Lifestyle Management

OBESITY

OBESITY
Know Your Ideal Body Weight
=
=Overweight – Present Body Weight > 10-20% IBW
=Obese - Present Body Weight > 20% IBW
Causes
=Energy Dense Foods
=Lack of Exercise
=Genetic Predisposition
=Certain medications
=Medical Problems
=Lack of sleep
=Slow metabolism
=Psychological stress
=Unhealthy eating habits, like Skipping breakfast,
Nibbling, Excessive consumption of junk food, Distress
eating
Ideal Body Weight (IBW) = Height in cm – 100
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=Social pressure to eat
=Holidays & Special Events
=Marketing/Advertisements
=Paired eating activities
Health Risks
=High Blood Pressure
=Diabetes
=Gall Bladder Disease
=Certain Cancer
=High Cholesterol Levels
=Cardio Vascular Diseases
=Joint Problems
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Self Control
Physical Activity Dietary Modification
Weight
Management

Dietary Modification
=
loss program, which puts you on a good, nutritious,
weight loss diet. No crash diets.
=Identify and avoid food triggers.
=Keep a watch on portion size.
=Eat a minimum of 500gms of fresh vegetables (less of root
vegetables) in the form of soups (no butter, corn flour, white
sauce), salads (without dressing), boiled and cooked in
minimum oil.
=High fiber foods like whole-wheat flour, bajra, jowar, millets,
oatmeal should be preferred to make your chapatis. Food
products made from maida (refined flour) like breads,
pastries, bhaturas, rumali rotis, naans, etc to be restricted.
=Pulses in the form of dals, whole pulses, usals, and sprouts
salads should be incorporated in the diet.
=Fruits like apple, orange, watermelon, papaya pomegranate,
peach, pineapple, pear, etc can be safely eaten as snacks.
=Always use skimmed milk. Remove the fat by refrigerating
the milk for 6-8 hours.
=Nutritious low calorie drinks like tomato juice, cucumber
juice,coconut water, lime juice, thin buttermilk, dudhi soup
can also be taken in between meals.
=Cut off sugar from your diet; avoid soft drinks, chocolates,
sweets, jams, ice creams, canned juice, mithai, cakes and
pastries.
To begin with, it is imperative to go on a monitored weight
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=
=Avoid deep-fried foods like wafers, puries, samosas,
wadas, bhajia, cutlets, farsans,etc
=Consume about 6-8 glasses of water every day.
=Prefer lean chicken, fish, egg white etc to high fat non-veg
foods.
=Use alternative cooking methods for frying like baking,
steaming, grilling, poaching, etc
=Festive seasons like Diwali, Christmas, and New Year are
times when people just let go. Always remember that
festivals can be enjoyed in a healthy way.
Limit your fat intake to two teaspoons a day.
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Practical Suggestions for Weight Reduction
=
weight loss program.
=Eat when you are actually hungry. Try not to eat snacks in
front of television.
=It is important to follow a regular meal pattern. Consume 6
small frequent meals. The gap between two meals should
not exceed to 3-4 hours.
=Never skip meals. If you skip a meal with the idea of losing
weight, you tend to eat next one in more quantity.
=Eat slowly. Savor each bite. Take fifteen to twenty minutes
to finish your meal as your brain needs twenty minutes to
register satiety.
=Eat wisely and learn to say NO to temptations.
=Maintain a diary where you record what you have eaten for
the day. This way you will be able to find out the increase or
decrease in your caloric intake.
=Stick to your treatment plan
=Remain motivated and confident
=Set the goal that is realistic.
=Adjust the rate of weight loss to 0.5kg week.
=Take the help of visual tool (weighing machine) and
motivation techniques.
Prudence and self-control are the keys to a successful
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=Increase your physical activity to about 45-60 minutes in a
day. Exercise is excellent to burn calories and improve both
mental and physical health.
=Anticipate plateaus. They are common to all. They occur due
to accumulation of water as fat is used up. Increase exercise
in this period to restart weight loss.
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DIABETES MELLITUS

