-3 days

Type 2 insulin diabetes 2-3 times a day followed by 2-3 days a week.

Pregnant diabetic patient should also monitor their blood glucose daily

Aim for a Fasting Blood glucose 4.0 -7.0mmol/l
Blood HbA1c 4.5 -7.0

This will check if your diabetes is under control.

If not, you need more medicines or further change in diet.

High blood pressure and high blood cholesterol level
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Reducing high blood pressure and high cholesterol level help to keep diabetes under control and protect against its complications.

Aim for a blood pressure of 130/80 or less
LDL cholesterol of 2.6mmol/l

Regular checkups is important in the treatment of Diabetes
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1. Regular monthly checkups for diabetes until fully controlled, bimonthly after that.

2. Check for hypertension and heart disease at the same time

3. Check for high blood cholesterol once a year.

4. Check eyes once a year.

5. Check for kidney problems at least once a year.

6. Check teeth once a year

7. Check you feet for signs of infection, gangrene and neuropathy.

Foot care:
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1. wash feet daily with soap and water
2. After washing ,dry thoroughly especially betwwen the toes
3. keep yor toe nails short,trimming them straight across to avoid ingrowing toenails
4. moisturise feet daily to prevent dryness and cracking of skin
5. examine feet daily for scratches, cuts, blisters and corn
6. use a mirror to check the sole of your feet
7. wear shoes that fit well and wear clean cotton socks which has loose fitting elastic tops
8.Avoid going barefoot
9.Seek prompt treatment for cuts and sores
10.annual review for foot ulcers,risk of neuropathy(poor sensation), blood circiulation( palpable pulses)

Health education
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It is important to increase your knowledge of diabetes and its complications.

With knowledge, diabetes can be more easily controlled.

A well controlled diabetic patient can live a normal life.

A Simple Guide to Hypertension

A Simple Guide to Hypertension

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What is Hypertension?

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Hypertension, or high blood pressure, refers to a condition in which the blood is pumped around the body above normal pressure.

It is a silent disorder and the only way to detect it is to have your blood pressure checked.

When is it High Blood Pressure?

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Blood pressure is not fixed. It varies with time of day or night, physical activity and emotional factors. Therefore, blood pressure has to be taken under resting condition and on more than one occasion.

A blood pressure reading of 120/80 is read as 120 over 80 millimetres of mercury.

The top number is your systolic pressure. This is the pressure in your arteries when your heart pumps.

The bottom number is your diastolic blood pressure. This is the pressure measured in your arteries when your heart relaxes between pumps.

Blood pressure may vary from 90/60 in a young healthy person to 130/80.

Normal blood pressure is below 130/80.

Blood pressure between 130/80 and 139/89 is called "pre-hypertension".

Blood pressure of 140/90 or above is considered high.
Hypertension is present when your blood pressure is persistently at or above 140/90( at least 3 consecutive readings).

What are the Causes of Hypertension?

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In 95% of cases, there is no definite known cause and it is known as essential hypertension. Older people and men are more likely to develop high blood pressure.

It also tends to run in families. Although, you may inherit the tendency to get high blood pressure, other lifestyle choices (eating an unhealthy diet, smoking, not exercising) will often determine if you eventually get the disease.

The other 5% of high blood pressure cases are due to kidney disease, glandular (hormone/endocrine) problems or a side effect of some medications and are called secondary hypertension.

Listed below are some causes of secondary hypertension:

Adrenal gland tumours

Cushing's syndrome

Kidney disorders

Kidney failure

Use of medications, drugs, or other chemicals

Pregnancy or the use of oral contraceptives

Diabetes mellitus

Obesity

What are the Symptoms of Hypertension?

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Hypertension often causes no noticeable symptom but can cause damage of various organs in the body if the blood pressure remains persistently high. It is thus often called the silent killer. Over years it can lead to damage to the heart and blood vessels, making it more likely that the individual will develop a stroke or heart attack.

Occasionally, especially when the blood pressure is extremely high, the individual may experience:

Headaches,

Dizziness,

Alterations in vision.

Confusion

Nausea

Vomiting

Anxiety

Excessive perspiration

Redness of the face or other areas

Muscle tremors

Angina-like pain: crushing central chest pain

How is Hypertension Assessed?

