2/9/2014

Obesity, Smoking, Hypertension Dr. SUSHUM SHARMA

MD (Med), MNAMS, FICP, FIACM, FIMSA, FISE MEDICAL ADVISOR & HOD -Internal Medicine (Gurgaon)

DIRECTOR-Preventive Health Program

Obesity

• Concept of Body Mass Index ( BMI)

• weight (kg) / [height (m)]2

• Normal BMI – 18.5 to 25 • Overweight- 25 to 30 • Obesity > 30

Example: Weight = 68 kg, Height = 165 cm (1.65 m) Calculation: 68 ÷ (1.65)2 = 24.98

John Yudkin (L) and Chittaranjan Yajnik (R) share the same body mass index, but Yajnik's body harbors significantly more fat.

Reprinted with permission from Elsevier (The Lancet, 2004, 363, 157−163)

• “Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management”

• Anoop Misra, Arnab Ghosh, AK Jhingan, Anupa Sidhu, Brij Mohan Makkar, Bharat Inder Singh, B. Sivakumar, C. M. Batra, C.R. Sridhar, Dhiraj Bhatia, G. S. Toteja, Jasjeet Wasir, Janaki Srinath, J.P.S. Sawney, Jagmeet Madan, Mahendra Narwaria, M.G. Karmarkar, Naval Kishore Vikram, Pradeep Chowbey, Puneet Mishra, Prashant Joshi, Prashant Mathur, Rekha Sharma, Ritesh Gupta, Raman Goel, Shaukat Sadikot, Shailaja Kale, Shashank Joshi, Sanjay Borude, Shashank Shah, S.V. Madhu, Vinita Sharma, Y.P. Munjal

• AK Gadpayle*, AK Kriplani*, Aarti Batavia*, Aashish Contractor, Aastha Arora, Ajay Ajmani*, Ajay Bijani*, Ajay Gainda*, Amit Kondal, Amrita Khare, Anil Gurtoo*, Anil Sharma, Anjali Garg, Anu Taneja Gupta, Anuj Maheshwari, Anuja Agarwala, Anura Kurpad*, Arun Prasad, Ashish Dey, Ashish Kohli, Ashish Sadana, Ashish Vashishtha, Ashok Gupta*, Ashok Jhingan, Ashok Kumar Das*, Ashutosh Mishra, Atul Luthra, Atul Sardana, Atul Wadhwa, B. Sivakumar, Brij Mohan Makkar, Balbir Singh*, Banshi Saboo*, Bela Shah*, Chhavi Kohli, CS Ramachandran*, CS Yajnik*, D K Hazra*, D Rajyasree*, Davinder Singh, Chadha, Deepak Gupta*, Deepali Khanna, Deepika Singh, Deepti Arora Gaba, Devki Nandan*, Dimple Kondal, Dr. Wadhawan, GR Sridhar, Gagan Deep Kaur, Gopi Ghosh*, Gurleer Kaur, HB Chandalia*, Harpreet Kaur, Harsh Vardhan*, IPS Kochar, Ishi Khosla, J.K. Sharma*, J.P.S. Sawhney, Jaya Benjamin, Jayashree Todkar, Jayashree Sood*, KK Aggarwal* , KN Srivastava, K Singh*, K.K. Trehan, Kiran Rai, Kris Vijay*, Kshipra Dhawan, Kumud Khanna*, Lokesh Khurana, MG Karmarkar, MS Mahar, M. Ramesh, Majid Ahmed*, M Janakiraman*, Manish Baijal, Manish Bansal, Manoj Kumar, Meeta Lall, Meeta Mathur, Mohit Jain, Mukta Vasishta, Nabanita Bagchi, Namrata Singh, Naresh Singhi, Neena Bhatia, Neeraj Garg, Neeru Gera*, Neha Singhal, Nikhil Tandon*, Niranjana Shah*, PC Mohanty, P Janaki Srinath, PK Dewan, P.K. Reddy, Pallavi Patankar, Pankaj Sinha*, Paramjit Kaur Sodhi, Parmeet Kaur, Parminder Singh*, Partla Biswas, Parveen Bhatia, Pavitra Ganguly, Peeyush Jain*, Piush Choudhry, Prabeer Ch. Mohanty, Prachi Kolhe, Prasanna Kumar Reddy, Priya Goel, Priyali Shah, Priyanka Nigam, RR Narayan*, R.K. Prasad, R.R. Kasliwal*, R.K. Lalwani, R.K. Marya, R.M. Pandey*, Rajeev Chawla*, Rajesh Bhojwani*, Rajesh Khullar, Rajesh Rajput, Rajiv Gupta, Rajeev Gupta*, Rajnish Kukreja*, Rajul Meswani*, Rakesh Parikh, Rama Vaidya*, Renuka Kishore, Richa Jaiswal, Rishabh Khanna, Rupali Datta, SK Kapoor*, SK Singh*, SK Wangnoo* , S Kapoor, SP Dembla, SV Arya, SY Kothari, Sandeep Agarwal, Sandeep Dave*, Sandeep Malhotra, Sanjay Chaurey, Sanjeev Bhambani*, Santosh Jain Passi, Sarita Khatri, Seema Gulati, SeemaPuri*, Sesikeran*, Shailaja Kale, Shakshi Chawla*, Sharath Gopalan*, Shashank R Joshi, Shashank Shah, Shashi Mathur, Shaukat M. Sadikot, Shelza Saluja, Shipra, Shiv Chopra, Shrihari Dhorepatil, SJ Passi, Somesh Mittal*, Sonal Lalwani, Soneera Arya, Subhash Aggarwal, Sudhir Kumar Kalhan, Sudhir Tripathi*, Sudhish Sehra*, Sujeet Jha*, Sukriti Jain, Sumeet Shah, Supreet Kaur, Surender Kumar*, Suresh K Abrol, Suresh K Chhabra, Surya Prakash Bhatt, Sushum Sharma*, Suviraj John, Swapna Chaturvedi*, Swati Bhardwaj, Swati Bhave*, SY Kothari*, Tarun Mittal, Tarun Jain, U. C. Biswal, Uliyar. V Mani*, Umesh Kapil*, Usha Srivastava, V Prakash*, Vandana Jain, Vandana Soni, Vandana Verma, Vanisha Nambiar, Vasanthi Ramesh, Veenu Seth, Vidya Kumari, Vijay Laxmi Singh*, Vijay Viswanathan*, Vikas Ahluwalia, Vikas Kapur, Vinay Sabharwal, Vinod Gujral*, Vinod Mittal, Vinod Singhal*, Vipin Mishra, Vishwas Gopal Naik*, Vivek Aggarwal, VK Goyal, Y.K. Gupta*, Y. Krishnamohan, Y.S. Kusuma, Yogesh Agarwala, Yogesh Gautam, Yogesh Kumar Sarin*

