Obesity- A real problem??

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Dr Qazi Arif

Are you always being teased by your friend as obese?
Does your spouse always insist you to lose some weight?
Are your clothes becoming tighter day by day?
Are you really worried being obese?
If answer to any of the question is YES then go on reading
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What does overweight or obesity mean?
“Excessive fat accumulation that is hazard for health is obesity”

Why a person becomes obese?
Obesity is usually the result of an imbalance between calories consumed and calories expended by a person.
A combination of increased consumption of highly calorific foods, without an equal increase in physical activity that leads to a positive energy balance which causes increase in weight.
What we eat should be expended or else it leads to excess.
How some persons put on weight despite dieting or regular exercise? That can be explained on the basis of their genetic susceptibility.
A few cases are caused by some endocrine disorders, medications, or mental illness, stress or some genetic diseases.
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What is the current trend?
Obesity is one of the leading causes of death worldwide, with increasing rates in adults and children particularly in urban areas. Evidence suggests over the last 35 years, the no. of obese people has become double. In modern era easily accessible and palatable diet, increased use of vehicles and mechanized manufacturing are the possible causes.
Obesity is more common in women than men. Earlier obesity was supposed to be symbol of wealth (
) but now scene has changed and everybody wants to be slim n fit due to increased awareness about hazardous effects of obesity.
Obesity and Diet
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Our diet consists of mainly carbohydrates proteins and fat. And it is observed that most of the extra food energy comes from an increase in carbohydrate consumption rather than fat consumption. The primary sources of these extra carbohydrates are consumption of fast foods, sweetened drinks such as soft drinks, fruit drinks, and energy and potato chips etc. is believed to be contributing to the rising rates of obesity.
Sedentary lifestyle
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Another important factor that plays significant role in obesity is sedentary lifestyle. Day by day world is shifting towards less physically demanding work, in addition to insufficient exercise. Increasing mechanized transportation and a greater prevalence of labour-saving technology in the home also making the things easy for obesity. Spending leisure time in front of television cannot be ignored.
Other illnesses

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Credits: glamcheck.com

Certain physical and mental illnesses and medicines used to treat them can increase risk of obesity.
Certain medications may cause weight gain or changes in body composition; these include some medicines used against diabetes, psychiatric diseases depression, convulsions. Not all but some commonly used medicines also contribute to it. Some forms of hormonal contraception and steroids are also responsible factors.
How it is diagnosed?
Whenever any person asks me, am i obese? Then as a doctor asking simply weight of that person is not enough, we ask height also so that we can calculate BMI. If 2 persons are having same weight, one can be obese and can have other normal weight, its due to difference in their heights.
Now what is BMI?
Body mass index (BMI) is a commonly used tool used by us to classify overweight and obesity in adults.
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BMI is the weight in kilograms divided by the square of the height in metres (kg/m2).
Depending on that person is classified into different categories:
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So our goal should be to keep the BMI in the range of 18.5 – 24.9.
WHO defines overweight as a BMI equal to or more than 25, and obesity as a BMI equal to or more than 30.
Advantage of using BMI is that it can be used for both males and females and give rough estimate of your obesity status. But BMI cannot suggest the total body fat so we have other parametres.
Waist circumference
It is a simple and practical method of identifying overweight people who are at increased risk of obesity. It’s a good screening tool and does not depend on height.
Correct method to measure your waist circumference is:
1. In standing position place a measuring tape around your middle, midway between your lower point of rib and highest of your hipbones.
2. Keep the tape horizontal around the waist.
3. Do not compress the skin but keep the tape snug.
4. Just after you breathe out take the reading.