Diabetes Mellitus is a condition where the amount of blood
glucose is too high because the body cannot use it properly.
Contributing Causes
Non-Modifiable:
=Heredity
=Age
Modifiable:
=Obesity
=Poor diet
=Sedentary lifestyle coupled with lack of physical
activity.
Symptoms
=Frequent urination
=Excessive thirst
=Unexplained weight loss
=Extreme hunger
=Blurry vision
=Tingling/ numbness in hands/ feet
=Feeling tired much of the time
=Dry skin
=Sores that are slow to heal
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DIABETES MELLITUS

Complications
Diabetes affects the various systems of body and leads to
the following complications
=Neuropathy (affects the various nerves)
=Retinopathy (affects eyesight/ vision)
=Nephropathy (affects the functioning of the kidneys)
=Leads to heart problems in the long run
=Stroke (injury to the brain)
=Diabetic foot leading to amputation
Prediabetes
Prediabetes is the state in which some but not all of the
diagnostic criteria for diabetes are met.
Impaired fasting glycaemia or impaired fasting glucose
(IFG) refers to a condition in which the fasting blood glucose
is elevated above what is considered normal
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Glucose
Levels
Normal Impaired
Fasting
Glycaemia
Impaired
Glucose
Tolerance
Diabetes
Mellitus
(IFG) (IGT) (DM)
Venous
Plasma
Fasting 2-
Hour
Fasting 2-
Hour
Fasting 2-
Hour
Fasting 2-
Hour
(mg/dl) <110 <140 = 110
&
<126
<140 <126 = 140 = 126 = 200

levels but is not high enough to be classified as diabetes
mellitus. It is considered a pre-diabetic state.
Impaired glucose tolerance (IGT) is a pre-diabetic state
which may precede type 2 diabetes mellitus by many years.
Management
The steps for effective management of diabetes include: -
onitoring
ducation
iet
xercise
edications
=Regular monitoring of blood sugar levels
=Know about the proper care that needs to be taken
=Follow regular eating habits
=Make the right food choices
=Include exercise and physical activity in daily routine
=Medications help in maintaining desired blood sugar
levels.
M
E
D
E
M
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Diet Guidelines:
=
=Take small frequent meals/snacks at regular intervals and
dine on time. Eat slowly
=Watch out for words like JUMBO, GIANT, DELUXE or SUPER-
SIZED. Larger portions mean more calories, more fat,
cholesterol and salt. Prefer regular/medium instead.
=Replace fried foods with grilled, roasted, steamed or baked
items.
=Avoid smoking and consumption of alcoholic drinks.
=Opt for fruits and salads as healthy snacks instead of
munching on to something which in the long run could harm
you like fried and bakery products.
=Limit the frequency of eating out. Always choose healthy
options.
No fasting, no feasting.
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Exercise tips:
=Consult your doctor before starting any exercise
program.
=Wear shoes that fit well and protect your feet.
=Start gradually to avoid stiff or sore muscles and joints.
=The type of exercise should be individualized for every
person.
=It may include
Aerobic exercise – 30 to 45 mins a day, atleast 5 days
a week
Flexibility exercise – 30 mins a day, 5 days a week
=Walk instead of drive whenever possible.
=Take the stairs instead of the elevator
=Test your blood glucose before and after exercise.
=Always carry a carbohydrate snack with you in case of
hypoglycemia.
=
=
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Foot care:
=
=Dry your feet well, especially between the toes.
=Check your feet for blisters, cut sores, swelling and
infected toenails.
=Trim the toe nails straight across and smoothen them.
=Never walk barefoot indoors or outdoors. Examine your
shoes everyday for crack, pebbles, nails or anything that
could hurt your feet.
Wash your feet daily with lukewarm water and soap.
“The Diabetic Who Knows the Most,
Lives the Longest’’
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Hypertension
Hypertension is defined as persistently high pressure in blood
vessels, wherein the systolic pressure is >120 mmHg and the
diastolic pressure is> 80 mmHg.
It is also called as a silent killer because people with
hypertension generally remain asymptomatic for years and
then have fatal stroke or heart attack. It is a lifestyle disorder.
Causes:
=Hereditary
=Stress
=Obesity
=Smoking
=Cardio vascular diseases
=Renal diseases
SYMPTOMS:
Usually it is asymptomatic.
=Headache
=Dizziness
=Impaired vision
=Failing memory
=Shortness of breath
=Pain over the heart
=Gastrointestinal disturbances
=Unexplained tiredness
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ADVERSE PROGNOSIS:
=Cardiac enlargement
=Ischemia (inadequate flow of blood)
=Left ventricular hypertrophy (thickening of muscle of heart)
=Left ventricular malfunction
=Myocardial Infarction (heart attack)
=Congestive heart failure (heart's pumping function is altered)
=Hemorrhages
=Impaired renal function
=Stroke (disturbance in the blood supply to the brain)
Recommendations:
=Weight reduction: It is very necessary to manage weight
and Body Mass Index. The BMI should be in range of 18—23
2
kg/mt .
=Physical Activity: Aerobic exercises and brisk walking help
to reduce blood pressure.
=Stress Management: It can be done by mediation, yoga,
some change in regular activities and pursuing some
hobbies.
=Alcohol and Smoking: These can lead to cardio vascular
diseases.
=Low fat diet is advised as the patient is susceptible to cardio
vascular diseases.
=Diet should include adequate amounts of potassium, calcium,
magnesium, vitamin D and K.
=Limit caffeine containing to 1 cup per day.
=Restrict alcohol beverages.
=Include DASH diet ie low in fats and cholesterol and rich in
vegetables, fruits and low-fat dairy products.
=Avoid pickles, preserved foods, papads, canned foods,
Chinese foods, frozen foods, salty foods, ketchups.
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Your heart is the center of your cardiovascular system, and
it is vitally responsible for just about everything that gives
your body life ranging from the oxygen supply to
strengthening your immune system. However, the foods
you eat and the amount of activity you choose to take part in
can dramatically affect the overall health of your heart and
many other tissues that make up your cardiovascular
system.
The term "heart disease" is often used interchangeably with
"cardiovascular disease." Cardiovascular disease generally
refers to conditions that involve narrowed or blocked blood
vessels that can lead to a heart attack, chest pain (angina) or
stroke. Other heart conditions, such as infections and
conditions that affect your heart's muscle, valves or beating
rhythm, also are considered forms of heart disease.
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Cardiovascular Diseases

