An Anti-Obesity Day awareness initiative

An Anti-Obesity Day awareness initiative Type 2 diabetes mellitus is strongly associated with obesity. There is a significant correlation between type 2 diabetes mellitus and obesity, especially in older individuals. Awareness needs to be raised about these comorbidities and how they affect each other. New Delhi, November 24, 2106: India has the infamous distinction of being the Diabetes capital of the world and on the obesity front, India ranks third worldwide. Clearly, these two morbidities are plentiful in the Indian population. Several studies have aimed at evaluating this relationship. The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg. Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial. Padma Shri awardee Dr. K.K Aggarwal, President HCFI and National President Elect IMA adds, “More than 80 percent of cases of type 2 diabetes can be attributed to obesity. It is seen that there is a curvilinear relationship between BMI and the risk of type 2 diabetes. The lowest risk is associated with a BMI below 22 kg/m2. At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.” Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes. It is a matter of extreme concern as weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes. “Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels. Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contributes to high lipid levels and high blood pressure”, added Dr. K.K Aggarwal further. It is important that those with preexisting Diabetes or those with a family history of type 2 Diabetes mellitus maintain a healthy body mass index. This will not only help in improving the course, severity and extent of the existing disease but also help in preventing the development of serious complications in high risk individuals.

BMJ reports Satyagraha

BMJ reports Satyagraha Doctors protest against bill to dissolve the Medical Council of India BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6259 (Published 22 November 2016) Priyanka Pulla Around 270 000 doctors across India took to the streets on 16 November to protest against the newly proposed National Medical Commission bill which seeks to dissolve the Medical Council of India (MCI) and replace it with a body of 20 members who would be nominated by the government.1 K K Aggarwal, the president elect of the Indian Medical Association, told The BMJ that the association was strongly opposed to the idea of a regulatory body with no elected members, and with members from fields other than medicine.2 In March this year a parliamentary panel urged the government to dismantle the Medical Council of India, saying that it could no longer be trusted with its responsibilities in view of its “massive failures.”3 It also said that the council had not done enough to tackle corruption in the medical profession. It recommended that a new regulatory agency be established and a draft bill creating a 20 member National Medical Commission, a new apex body for medical education, was published in August.1 The Indian Medical Association wants to retain the current structure of the MCI—with two thirds of the body elected and one third nominated—Aggarwal said. “They can’t replace a 130 member body with a 20 member body that is completely nominated,” he said, equating the action with dissolving the Indian parliament and replacing it with a group of nominated members. The association postponed countrywide protests against the proposed bill last year after the government agreed to meet leaders to discuss their demands.2 The Indian Medical Association is calling for a new law to protect doctors against violence; for the enforcement of existing laws that stop alternative medicine practitioners from prescribing modern drugs; for changes to laws to exempt doctors from penalties for clerical mistakes, for the end to cumbersome requirements for single doctor hospitals such as the maintenance of electronic health records and minimum staff numbers; and for the introduction of a cap on the amount of compensation paid to victims of malpractice. But the association has been frustrated with the slow progress in meeting these demands and is calling for the health minister, J P Nadda, to intervene. “Nadda has been saying for the last two years that he agreed with our demands in principle, but we want results,” Aggarwal told The BMJ. Aggarwal said that corruption in the Medical Council of India was just a matter of perception and that the current council had taken steps to quell this notion, including implementing a common entrance exam for medical colleges across India, tackling the issue of capitation fees, and introducing biometric identification cards for medical college faculties to ensure that they met their teaching commitments. He said that the association was planning to submit to the government a list of amendments to the act to ensure more transparent working of the council. References 1. Mudur G. Draft bill for new regulatory structure for medicine in India prompts criticism. BMJ 2016;354:i4541. 2. Bagcchi S. Indian Medical Association calls off protest after government agrees to discuss demands. BMJ. 2015;351:h6194. 3. Mudur G. Indian medical council should be scrapped, says parliamentary committee. BMJ2016;352:i1610. (Source: BMJ)

ADA’s first position statement on psychosocial care for people with diabetes

ADA’s first position statement on psychosocial care for people with diabetes It is well known that psychosocial factors, which include environmental, social, behavioral, and emotional factors, affect diabetes, both type 1 and type 2. The American Diabetes Association (ADA) has released its first Position Statement on ‘Psychosocial care for people with diabetes’, which encourages comprehensive, personalized mental health assessment and treatment as part of routine care of diabetes and recommends care based on factors like age, type of diabetes and family support system. The most common psychological factors affecting people with diabetes, including diabetes distress, depression, and anxiety and eating disorders are covered in the guidelines. The emotional health and life circumstances of a person with diabetes should be evaluated during an initial visit followed by examinations at regular intervals for timely diagnosis and management. Few key recommendations are: • Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life. • Providers should consider an assessment of symptoms of diabetes distress, depression, anxiety, and disordered eating and of cognitive capacities using patient-appropriate standardized/validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. Including caregivers and family members in this assessment is recommended. • Consider assessment of life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies. • Addressing psychosocial problems upon identification is recommended. If an intervention cannot be initiated during the visit when the problem is identified, a follow-up visit or referral to a qualified behavioral health care provider may be scheduled during that visit. The position statement was published online November 22, 2016 and is to be published in the December 2016 issue of the journal Diabetes Care. (Source: Diabetes Care, ADA Press Release November 22, 2016)