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Credits: whyiexercise.com

If waist circumference is greater than 40inches for men and 35inches for women, it means they have excess abdominal fat, which puts them at greater risk of health problems, even if their BMI is about normal.
Waist to Hip Ratio (WHR)
Calculation of WHR is easy and you can easily do at your home. It’s better to have lower waist-to-hip ratio as more the WHR more is the risk. If you are wider at the waist then more is the chances to have obesity related health problems.
Women with a waist-to-hip ratio of 0.8 or less, or men with a ratio of 0.9 or less, are considered “safe.” A WHR of 1.0 or higher, for both gender, is considered “at risk” for overweight-associated health problems.
How to calculate WHR
Measure waist circumference with the technique as above then write it down.
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Now again in the standing position wrap a flexible tape measure around your hips below the most prominent bony point as shown in the picture.
The resulting measurement is your hip circumference. Again, write it down.

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Credits: whyiexercise.com

Divide your waist circumference by your hip circumference. The result is your waist-to-hip ratio or WHR.
For example: A waist measurement of 30 inches (75 cm) divided by a hip measurement of 36 inches (90 cm) would calculate to a WHR of 0.83.
So I have provided you the methods, now just apply it and see are you really obese???
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Y chromosome or WHY chromosome???

At 2am, ward boy knocked the  doctor’s room door…..
“Sir new patient” he shouted from outside.
I got up and opened the door. He further informed “burn patient”
“Ok I’m coming” I told after opening the door.
It was really the coldest night of the season. Everybody was wearing either shawl or sweater. At the peak of coldness, I was very lazy, but still I had to do attend that patient.
I rushed to emergency room, the patient was young female, on asking details, she was KUSUM A NEWLY MARRIED BURN PATIENT. Burnt from top to bottom, asking for water. She was so thirsty that she could drink whole the river. Screaming in agony.
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Those who were accompanying her told that after sunset, they found her naked on the front step of her house where she was living with her husband and in-laws on the outskirts of the city.
She was burnt more than 80 per cent of her body. The only places not burned were the inside of her arms, her ankle, some part on her belly and the area around her eyes. However, her scream was more horrible than her charred body. Wrapped in blankets and burnt saree, one could hardly see normal skin. Kerosene smell was making its presence felt.
On inquiring, persons which were accompanying her were her neighbours. They were looking puzzled.
When I examined her, she was cold like a dead body, pulse was barely palpable.
I was not getting any vein as If all her blood was dried up. Limbs were swollen. I did emergency venous cutdown (emergency proceduere where skin is cut and cannula is put in the vein under vision). My aim was to give her fluid so that she should not dry up. She was in agony, nursing staff was active enough to give her necessary injections and pain relieving medications which I advised.
With initial medications we somehow managed to give her some relief with saline administration in jet.
By this time, her parents came to the hospital, I was standing beside her doing necessary management. Her mother entered yelling. She was crying like anything “maine kaha tha myke aa ja lekin wo nahi mani”
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I didnot tell her anything I was just watching this worst part of her emotions. Father who was standing behind wasnot saying a single word but his eyes were expressing all his emotions. Continuously flowing tears were making his emaciated face more worried. Mother was shouting continuously “wo log insan nahi hai, bhagwan unko saza de kr hi rahega”
Her father came to me and asked “meri beti ko bacha lo”
I had no words but I had to tell him something I told “Hum bachane ki poori koshish kar rahe hai lekin….”
I was looking at his face and i dont know why it was very difficult for me to utter these words. But i continued after a pause “…Lekin bachne ki ummid bahot kam hai”
He told with his dried tongue “docto sahab koi bhi dawa do chahe kitni bhi mehangi ho mai laane ke liye tayyar hu”.
I was looking at his poor face i knew he would sell himself but will arrange something to buy that medicine but it was unfortunate that nowhere in my medical books i read any medicine which could save his daughter.
Her father showed me her wedding picture, she was a cute village girl, wearing red saree with bridal makeup. But now she was a charred body, hardly one can see her facial features.

