IPHREHAB : LIFESTYLE QUESTIONNAIRE ANALYSIS FOR STRESS CONTROL AND WEIGHT MANAGEMENT

IPHREHAB

IPHREHAB : LIFESTYLE QUESTIONNAIRE ANALYSIS FOR STRESS CONTROL AND WEIGHT MANAGEMENT


Lifestyle Questionnaire Analysis
Please select which of the following relate to you and workout accordingly, consult to your physician and consult the experts. you can mail and comment also.

A. Stress control Profile

• 1. Have you experience lower energy levels, now compared to past.
• 2. Do you feel anxious and tensed , unhealthy mind is not good for health.
• 3. Are you clear about your goals , sole search is important as what you want.
• 4. Do you become angry easily , as Anger is one word short of Danger.
• 5. Do lots of things simultaneously , it will lead you nothing in end.
• 6. Have problems in sleeping, as it will leads to abnormal weight gain or loss. 

B. Weight Management

• 1. Water Retention , main problem in weight gain
• 2. Binge eating/drinking , habitual training needed with environmental change.
• 3. Cravings for certain foods , control and management in diet plan.
• 4. Lack of appetite , ultimately leads to under-nutrition.
• 5. Compulsive eating , main reason for weight gain and obesity.
• 6. Unexplained weight loss or weight gain, thyroid , genetics can be reason.

Stress control and weight management are both interdependent on each other as one control other, for further discussion you can comment or mail to ask specific questions. 

IPHREHAB : OBESITY & TREATMENT

IPHREHAB

OBESITY & TREATMENT

TREATMENT
Behavior Modification is most important in programs of weight reduction. 
Typically, the patient is requested to monitor and record the circumstances related to eating, and rewards are designed to modify maladaptive behaviors. 
Patients may benefit from counseling offered in a stable group setting.

DIET THERAPY
Diet  forms most important treatment in Obesity
Reduced caloric intake is cornerstone. 
Sustained reduction of energy intake rather very is difficult. 
Eating 100 kcal/d less for a year should cause a 5-kg weight loss, and a deficit of 1000 kcal/d should cause a loss 1 kg per week.

Very low energy diets (e.g., 400 to 600 kcal/d) are widely used. The liquid protein diets popularized in the 1970s were proved to be unsafe

No obesity is seen during femine

No obese is centenarian 

EXERCISE

Exercise is another important component

Exercise leads  to Increased energy expenditure 

It should be gradual and under medical supervision 

Exercise appears to be a valuable means to sustain diet therapy 

Valuable in the obese individual for its effects on cardiovascular tone and blood pressure. 

DRUG THERAPY

Drug treatment of obesity is not very  efficacious. 

Phentermine  & phenylpropanolamine :-an amphetamine-like drug with low addictive potential has shown modest efficacy.

Fenfluramine, have modest efficacy.. But there is the risk of pulmonary hypertension.

SIBUTRAMINE

Sibutramine is a novel latest Drug.

It is of inhibitor norepinephrine, serotonin and Intestinal lipase.

Using a once-daily dose over 24 weeks, it produced a 7% weight loss. 

It lowered cholesterol and triglyceride.

Sibutramine increases pulse and blood pressure in some patients.

CONCLUSIONS

Obesity is becoming an epidemic.

USA is the most obese country-25%

Japan & France are slim countries.

There is rise in childhood obesity.

Diet & Exercise are the best methods to reduce weight.

Drugs have limited role.

IPHREHAB : OBESITY & RISKS

IPHREHAB

OBESITY 


 RISKS
Obesity has major adverse effects on health. 
Very obese individuals have as much as a twelvefold increase in mortality. 
Morality rates rise as obesity increases, particularly when obesity is associated with increased intraabdominal fat.
It is also apparent that the degree to which obesity affects particular organ systems is influenced by susceptibility genes.

Insulin Resistance and Type 2 DM is more strongly linked to intraabdominal fat than to fat in other depots. 

Obesity, however, is a major risk factor for diabetes, and as many as 80% of patients with type 2 diabetes mellitus are obese.

Weight loss, even of modest degree, leads to increased insulin sensitivity.

Reproductive Disorders. Male hypogonadism is associated with increased adipose tissue, plasma testosterone and sex hormone-binding globulin (SHBG) are often reduced, 

Gynecomastia may be seen. However, masculinization, libido, potency, and spermatogenesis are preserved in most of these individuals. 