An Anti-Obesity Day awareness initiative

An Anti-Obesity Day awareness initiative Obesity has continuously been undermined as a factor of deteriorating public health in India India is the third most obese country in the world with more than 30 million people suffering from moderate to severe obesity According to a report, around 11 percent of adolescents and 20 percent of adults are overweight and have a body mass index higher than 25 kg/m2 to 30 kg/m2 New Delhi, 25th November 2016: Over 30% of the Indian population including children is found to be suffering from Potbelly abdominal obesity. The incidence of metabolic syndrome, characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high blood sugar is at an all-time high in the country and continues to rise. The reason for this is the unhealthy lifestyle choices made my majority of the population including consumption of a diet, which predominantly has high trans fat and sugar levels, long hours spent working in closed spaces with minimal physical exercise and dependence on evils such as alcohol and cigarettes. In fact, nowadays seeing the surge in preventable deaths annually, obesity is being considered as a new killer disease. It makes the young vulnerable to long-term chronic diseases like cardiovascular issues, diabetes and blood pressure fluctuations. Obesity is not only prevalent in youngsters or adults but is also plaguing the children. Children often become overweight due to innumerable factors like lack of physical activity, unhealthy eating habits, increasing reliance on convenience foods and hormonal issues. However, weight problems are also linked to medical heredity complications. Thus, if obesity runs in the family, one must ensure that adequate prevention measures are taken to prevent it from becoming a part of their offspring's life as well. Speaking about the growing problem, Padma Shri awardee Dr. K.K Aggarwal, President HCFI and National President Elect IMA said, “Very few people are aware of the fact that obesity can be prevented and managed if one's weight and eating habits are monitored properly. As the first step in this direction, all individuals should adopt a healthy eating pattern, which includes cutting down on the consumption of processed and convenience food items, as they boost the deposition of bad cholesterol in the body. A balanced diet should consist of items of all six tastes and all seven colors and associated vitamins and minerals to help condition the human body to perform better and build a shield against diseases. Secondly, watching the portion size of each meal is crucial. Eating small portions in regular intervals will help you in balancing the energy intake and output. In addition to this, one should always plan an exercise routine, being physically active helps our body to function flexibly and avoid joint pains and bone fractures." Few tips to keep in mind maintain a healthy lifestyle: • Follow a healthy eating plan. Make healthy food choices, keep your calorie needs and your family's calorie needs in mind, and focus on the balance of energy IN and energy OUT. • Focus on portion size. Watch the portion sizes in fast food and other restaurants. The portions often served are enough for two or three people. Cutting back on portion size will help you balance energy IN and energy OUT. • Be active. Make personal and family time active. Find activities that everyone will enjoy. For example, go for a brisk walk, bike or rollerblade, or train together for a walk or run. • Reduce screen time. Limit the use of TVs, computers, DVDs, and video games because they limit the time for physical activity. Health experts recommend 2 hours or less a day of screen time that does not work- or homework-related. • Keep track of your weight, body mass index, and waist circumference. Also, keep track of your children's growth. • Ensure that your abdominal circumference is lower than 80 cm/90cm (women and men) • Keep fasting sugar lower than 80 mg% and blood pressure lower than 80 mm Hg. • Keep heart rate lower than 80 per minute and bad LDL cholesterol lower than 80 mg%. • Do not consume more than 80 grams of caloric solid or liquid food at once. • Observe carbohydrate fast 80 days a year. • Consume at least 80 fruits and vegetables servings in a week. As they say, you reap what you sow, and hence, to be able to live a disease free lifestyle, one should give up all the addictions this anti-obesity day, which may put them in a danger of suffering from life-threatening diseases in the future.

