management of sedentary disease and their prevention briefly discussed.

1. HEALTH THREATS OF
SEDENTARY LIFESTYLE
ByAnkur Singhal
Batch-08
G.R.M.C. Gwalior

3. Outline
 What
are “sedentary lifestyles?”
 Epidemiology
pertaining to us and the
world.
 Overview
of Health Consequences
 Hypokinetic
 The
diseases
Evidence
 Sedentary
Lifestyle is an Independent Risk
Factor for Cardiovascular Disease & Mortality
 What
Can Be Done?

4. What are sedentary
lifestyles?

Any lifestyle that has
- insufficient physical activity or exercise
+
=

5. EPIDEMIOLOGY: The INDIAN SCENARIO
It’s Crazy to be Lazy…
“Physical inactivity contributes substantially
to the global burden of disease, death and disability.”
WHO:
~ 2 million deaths per
year can be attributed to
sedentary life style due to
increased co-morbidities.

6. India is, in our own eyes, still a country of poverty, hunger and malnutrition. India is one of the capitals of diabetes and cardiovascular diseases.
Accordig to NFHS, The overall prevalence of subjects >23 kg/m2 was 50.8% and central obesity was 52.6%. The overall prevalence of sedentary
behavior was 59.3% among women and 58.5% among men. Both sedentary behavior and mild activity showed a significantly increasing trend in
women after the age of 35–44 years. In men, such a trend was observed above the age of 45 years.

7. 
But today, obesity in children and adults is a reality
that poses a double jeopardy to the government
and health experts - on the one hand, they have to
tackle the malice of malnutrition and on the other,
they have to fight obesity among children.

The prevalence of overweight rose from 2% to 17.1%
in rural india due to changing life style of the rural
dwellers as it was found to be a contributory factor
for the rising rates of obesity and associated
metabolic diseases, such as diabetes according to
NFHS survey being conducted in 1989 and 2009
respectively.

The prevalence of overweight in 14 to 17 years old
school children has increased significantly from 10% in
2006-2007 to 12% in 2009, while those underweight
decreased in Delhi. Affluence clearly impacts body
weight.

8. States of India ranked in order of %age of people who are overwt. or
obese, based on data from the 2007 National Family Health Survey

9. The European Youth Heart Study
Results:
3.29 times increased Risk!
Independent of weight status!!
Kuopio Ischemic Heart Disease Risk Factor Study
Increased risk of “Metabolic Syndrome”
Strong predictor of cardiovascular mortality
Study conclusion:
Sedentary lifestyle is actually a “feature” of MS
The Health and Retirement Study

10. Overview of health
consequences

11. EFFECTS
Of A Sedentary Lifestyle
- Weight Gain
- Obesity
Heart Disease
Joint Pain
Diabetes
Weakened Immune System
Plethora of Ds.BAD

12. Hypokinetic diseases are conditions
that occur from a sedentary lifestyle.
Examples
could
include
Anxiety
Colon cancer
Cardiovascular disease blood pressure
High
Mortality in elderly
Obesity
men by 30% and double Osteoporosis
the risk in elderly women
Lipid disorders
Deep vein thrombosis
Kidney stones
Depression
Diabetes

13. Co-morbidities associated with obesity
Depression
Sleep apnoa
Ischemic stroke
Coronary heart disease
Respiratory disease
Gallbladder disease
Dyslipidemia
Osteoarthritis
Hyperuricemia
and gout
Type 2 Diabetes
Cancer (breast, endometrial,
colon, prostate)
Hormonal abnormalities
and pregnancy
complications