The various diseases that fall under the umbrella of
heart disease include –
·Myocardial infarction(interruption of blood supply
to a part of heart causing heart cells to die)
·Coronary insufficiency(insufficient blood flow
through one or more coronary arteries supplying
heart)
·Angina(chest pain)
·Ischemic stroke (impaired oxygen supply to heart
tissue)
·Hemorrhagic stroke(bleeds resulting from
weakened vessels in the surrounding heart tissue)
·Transient ischemic attack(mini stroke with
symptoms appearing for short time)
·Peripheral artery disease(formation of plaques in
the arteries) heart failure
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The more risk factors you have, the more likely you are to
develop heart disease. Some risk factors can be changed,
treated, or modified, and some cannot. But by controlling as
many risk factors as possible, through lifestyle changes
and/or medicines, you can reduce your risk of heart disease.
Major Symptoms:
·Breathlessness
·Palpitations
·Chest pain
·Decreased urine output
·Abnormality in heart rhythm
·Syncope(sudden blackout)
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Diagnostic Investigations
·
·Stress Testing
·Thallium Stress Test
·Echocardiography
·Doppler Study
·Coronary Angiogram
Electrocardiogram (ECG)
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Target Goals
Some preventive measures you can take:
Don't smoke or use other tobacco products.
·Eat a varied diet, rich in fruits, vegetables and low-fat
foods.
·Maintain a healthy weight.
·30 minutes of exercise daily is a must.
·Keep your cholesterol levels in normal ranges.
·Control your blood sugar if you have diabetes.
·Control your blood pressure.
Diet Guidelines for Cardiovascular diseases
·Be liberal on raw and green leafy vegetables, fruits.
·Make use of the oven or tandoor more than frying- pan
by baking, grilling or roasting foods.
·Choose lean chicken and fish over mutton and red meat.
·
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FACTOR
Total Cholesterol
LDL (Bad)Cholesterol
HDL (Good)Cholesterol
Triglycerides
Blood Pressure
Fasting Glucose
Body Mass Index (BMI)
Waist Circumference
Exercise
GOAL
<200 mg/dL
<100 mg/dL
>50 mg/dL
<150 mg/dL
<120/80 mmHg
<100 mg/dL
<25 kg/dL
<35 Inches
Minimum of 30 minutes all
days.

