Empowering the battle against “Globesity”

Obesity is a composite condition, with serious social and psychological dimensions, and one that can affect practically anyone, ranging across various age and socioeconomic strata. It poses an overwhelming threat to both developed and developing nations.

The Body Mass Index (BMI), or weight-to-height ratio, is currently the most common measure we use to determine if adults are within the healthy limits of weight for their respective heights. For most adults, an ideal BMI is in the 18.5-24.9 range. If a person’s BMI is higher than 25, his weight is more than what is ideal for his height. “Overweight” is defined by the WHO as having a BMI greater than or equal to 25 and lower than 30, while “obesity” is having a BMI equal to or greater than 30.

Located at the other end of the malnutrition spectrum, obesity is one of today’s most brazenly visible yet most neglected public health problems. Global obesity, or “Globesity,” is now taking over many parts of the world, becoming an issue warranting major concern, particularly in some Asian countries. Dr. Praveen Raj of Gem Hospitals Coimbatore, India, states that Obesity is a metabolic syndrome where it is a metabolic abnormality internally, that is responsible for obesity and diabetes which has evolved to be the biggest epidemic of today. 

 There is a common view that men are more prone to being overweight, while obesity favors women. This being said, obesity poses a major risk for contracting serious non-communicable diseases (NCDs), including diabetes mellitus, certain cancers, cardiovascular diseases, sleep apnoea, hypertension and stroke. Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life.

What causes obesity?

  • Obesity typically results from over-eating (especially an unhealthy diet) and lack of enough exercise. With the rise in fast food, together with the exponential growth of fast food joints providing cheap and quick meals, it is not surprising that this epidemic is spreading rapidly the world over. With the consumption of these foods, which are high in salt, sugars and fat, combined with our increasingly sedentary lifestyles, increasing urbanization and changing modes of transportation, it is no wonder that obesity has rapidly increased globally over the last few decades. Healthy eating is very often more expensive than less healthy options.
  • Another common cause of obesity is attributed to genetics. A person is more likely to develop obesity if one or both parents are obese. Genetics also affect hormones involved in fat regulation.
  • Medications can also cause the side effect of weight gain. Some of these belong to the class of antidepressants, anticonvulsants, diabetes medications, antihypertensive drugs and antihistamines, oral contraceptives, and most corticosteroids.
  • For quite a few people, emotions influence their eating habits. Many individuals eat excessively in response to stress, sadness, or simply because they are bored. It has been found that about 30 percent of people who seek treatment for serious weight problems are dealing with the habit of binge eating.
  • Certain diseases such as hypothyroidism, polycystic ovary syndrome (PCOS), and Cushing’s syndrome are also contributors to obesity.
  • In general, women tend to gain weight surrounding events such as pregnancy, menopause and sometimes with the use of oral contraceptives.
  • Levels of physical activity can also affect obesity.
  • Socioeconomic inequality can lead to different groups being disadvantaged and having less access to needed resources and healthier foods.

Is there a solution to this epidemic?

Since obesity is a chronic illness, its solution needs to be an on-going and lifelong process. Very often, obese individuals take up strenuous diet plans to achieve their “ideal body weight.” It must be understood that these diets may aid in a certain amount of weight loss but are not a permanent fix. It should also be noted that once the individuals resume their regular diet, the lost weight returns. Most people who lose weight regain it within five years. The goal of treating obesity should not be to strive towards an ideal weight but should be to establish a healthier weight. Here are some factors to consider as a part of a healthier lifestyle to combat obesity.

Eat and work out right!

A safe and effective long-term weight reduction and maintenance diet has to contain balanced foods to avoid deficiencies and malnutrition. Eating right would signify consuming a protein rich diet with reduced intake of carbohydrates. Make sure to increase consumption of complex carbohydrates compared to simpler ones that are easier to digest. Perform 20-30 minutes of moderate cardio exercise five to seven days a week. Something as simple as a half hour of brisk walking every day could aid in leading a healthier life and keeping one’s weight in check.

Do medicines play a significant role in weight loss?

Several FDA-approved over the counter drugs claim to aid in weight loss. While studies have proven that certain medicines do help, they should be used only as an adjunct to diet modifications and an exercise programme. Medications, in general, should not be taken for cosmetic reasons and must be used only by individuals who are at risk of other obesity-related illnesses.

Can surgery help?

Surgery is one of the most effective solutions in the management of obesity. It is, however, indicated by the National Institutes of Health only in:

  • Patients with a BMI of greater than 40
  • Patients with a BMI of greater than 35 who have serious medical problems such as sleep apnoea that would improve with weight loss

Cosmetic surgery, like liposuction and resection of portions of fat and skin, or a combination of the two, are done mainly to alter a person’s physical appearance. In other words, you can see that the change is only on some specific parts of the body and only on the fatty tissue found right under the skin. It does not particularly deal with the problem of obesity. Cosmetic surgery only changes the physical appearance of those parts of the body that “bother” the patient and they want to modify.