Obesity has long been associated with menstrual abnormalities in women, 

Interestingly, most nonobese women with PCOS are also insulin-resistant, suggesting that insulin resistance, hyperinsulinemia, or the combination of the two are causative or contribute to the ovarian patho-physiology.

CARDIOVASCULAR RISKS

Framing ham Study revealed that obesity is an independent risk factor for CVS  disease in men and women.

The waist/hip ratio may be the best predictor of these risks.

Obesity is also associated with high BP.

Measurement of blood pressure should be larger cuff size to avoid artifactual increases. 

PULMONARY DISEASE

Severe obesity is  associated with obstructive “Sleep Apnea Syndrome”

In Obesity there is sixfold increased in gallstones. 

In Obese  males there is higher mortality from cancer of the colon, rectum, and prostate 

RISKS

In obese females there  higher risk of cancer of the gallbladder, bile ducts, breasts, endometrium, cervix, and ovaries. 

In obese  prevalence of osteoarthritis, is very high due to the trauma of added weight bearing. The prevalence of gout is also increased.

IPHREHAB : OBESITY ETIOLOGY

IPHREHAB

OBESITY 


AETIOLOGY
Obesity is a heterogeneous group of disorders.
Causes of obesity remain elusive 
At one level, the pathophysiology of obesity seems simple: a chronic excess of nutrient intake relative to the level of energy expenditure. 
Complexity of the neuroendocrine and metabolic systems  has been difficult to quantitate

GENES

Obesity is commonly seen in families.

Inheritance is usually not Mendelian,

Adoptees usually resemble their biologic rather than adoptive parents with respect to obesity

Likewise, identical twins have very similar BMIs whether reared together or apart, and their BMIs are much more strongly correlated

ENVIRONMENTS

It plays a key role in obesity, 

Famine prevents obesity in even the most obesity-prone individual. 

Recent increase in the prevalence of obesity in the United States is due to environments

Cultural factors are also important. Easy availability and composition of the diet 

Decreased physical activity. 

In industrial societies, obesity is more common among poor women, whereas in underdeveloped countries, wealthier women are more often obese. 

In children, obesity correlates to some degree with time spent watching television.

High-fat diets may promote obesity, as may diets rich in simple carbohydrates. 

CAUSES OF OBESITY

Cushing's Syndrome  Although obese patients commonly have central obesity, hypertension, and glucose intolerance

Hypothyroidism should be considered when evaluating obesity, but it is an uncommon cause

Insulinoma  Patients with insulinoma often gain weight to avoid hypoglycemia

Craniopharyngioma and Other Disorders Involving the Hypothalamus  

Tumors, trauma, or inflammation, hypothalamic dysfunction of systems controlling satiety, hunger, and energy expenditure can cause varying degrees of obesity

Leptin in Typical Obesity

The vast majority of obese people have increased leptin levels but do not have mutations of either leptin or its receptor.

"leptin resistance." Data suggesting that some individuals produce less leptin per unit fat mass than others or have a form of relative leptin deficiency that predisposes to obesity

IPHREHAB : OBESITY..REGULTAION

IPHREHAB

OBESITY.

PHYSIOLOGY

Body weight is regulated

• Endocrinal Component
• Neural components 

Small imbalances between energy intake and expenditure will ultimately have large effects on body weight. 

For example, a 0.3% positive imbalance over 30 years would result in a 9-kg weight. gain

NORMAL REGULATION

There is autoregulation weight

Weight loss increases appetite and energy expenditure falls 

With overfeeding, appetite falls and energy expenditure increases. 

This latter compensatory mechanism frequently fails in OBESE PERSONS, permitting obesity to develop when food is abundant and physical activity is limited. 

REGULATION-LEPTIN

Leptin is hormone which is a major regulator of these adaptative responses

It is the adipocyte-derived hormone

 Leptin, acts through brain circuits (predominantly in the hypothalamus) to influence appetite, energy expenditure, and neuroendocrine function

APPETITE CENTRE

Appetite centre is in the the hypothalamus Signals affecting on the hypothalamic are neural, hormonal , and metabolic. 

Vagal inputs are particularly important, bringing information from gut distention. 

Hormonal signals include leptin, insulin, cortisol, and cholecystokinin, which signals to the brain through the vagus nerve. 

Metabolites as glucose also  influence appetite.  Hypoglycemia  induces  hunger

The hormonal, metabolic, and neural signals  can act by influencing the expression and release of various hypothalamic peptides [neuropeptide} 

Psychological and cultural factors also play a role in the final expression of appetite. Apart from rare syndromes involving leptin, its receptor, and the melanocortin system the defects in this complex appetite control network that account for common causes of obesity are not well understood.