OVERWEIGHT & OBESITY IN INDIANS ( JAPI. 2009; 57: 163-170)

BMI= weight (kg) / [height (m)]2

BMI > 23 OVERWEIGHT

BMI > 25 OBESITY

Av. Ht. FEMALE (155 Cms) > 55 Kg > 60 Kg

Av. Ht. MALE ( 170 Cms) > 65 Kg > 70 Kg

What should a common person do….

• EAT LESS , WALK MORE

• AWARENESS ABOUT CALORIE VALUE OF DIFFERENT FOOD ITEMS

• TARGET DAILY INTAKE- 25 Kcal/ Kg. Ideal Body Weight • Female- 1350 kCal/day • Male- 1600 kCal/day

AWARENESS of CALORIES Value

8

80 1 Boiled Egg

250 1 piece Tandoori Chicken

150 1 bowl Sweet corn soup

100 1 cup Curd/Milk

100 1 Katori Vegetable

150 1 Katori Dal

200 1 Nan/ Roomali roti / Parantha

100 2 Phulka / Bread Slices

20 1 tsf Sugar Calories Quantity Name

High Calorie items

9

400 2 scoops Ice creams

350 2 Gulab jamun

400 1 katori Carrot Halwa

500 1 Sizzler

400 1 Masala Dosa

400 1 serving Papdi Chat/Aloo Tikki

600 100 gm Groundnuts/Kaju

500 1 serving Chole-/-Bhature(2)

600 Cal. 1 Burger

Low Calorie items

10

100 30 gm Uncooked Dal /Rice/Atta

50 100 gm Orange/Apple/Guava

100 100 gm Potato (Boiled, baked)

15 100 gm Water Melon/Kharbooza

10 100 gm Lauki /Turai /Kaddu

20 100 gm Tomato/Lettuce

50 100 gm Onion/Carrot

25 100 gm Cabbage/cauliflower

6 Cal. 100 gm Kheera / Kakdi /Radish

Source: MedMarket Diligence, LLC, Report #S835, "Products, Technologies and Markets Worldwide for the Clinical Management of Obesity, 2011-2019."

$ 275 Million

Country Profile INDIA

MALES - 57.2 %

Doll R et al. BMJ. 2004;328:1519–1527.

Smokers Die an Average of 10 Years Younger

4

26

59 81

94

100

80

60

40

20

0 40 50 60 70 80 90 100

Physicians Who Smoked Cigarettes

Physicians Who Did Not Smoke

Cigarettes

10 years

97 91

81

59

24

2

Years

% Survival From Age 35

Rs- 1,21,330 CRORE

Rs 29.6

Crore

HYPERTENSION

• As per latest JNC-8 guidelines ( Dec 2013)—Blood pressure Limits– • For people over 60 yrs--150/90 • For all others--- 140/90

• Obesity, smoking, Alcohol – predisposing factors

• Prevalence in Adult Population in India- 20 %

• Excessive salt intake by our society is important contributor

Reduction in SALT intake

• Average Indian habitually consumes more salt, about 8-10 gms., while requirement is 6 gms/day

• Endogenous salt in diet is 1-2 gm, so add about 5 gm OR one level teaspoonful per day.

This will lower the B.P by 5-10 mm Hg & reduce Strokes by 35%, Heart Attacks by 20% & all cause deaths by 13%.

18

• The American Heart Association recommends home monitoring for all people with high blood pressure .

• Home monitoring is not a substitute for regular visits to your physician

Self BP Monitoring at home……

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/SymptomsDiagnosisMonitoringofHighBloodPressure/Home-Blood-Pressure-Monitoring_UCM_301874_Article.jsp

WHO three pillars of Prevention • 1 Healthy and Salt Restricted Diet • 2 Regular Physical Activity • 3 Avoidance of Tobacco

• Will prevent— • 80 % of all cases of C.V. disorders and Type 2 DM • 40 % of all Cancers

Harrison’s Principles of Internal Medicine, 18th Ed 2012, pp17

Thank you