·Eat more fish. Fish is a good source of protein. It also
contains Heart friendly fats, omega-3 fatty acids,
which may help reduce the risk of heart disease and
stroke.
·Thin buttermilk, coconut water, clear soups, kokam
sarbat can be included in diet liberally.
·Vegetable oils such as safflower oil,rice bran oil,
soyabean oil, sesame oil are most recommended. Use
combinations of oil.
·DO NOT Mix two oils together. Learn with your Diet
counselor how to use combinations of oil.
·Control the salt in your diet. Restrict your salt to half a
teaspoon per day
·Avoid salted foods, namkeens, pickles, chutneys,
dried papad, ketchups and canned foods.
·NO ALCOHOL and SMOKING.
·Have a healthy weight loss and maintain our ideal
body weight.
·Sustain your diet as well as workout.
·Exercise is the key!
.
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Physical Activity

Regular physical activity is one of the most important things
you can do for your health.
It can help to-
·Control weight.
·Reduce risk of cardiovascular diseases.
·Reduce risk of type 2 diabetes and metabolic syndrome.
·Reduce risk of some cancers.
·Strengthen bones and muscles.
Approximately 30-60 min of moderate intensity
physical activity per day is recommended.
There are various types of physical activity that help you to
achieve overall fitness.
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Physical activity and health
Types of activity Benefits Examples
1. Aerobic or
cardiovascular
exercises.
a) Increases stamina.
b) Helps to decrease
body fat .
c) Improves
cardiovascular
function &
reduces blood
pressure by
increasing blood
flow to the
muscles.
d) Improves blood
sugar control by
increasing the
sensitivity of the
body to insulin.
Walking , jogging,
bicycling, climbing
stairs, dancing,
swimming, tennis, zumba,
kick boxing,
Spinning.

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2) Strength or weight
training
a) Helps to increase
your metabolism so
that you burn more
calories.
b) Helps to make
bones stronger
c) Improves balance
d) Increases muscle
strength
Lowers the risk of
fractures and
lessens arthritis
pain.
use weight machines, lift
free weights, push-ups,
pilates. Can use
household items like
bottles filled with water as
weights.
3) Stretching or
flexibility
a) Helps to ease
movement.
b) Improve flexibility
c) Prevents muscle
sprain and injury.
Gardening, moping the
floor, vaccuming, Bowling,
yoga, curling.

Always keep yourself motivating by:-
·
losing few kilos just to fit in the old favorite dress.
·Finding a workout buddy so that both can push each
other to try a bit harder.
·Getting indulged in any sports activity of your choice.
·Making it a fun – Don't make exercise regime bore and
sad. Try something different like Zumba Aqua exercises,
aerobics, Flexibility, Yoga, etc.
Setting Small, Realistic and Achievable goals — it might be
,
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·
Remember the rewards should be healthy like a healthy
snack, spa, hair spa, etc
·Buying a new dress for the next birthday, a size smaller. Let
the thought of fitting in to it motivate you.
·Stick to the workout plan. Print it out and put it somewhere
you can see it daily.
·Keeping a backup plan ready in case of weather problems.
·Avoid exercising on an empty stomach or immediately after
taking insulin.
·Carry a fast acting source of energy (CHO) with you ,such as
glucose or raisins just in case of low blood glucose.
All the Best!!
Rewarding yourself on successfully achieving a goal —
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