Over the past three decades the treatment protocol that has grown in popularity is bariatric surgery. This procedure is a metabolic surgery that addresses the problem of obesity at the grass root levels, reducing the amount of overall body fat, i.e., visceral fat and under the skin, by reducing the percentage of it in the entire body. Currently, there are basically two types of bariatric surgery:

Restrictive surgeries: These surgeries restrict the size of the stomach and slow down digestion.

Malabsorptive/Restrictive surgeries: These surgeries restrict the size of the stomach but also bypass or remove part of your digestive system to decrease absorption of food/calories.

Bariatric surgery is a necessity for management of obesity in those who are unable to reduce their weight by regular and simpler means. The role of bariatric surgery is not just in the treatment of obesity, but in addressing all the components of metabolic syndrome including poly cystic ovarian syndrome , non-alcoholic fatty liver disease ; obstructive sleep apnea etc., says Dr. Praveen Raj. The best solution for weight management, however, is always to take the preventive route. Opting for healthier eating habits and adding activities to the day’s schedule to break up your sedentary lifestyle cycle are the best places to start.

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Where to find help for HIV/AIDS patients in Tamil Nadu #AIDSAwarenessWeek

Hello again from the capital city of Tamil Nadu! Its HIV awareness week so it would be most appropriate to bring to you public health services available to women and children affected by HIV/AIDS especially in Tamil Nadu. Let us first take a look at some numbers to understand what we are doing right and if we are doing enough. The UNAIDS Gap report, 2016, states that in 2013, HIV prevalence in India was an estimated 0.3%. This figure is considerably small compared to most of the other middle-income countries. However, since India has an enormous population of approximately 1.2 billion people, this equates to 2.1 million people living with HIV. Of this infected population, an estimated 1,30,000 people died from AIDS-related illnesses. Overall, India’s HIV epidemic is slowing down, with a 19% decline in new HIV infections (130,000 in 2013 to 86,000 in 2016).

SAATHI, an NGO striving towards prevention and control of HIV since the year 2000, has published that children under the age of 15 account for 4.4% of all infections while women account for 39% of all HIV infected women. That gives us a population of 0.93 million women and 43000 pregnant women infected with HIV. It has also been noted that TamilNadu is one of the (Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu) which put together account for 57% of the HIV infected people in India.

How is it Transmitted?

HIV is transmitted through sexual intercourse with an infected person, through blood transfusion with infected blood, and through an infected mother to her child during childbirth, among other routes of transmission. Though HIV is transmitted through several modes of fluid exchange, it is majorly acquired through sexual intercourse and is associated with the same in our country. Therefore unprotected sex is high risk behaviour for contracting the virus. HIV compromises the immune system of the individual and therefore, makes the individual susceptible to any common infection around them. Other Sexually Transmitted Diseases (STDs) also seem to serve as an important risk factor, which facilitate the transmission and acquisition of HIV due to the presence of ulcers and inflammation of the skin or mucous membranes of the genitalia. Specialist treatment is provided in all the STD clinics free of cost.   In addition HIV/AIDS cases are treated as in-patients in Government Hospitals of Thoracic Medicine, Tambaram, Government General Hospital and also in Medical College Hospitals for all opportunistic infections, free of cost.  Adequate funds are also released to the Director of Medical Education and Director of Medical and Rural Health Services for supply of medicine, equipment and other minor civil works, etc.

In Government Hospital of Thoracic Medicine, Tambaram, Siddha medicines along with other allopathic medicine are also given to persons affected with HIV/AIDS on trial basis which has showed slight improvement to the patients.

What is Available?

Available on Public Domain:

There are several portals with links to “helpful sites” for those in need of information. However quite a few of these links lead nowhere and leave a person very frustrated. For a person searching for necessary information, this would leave them desperate and depressed for want of information.

To get better insight into the services provided by the various centers for care of the HIV infected patients, I spoke to a few of the public health centers and gathered that while some of them provide testing others simply provide services such as IEC (Information Education Communication), integrated counselling and testing centers, etc. On asking the personnel present, I was informed that while information was available freely, mentioning the name of the organization was forbidden without approval from the city council. This piece of information was disheartening, though I received unhindered information from the people working there. Also the state is going a long way to promote HIV testing by trying to eliminate the stigma and discrimination associated with it. The Health Secretary Mr. J. Radhakrishnan told reporters on the side-lines of an event organised as part of World AIDS Awareness Day on December 1st 2016, that though India does not permit HIV self-testing, Tamil Nadu is planning to allow self-testing with HIV kit at home. This would be permitted after quality testing and also evaluating how it can be adopted in the State. This is a major milestone in the elimination of the stigma and discrimination associated with HIV.