IPHREHAB : OBESITY

IPHREHAB 

OBESITY

•It is often viewed as equivalent to increased body weight,
              This is somewhat arbitrary

•Obesity is a state of excess adipose tissue mass.

•Obesity is therefore more effectively defined by assessing its linkage to morbidity or mortality.

MEASURMENT

Body mass index (BMI), most widely used method to gauge Obesity

It is equal to weight / height2 (in kg/m2)

BMIs range from 19 to 26 kg/m2;

At a similar BMI, women have more body fat than men.

BMI of 30 is most commonly used as a threshold for obesity in both men and women. 

MEASURMENT

•Term overweight  is used to describe individuals with BMIs between 25 & 30.

•A BMI between 25 and 30 should be viewed as medically significant and worthy of therapeutic intervention .

•BMIs above 30 indicate Gross Obesity .

•He or she is definitely Overweight.

•Anthropometry (skin-fold thicknes)

•

•Densitometry (underwater weighing)
 

•CT or MRI, and electrical impedance

DISTRIBUTION

The distribution of adipose tissue has substantial implications for morbidity.

Intra-abdominal and abdominal subcutaneous fat have more significance. Pear Shaped Apple Shaped

Waist-to-hip ratio, with a ratio >0.9 in women and >1.0 in men being abnormal.

PREVALENCE

American adult population with obesity (BMI > 30) has increased from 14.5% to 22.5% 

50% of U.S. adults 20 years of age were overweight 

Obesity is more common among women and in the poor; 

The prevalence in children is  rising at a worrisome rate.

IPHREHAB: OBESITY & LIFESTYLE HAZARDS AND CONTROL

IPHREHAB

OBESITY

VERY COMMON NOW-A-DAYS

USA IS OBESE COUNTRY OF WORLD

CHILDHOOD OBESITY HAS BECOME NATIONAL PROBLEM

18 YEARS OLD GIRL WEIGHING 320 POUNDS DIED IN CLEVELAND

OBESITY REDUCES LIFE SPAN

NOT A SINGLE CENTURION IS OBESE

JAPAN  &  FRANCE ARE CALLED SLIM COUNTRIES

RESPONSIBLE FOR MANY DISEASES- Osteoarthritis, Hypertension, Heart Attack

FAST  FOODS  ARE   RESPONSIBLE  FOR THIS

FIBRE IN DIET REDUCES WEIGHT

ISAPHGOL (Grandmother’s Remedy) COMMONLY USED IN INDIA

WINE

WINE IF TAKEN PROPERLY GIVES PLEASANT INTOXICATION AND PRODUCES EXHILARATION, ENERGY, CONTENTMENT, COPULENCE, FREEDOM FROM DISORDERS, SEXUAL POTENCY AND STRENGTH

Charak Samhita 800 BC

ALCOHOL

In small amounts it is GOOD

In large amounts it is Dangerous

It increases HDL level

It reduces Cholesterol. & LDL

Two small  Pegs twice a week better with water than Soda.

STRESS

MAJOR CAUSE OF HIGH BLOOD PRESSURE

DIFFICULT TO DEFINE

IMPOSSIBLE TO MEASURE

ACUTE STRESS CAN BE FATAL

BUT IS ESSENTIAL FOR LIFE

 IT IS DRIVE FOR COMPETITION

PERFECTIONIST

HE  IS  NEVER  HEALTHY

HE HAS  PHYSICAL & MENTAL PROBLEMS

HE HAS EATING DISORDERS, DIFFICULT  RELATIONSHIPS & SUICIDAL  TENDENCIES

HE  IS  ANTISOCIAL

HE  SUFFERS FROM  HIGH BLOOD PRESSURE

WAYS TO RELAX

YOGA

   THEY ARE HINDU MEDITATIVE PRACTICES MAINLY CONTROL BREATHING & POSTURE

TRANSCENDENTAL MEDITATION (TM)

   USUALLY THINKING OF A WORD OR  SOUND

PROGRESSIVE MUSCLE RELAXATION (PMR)

   ACHIEVE CONSCIOUS CONTROL OVER MUSCLES GROUP AND INDUCE DECREASE IN TONE

 BIO FEED MECHANISM
    REDUCES BLOOD PRESSURE DRAMATICALLY IN HYPERTENSIVE .