14. The problem of sedentary lifestyle: The Diabesity
Obesity in type-2 diabetic patients is a very common phenomenon
and often termed as "Diabesity." Diabetes, obesity, hypertension,
dyslipidemia are grouped under one name "Metabolic syndrome."
The rising prevalence of these lifestyle disorders in India is of concern
as singly or in combination, which act as major risk factors for
coronary artery diseases (CAD).
Increased
predisposition to diabetes and premature CAD in Indians
has been attributed to the "Asian Indian Phenotype" characterized by
less of generalized obesity measured by BMI and greater central
body obesity as shown by greater WC and WHR.
Many
Indians fit into the category of metabolically obese, normal
weight individuals. The body fat percentage of an Indian is
significantly higher than a western counterpart with similar BMI and
blood glucose level. It has been hypothesized that excess body fat
and low muscle mass may explain the high prevalence of
hyperinsulinemia and the high risk of type-2 diabetes in Asian Indians

15. WHY????????

16. Sedentary Careers or Jobs




Many jobs require you to sit behind a
computer all day which promotes you to
live a sedentary lifestyle.
You sometimes get home late and have
no time to cook so you buy fast food on
the way home.
You lack physical activity and don’t eat
healthy.
But this is all your decision because you
can always get a different job or use your
free time to be active and eat healthy.

17. WHAT CAN BE DONE:

Well it’s quite obvious now to tackle any of these large
group of co-morbidities , a multi-disciplinary approach
is required in order to shift the curve towards the better
of this slowly rising epidemic…..

18. Focus for Change
Individual
Belief
Micro
attitudes
in abilities
environment
Conduciveness
work & home
Macro
of activity at
environment
Socioeconomic
environment
culture &

19. A multidisciplinary approach to tackle health risks of sedentary lifestyle

20. How to Avoid Death
(Or At Least Postpone It)
Daily
walks
Take the stairs
Gardening
Cycling, swimming, sports
You get the idea…

21. THE EVIDENCE
FOR EXERCISE…

22. Positive Health Effects of
exercise and evidences of its
effectiveness:
Cardiovascular
disease
Overweight & obesity
Diabetes
Cancer
Musculoskeletal health
Psychological well-being

23. Reduction of CVD Risk

Greatest benefit of physical activity

Inactive people have 2x risk vs active

Prevents stroke

Improves CVD associated
risk factors

24. Sedentary Lifestyle and
Cardiovascular Fitness

Most reliable index of physical activity


Define “Cardiorespiratory Fitness”
Decrease in Cardiorespiratory Fitness

Powerful Predictor

Cardiovascular Disease

Mortality

Type II Diabetes Mellitus

25. Overweight & Obesity
“Ex-Ur-Size!”

Dramatic increase in prevalence over last 20 years
(Remember last week?)

Energy intake>>>total energy expenditure

Physical activity → weight loss


Decreases risks of obesity
Health benefits independent of weight loss!!

26. Diabetes
Increasing
prevalence in
developing country like us
Usual onset after age 40
Emerging in children…
Evidence: 30% lower risk in
active
Moderate
and vigorous
activity levels

27. Cancer
Physical
Colon
activity ↓
cancer risk
Breast cancer
Prostate cancer?

28. Musculoskeletal Health

Regular physical activity


Strength and flexibility


Reduces age decline
Reduces risk of falls & hip fractures
Weight-bearing activities

Prevents osteoporosis

29. Psychological Well-Being

Physical activity

Reduces symptoms of depression, and
possibly stress, & anxiety

Positive self image and self-esteem

Increases social interaction

Builds social skills among children

Improves quality of life

30. Summary

Physical activity:

Many benefits…

Decreases cardiovascular risk factors

Independent of weight loss

Physical activity is an independent predictor of mortality…

Leanness ≠ invincible

31. So overview is

32. Pharmacotherapy for
the Treatment of
Obesity
“BUT DOC, ISN’T THERE A PILL I CAN TAKE?”

33. Drugs:

Sibutramine(withdrawn)

Phentermine(amphetamine)

Amfepramone(congener of ethcathinone)

Orlistat

Metformin

Exenatide

Bupropion

Fluoxetine

Mixed

Rimonabant

34. Indications for Drug Therapy in
Obesity

Failure of diet and exercise alone

Significant obesity related comorbidities even if
BMI < 30 (ie 25-30).