Delhi chokes under deadly smog

Delhi chokes under deadly smog The days after Diwali have been filled with thick smog blanketing the city. Delhi has recorded its worst ever pollution record with harmful gaseous cocktail reaching upto 42 times the safe limit. This warrants urgent attention and the concerned authorities need to take prompt measures, otherwise the health of 10 million city residents hangs in balance. New Delhi, 02nd Nov, 2016: Air pollution in the capital increased to dangerously high levels post-Diwali. Pollution in the national capital reached extremely unhealthy levels as a dangerous cocktail of noxious gases and respirable pollutants were coupled to low temperature and negligible wind movement, which caused the pollutants to remain close to the surface and be easily breathable. Ultra fine PM (Particulate Matter) 2.5 considered to be the most dangerous particulate matter pollutant rose to "hazardous" levels – and reached up to about 999 micrograms in various areas of the city, which is several times higher than the safe limit of 60 micrograms per cubic meter, standardized by the WHO Central Pollution Control Board. To offer a comparative perspective, Air quality index levels in London on Monday morning was 139 and that in China hovered from 380-400. Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) & National President Elect IMA, added, “The hazardous levels definitely are a reason to panic. Respiratory problems and heart conditions will only worsen in the coming days. PM2.5 is absorbed in lung and enters circulation. It increases free radicals, cholesterol deposition and precipitate heart attack, stroke, and hypertension. Short-term exposure to PM2.5 pollutants is associated with acute coronary ischemic (insufficient blood flow in the coronary arteries of the heart) events and the chances of irregular heart rhythm jumps by 26% for each 6 mcg/cu mm increase in PM 2.5 levels. Such high levels are potent and can trigger endothelial dysfunction, blood thickening and atrial fibrillation (within 2 hours of exposure)”. Noise pollution also breached the safe barrier in the city. Decibel level readings show that the noise pollution ranged from 66.1 decibel (A) and 75.8 dB(A) while the safe levels are around 55dB. Speaking further about the city’s debilitating air condition, Dr. K.K Aggarwal said, “Delhi’s air remains in the “unhealthy” category with respect to air quality index levels throughout the year, Diwali just added to this burden. Moreover, recent crop stuble burning in neighboring states of Punjab and Haryana has also exacerbated the issue. The timing also seems to be crucial, this changing weather has moisture hanging in the air that traps pollutants and acts as a sustained reservoir, and low speed winds are unable to sweep away this particulate matter. There is an urgent need to take prompt and stringent actions, there needs to be a blanket ban on firecrackers, especially those illegally imported that fail to meet pollution standards.” Other measures that can prove fruitful to city’s air quality include imposing a strict ban on garbage burning, and increasing the tax on tobacco. Vehicular emissions need to be controlled further as clearly, current measures are insufficient. Crop burning in agriculture oriented neighboring states needs to be controlled and vigilantly monitored

Fog vs Smog

Fog vs Smog Whenever the humidity is high, air movement is less and temperature is low, fog is the automatic result. It occurs when water droplets are suspended in the air. Smog, on the other hand, is the combination of smoke and fog. When the level of pollutants is high in the atmosphere, the pollutant particles get mixed into the fog, thereby reducing the visibility further. The result is called smog. The smoke includes toxic emissions from vehicle pollutants, open burning of crops or industrial pollutants. Fog and smog are more common during wet or early winter. Wet winter is characterized by fall in temperature along with high humidity. Whereas, dry or late winter is characterized by absence of fog, smog and presence of chilly airy winds. Exposure to smog has known adverse health effects. Acute ill-effects may include redness of eyes, coughing or throat irritation, difficulty in breathing. Smog can trigger acute asthma attacks; it may even trigger a heart attack, stroke, arrhythmia. Children, elderly, patients with diabetes, heart and lung diseases are especially vulnerable to the adverse effects of smog and so should take special precautions to protect themselves. • Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days. • Avoid exertion or activities like running, jogging in conditions of smog. • Avoid walking during smog hours. • Avoid going out as much as possible. • Drive slowly during smog hours. • Heart patients should stop their early morning walk during smog hours. • Remember to get flu and pneumonia vaccination.

Toxic Benzene levels in Delhi air

Toxic Benzene levels in Delhi air

Dr K K Aggarwal Most of the times, we worry about PM 2.5 and PM 10 levels. But, we ignore benzene levels, which indicate the yearly pollution stays of an area. The normal levels are 5 µg/m3. Following is the yearly average in most parts of Delhi for example. • Anand Vihar: 44.3 µg/m3 • Mandir Marg 9.2 µg/m3 • Punjabi Bagh 2.2 µg/m3 • RK Puram 17.0 µg/m3 • IGI Airport 12.68 µg/m3 • Civil Lines 23.14 µg/m3 Some facts about benzene • Benzene is a pollutant often released from oil refineries and traffic exhaust. • Benzene is a compound of crude oil and petrol that can be harmful even at trace levels. • Apart from vehicular exhausts, evaporation from petrol filling stations can also cause benzene levels to rise. • Benzene is a hazardous air pollutant. • Benzene is a known human carcinogen. Long-term exposure to high levels of benzene in the air can cause leukemia and lymphomas • Human studies suggest that maternal exposures to benzene during pregnancy may increase risk for miscarriages, low birth weight infants and childhood cancers. • Pregnant women living in areas with higher air levels of benzene are more likely to have babies with neural tube defects. Women living in the areas with the highest benzene levels are at a two times greater risk for their children to be born with spina bifida. • Delhi should install vapor recovery systems at petrol pumps as soon as possible to deal with high benzene levels. • The air quality index (AQI) recently launched by the Centre does not monitor the quantity of benzene. The AQI deals with pollutants that have immediate short-term impacts like respiratory or cardiovascular diseases. Benzene, on the other hand, is an air toxin and a carcinogen which can cause damage in the long run. • Benzene levels are higher when the temperature is lower. • Benzene rises after sunset and peaks early morning. • Benzene gets mixed with blood while breathing.