On further research I noticed that there are several websites which offer education as well as help to those who go seeking it. Apart from health centres established by the state (Health and Family welfare Department, Govt. of TamilNadu), working towards the goal of prevention and further spread of HIV/AIDS. To name a few, I came across SAATHI, Desire Society, AIDS Research Foundation of India and Indian Network of People Living with HIV/AIDS. SAATHI has several projects in play all year around. One of their core programmes is prevention of mother to child transmission (PMTCT) project which focusses on reducing vertical transmission (mother to child) among pregnant women accessing private health sector in the high risk states. Some of the important services provided by SAATHII are:

  1. Technical, Financial and Operational Assistance
  2. Advocacy
  3. Research to generate evidence for informed programme responses
  4. Knowledge transfer and sharing of HIV-related science, policy and advocacy updates
  5. Networking to bring people from multiple sectors together and foster collaborations

Where We Stand

We have come a long way, in our quest to prevent and control the spread of HIV/AIDS. The effort of the Tamil Nadu government in cahoots with other organization speaks a great deal about the sincerity of this state to bring this epidemic under control and make the state inclusive for those unfortunate to have contracted the infection.

List of STD Clinics in Tamil Nadu where HIV testing and other services are available:

SNo. Name of the District Name of the Medical Institution in which STD Department/Clinic is functioning.
   1. Chennai 1. Government General Hospital, Chennai.
2. Government Stanley Hospital, Chennai.
3. Government Royapettah Hospital, Chennai.
   2. Thiruvallur 4. Government Hospital, Thiruthani.
5. Government Head Quarters Hospital, Tiruvallur.
   3. Kancheepuram 6. Government Head Quarters Hospital, Kancheepuram.
7. Government Chengalpattu Medical College, Hospital     Chengalpattu.
   4. Vellore  8. Government Pentland Hospital, Vellore
9. Government Hospital, Tiruppathur.
10. Government Hospital, Gudiyatham.
  5. Thiruvannamalai 11.  Government Headquarters Hospital,        Thiruvannamalai.
  6. Villupuram 12.  Government Headquarters Hospital, Villupuram.
13.  Government Hospital, Kallakurichi.
  7. Cuddalore 14.  Government Headquarters Hospital, Cuddalore.
  8. Salem 15.  Government Mohan Kumaramangalam Medical College Hospital, Salem.
16.  Government Headquarters Hospital, Mettur Dam.
  9. Dharmapuri 17.  Government Headquarters Hospital, Dharmapuri.
18.  Government Hospital, Krishnagiri.
19.  Government Hospital, Hosur.
 10. Erode 20.  Government Headquarters Hospital, Erode.
21.  Government Hospital, Gobichettipalayam.
 11. Nilgiris 22.  Government Headquarters Hospital, Ootacamund
23.  Government Hospital, Coonoor.
 12. Coimbatore 24.  Government Coimbatore Medical College Hospital,  Coimbatore.
25.  Government Headquarters Hospital, Tiruppur.
26.  Government Hospital, Udumalpet.
 13. Dindigul 27.  Government Headquarters Hospital, Dindigul.
28.  Government Hospital, Palani.
 14. Namakkal 29.  Government Headquarters Hospital, Namakkal.
 15. Karur 30.  Government Headquarters Hospital, Karur.
 16. Perambalur 31.  Government Headquarters Hospital, Perambalur
 17. Tiruchirapalli 32.  Government Annal Gandhi Memorial Medical College Hospital, Tiruchirapalli.
33.  Government Hospital, Thuraiyur.
34.  Government Hospital, Srirangam.
 18. Thanjavur 35.  Government Hospital, Kumbakonam.
36.  Government R.S.Hospital, Thanjavur.
37.  Government Hospital, Pattukottai.
38.  Government Hospital, Mayiladuthurai.
 19. Thiruvarur NIL
20. Nagapattinam 39.  Government Headquarters Hospital, Nagapattinam.
21. Pudukkottai 40.  Government Headquarters Hospital, Pudukkottai.
41.  Government Hospital, Aranthangi.
 22. Sivagangai 42.  Government Headquarters Hospital, Sivagangai
23. Madurai 43.  Government Rajaji Hospital, Madurai.
44.  Government Headquarters Hospital, Usilampatti
24. Theni 45.  Government Headquarters Hospital, Periakulam at Theni.
 25. Virudhunagar 46.  Government Headquarters Hospital, Virudhunagar
 26. Ramanathapuram 47.  Government Headquarters Hospital,        Ramanathapuram.
48.  Government Hospital, Rameswaram.
 27. Thoothukudi 49.  Government Medical College Hospital, Thoothukudi
50.  Government Hospital, Tiruchendur.
 28. Thirunelveli 51.  Thirunelveli Medical College Hospital, Thirunelveli.
52.  Government Headquarters Hospital, Thenkasi.
53.  Government Hospital, Koilpatti.
54.  Government Hospital, Sankarankoil.
 29. Kanyakumari 55.  Government Headquarters Hospital, Nagercoil.
56.  Government Hospital, Padmanabhapuram.

Here’s a list of care and support centres compiled for any patient’s reference:

LIST OF CARE AND SUPPORT CENTRES

USEFUL LINKS

AIDS Prevention and Control Project

AVERT

National AIDS Control Organisation

South Asia against AIDS Foundation

Tamil Nadu State AIDS Control Society

The Joint United Nations Programme on HIV/AIDS

The United Nations Children’s Fund

World Health Organization

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