No contraindications to drug therapy lest

Medication interactions

Medical conditions that may be adversely affected
by the obesity drug

35. Summary

Weight loss with obesity
medicines is modest
Drug
Sibutramine
Wt loss
4-5 kg

Obesity medicines are
not a substitute for diet
and exercise
Phentermine
Orlistat
3-4 kg
2-3 kg
Metformin
Exenatide
2 kg
2-3 kg
Bupropion
Fluoxetine
2-3 kg
Mixed
Topamax
Rimonabant
6-7 kg
6-7 kg


Weight loss is often not
maintained after drug
is discontinued
Most obesity medicines
are not covered by
insurance

36. SURGICAL THERAPY:
CLASSIFICATION OF BARIATRIC SURGERY:
Bariatric surgery procedures can be categorized into operations utilizing 3
methods to produce weight loss: gastric restriction, mal absorption, or a
combination of the two.
1. PREDOMINANTLY RESTRICTIVE PROCEDURES
2. PREDOMINANTLY MALABSORBTIVE PROCEDURES
3. MIXED OR COMBINATION PROCEDURES

37. Recommends bariatric surgery for obese people:
BMI > 40 without co morbidities
BMI >35 with 1 or more co morbidities.
or
BMI of 30 to 35 with significant or serious co morbidities.
or
When less invasive methods of weight loss have failed and the patient is at
high risk for Obesity-associated morbidity and mortality.

38. RESTRICTIVE PROCEDURES:
Procedures that are solely restrictive by creating a small gastric pouch
& a degree of outlet obstruction leading to delayed gastric emptying.
The goal is to reduce oral intake by limiting gastric volume, produce
early satiety, and leave the alimentary canal in continuity, minimizing
the risks of metabolic complications
1.VERTICAL BANDED GASTROPLASTY
2.ADJUSTABLE GASTRIC BANDING
3. SLEEVE GASTRECTOMY
4.GASTRIC PLICATION
5. INTRA GASTRIC BALLOON

39. MALABSORPTIVE PROCEDURES
Malabsorption is achieved by creating a short gut syndrome and/or by
accomplishing distal mixing of bile and pancreatic juice with ingested
nutrients thereby reducing absorption.. Some purely malabsorptive
operations are no longer recommended due to their potential hazard to
cause serious nutritional deficiencies.
1. BILIOPANCREATIC DIVERSION
2. THE JEJUNAL-ILEAL BYPASS
(no longer performed)
3. ENDOLUMINAL SLEEVE

40. MIXED PROCEDURES:
The following procedures combine restrictive and malabsorptive approaches.
By adding malabsorption, food is delayed in mixing with bile and pancreatic
juices that aid in the absorption of nutrients. The result is an early sense of
fullness, combined with a sense of satisfaction that reduces the desire to eat.
GASTRIC BYPASS ROUX-EN-Y ( RYGBP).
Most commonly performed procedure these days. Done laparoscopically.
1.
2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH
3. IMPLANTABLE GASTRIC STIMULATION

41. Patient Criteria for surgery
1. A Body Mass Index (BMI) ≥ 40 or a BMI ≥ 35 with obesity related co-morbid conditions.
2. Age – 16 to 65 yrs.
3. Screening for mental or behavioral disorders that may interfere with post-operative outcomes
(e.g. eating disorders, depression, and substance abuse).
4. Counselling and advise to stop using tobacco products & alcohol, 4 weeks prior to surgery.
5. No absolute contraindication to major abdominal surgery
6. Obesity of long standing. Should have completed a weight loss program is recommended but
not required.
eg: dieting, nutritional counseling, an exercise program and commercial/hospital.
7.To adhere to post-surgical attention to lifestyle, an exercise program and dietary changes and
post-surgical follow-up with applicable professionals (e.g. nutritionist, psychiatrist, exercise ,
physical therapist, support group participation, on regular basis.

42. Ideas

Reduce TV and Computer Use

Schedule your time for physical activity
Play cricket
Lift Weights
Run like Usain Bolt

43. Take the stairs
WALK
Don’t take your vehicle.
IT’S NOT THAT FAR
SERIOUSLY