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Assessment of hypertension is important in determining the known causes of Hypertension (5%) and in the treatment of the condition:

1. Medical history

2. Physical examination

3. Evidence of complications

4. Blood and urine tests

5. Chest x-ray

6. ECG (electrocardiogram)

What are the Complications of Hypertension?

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Hypertension is an important risk factor for coronary heart disease and cerebrovascular disease e.g. strokes.

Poorly controlled hypertension ultimately can cause damage to blood vessels in the eye, thickening of the heart muscle and heart attacks, hardening of the arteries (arteriosclerosis), kidney failure, and strokes.

An elevation of the systolic and/or diastolic blood pressure increases the risk of developing

1. Heart (cardiac) disease,

2. Kidney (renal) disease,

3. Hardening of the arteries (atherosclerosis),

4. Eye damage, and

5. stroke (brain damage).

These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure.

For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.

It was previously thought that rises in diastolic blood pressure were a more important risk factor than systolic elevations, but it is now known that in people 50 years or older systolic hypertension represents a greater risk.

Prevention, early detection and adequate treatment of hypertension are necessary to prevent complications of hypertension.

What is the Treatment of Hypertension?

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The aim of treatment is to reduce the risk of complications.

This is done in 2 ways:

Control of high blood pressure

Management of the risk factors eg obesity, diabetes, raised blood cholesterol

Every hypertensive patient or person at risk of developing high blood pressure should adopt a healthy lifestyle.

This means eating wisely:

A diet with reduced salt,

Low fat and high fibre.

Keep your weight in the healthy range,

Exercise regularly,

Not smoke or drink and

Manage your stress better.

Occasionally, marginally raised blood pressure goes back to within the normal range when the patient loses weight, exercises more and cuts down salt intake.

If these measures are not successful, then drug treatment is necessary.

Once medication is started, it important to continue treatment as well as continue with healthy lifestyle practices.
The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Your doctor will try to prescribe a single drug with minimal side effects to control your hypertension. But if a single drug does not work, he will prescribe two or more drugs.

Some of the common drugs used are:
1. Diuretics, which increase urination, to reduce salt and water retention and lower blood volume. They may be used alone or in combination with other drugs.

2. Beta-blockers, which slow the heart rate and cause the heart to beat less forcefully. 3.Calcium channel blockers which relax the blood vessels by slowing the entry of calcium into cells.

4. Angiotensin-converting enzyme (ACE) inhibitors which block the production of angiotensin II (which causes arteries to constrict and stimulate the release of a hormone which causes salt retention).

5. Angiotensin II receptor blockers (ARB) which relax blood vessels by blocking the action of angiotensin II.

Which drug is suitable for you depends on the effectiveness of the drug on your blood pressure and also on the side effects. If the the side effects are severe, it is advisable to change the medications until you have a suitable drug.

Treatment for most people is life-long.

Do not stop or reduce the dosage of your medications without consulting your doctor.

For effective blood pressure control, you should visit your doctor regularly to monitor your blood pressure. You can also monitor your own blood pressure at home with an electronic blood pressure monitor.

How do you prevent the risk of Hypertension?

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You can adopt these lifestyle measures to reduce your risk of high blood pressure.

Lifestyle changes are also important for those who already have high blood pressure.

1.Lose weight, if overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.

2.Adopt a healthy diet. Dietary adjustments may be beneficial, especially a decrease of sodium in your diet. Sodium intake may have little effect in persons without hypertension but may have a profound effect in those with hypertension. Salt, MSG, and baking soda all contain sodium. Make sure you eat a diet rich in vegetables and fruit and low in fat.

3.Stay active. Do at least 30 minutes of moderate intensity exercises five or more days a week. You can break up the 30 minutes of exercise a day into 10 minute bouts. As your fitness level improves, do vigorous intensity exercise for 20 minutes a day at least 3 times a week for example, jogging or swimming continuous laps. Remember to consult your doctor before you embark on any exercise plan.

4.Stop smoking. If you are a smoker, stop smoking. Smoking greatly adds to the risk of suffering a heart attack or stroke.

5.Limit alcohol intake. Keep your alcohol intake to less than 1 or 2 standard drinks a day.

6.Learn to relax and avoid stress. Meditation, yoga, tai-chi are some ways in which you can learn to relax and lead a less stressful life.

REMEMBER that long term effective control of high blood pressure is crucial in reducing the risks of serious complications of HYPERTENSION !