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This pic does not represent real kusum

I asked him how this has happened??
He told “my daughter got married last year. It was the mightiest wedding cermony in his village. For initial few months everything was perfect, then her in laws started pressuring her for dowry.
They started asking for cash, gold to start new business. They told the money which i gave at the time of wedding was not sufficient though i gave what was decided earlier.
Gradually demands for money turned to threats of violence, they started beating her often and now see what they have done this time”. He started crying like a kid.
I was not brave enough to stay there and see the worst side of our society. I left the place.
I knew she has very less chance of survival and even if she survives its going to be a roller coaster ride for all.
About 2hours later she took her last breath infront of me, and i was standing helplessly witnessing another dowry death.
This story doesnot end here, it is the same repeated story you can find in any government hospital of India. Statistics say one woman die of dowry death every hour in India, more than 8000 women a year according to National Crime Records Bureau (NCRB).
You might think this only affects poor, uneducated people but higher socio-economic strata is equally involved in such practices. Even the highly educated class of our society do not say no to dowry. It runs deep into our social system and most of the time dowry deaths are not reported.
Though dowry is not a new word for Indian but if we define it ‘Dowry is the sum of all the money as well as other items such as jewellery, car, furniture, and house, etc., given by the bride’s family to the groom and his family.’
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But greed is limitless, which many a time leads to either suicide in some cases or murder in some.
Though feminist groups are active in increase awareness regarding the problem of dowry, dowry harassment and dowry deaths. They devise strategies.
Government is also making efforts to stop this worst custom of dowry.
The Section 304-B, IPC deals with the Dowry Prohibition Amendment Act. Apart from this Act, we also have Protection of Women from Domestic Violence Act, 2005.
Despite all these getting dowry death cases are the usual phenomenon. Its a social evil which should be stopped.

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Here are some of my suggestions and solutions to tackle the situation.

1. Awareness: The prime solution to the problem of dowry deaths is awareness. Women should be taught about her legal rights and this can be achieved by setting up some awareness programmes in different sections of the society.
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2. Education: alternative approach to increase awareness by educating people about such issues and imbibing such social issues into the curriculum of primary education.
3. Strict punishments and speedy trials of the cases: heavy punishment to the people convicted of crime related to dowry can also help to creat deterrent effects. In addition speedy trials will surely help the victims.
4. Enforcement Mechanisms to be strengthened:
Though we have many laws against it but still the problem of dowry demand continues, now it is the time to strengthen the enforcement of these legislations.
5. Intellectual people should play an active part. So many blogs/articles or even books can be written on this topic but now enough is enough. All of us especially young people should take initiative. We can start campaign with the use of social media. Take positive steps to “STOP DOWRY DEATHS”.
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Kill cancer before it KILLS YOU…

Written by: Dr Arif Qazi
                                         

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One disease, which everybody feared of is CANCER. In modern era, we are surrounded by so many factors which directly or indirectly cause cancer. Many a time we know the direct association of certain substance ingestion or use with cancer still we take a chance and continue to use them, underestimating the risk. I would say only a fool can take risks to such an extent that his/her habits take his/her own life.
Here I am presenting the most common example how people make a fool out of themselves….

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Credits: medicalnewstoday.com

First lets know What is cancer?
Cancer is uncontrollable growth of cells that invade and cause damage to surrounding tissue.

What is Oral (mouth) cancer?
Oral cancer is the 3rd the most common type which accounts for over 30% of all cancers in India. Almost 80,000 cases are diagnosed every year.
According to the report, almost one million people die of oral cancer in India yearly.
Oral cancers include cancers of the:
lips
tongue
cheek
gums
floor of the mouth
hard and soft palate.

Most of the time, patient comes to the hospital in late stage but Early detection is the key to for better results.
Who are at risk of oral cancer?
1) Tobacco use in any form like smoking cigarettes, bidi, cigars, and pipes, as well as chewing tobacco quid, khenni.

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•Another major problem is the use of betel quid (paan), which is made of pieces of areca nut, processed or unprocessed tobacco, aqueous calcium hydroxide (slaked lime), and some spices wrapped in the leaf of piper betel vine leaf. Gutka, zarda, kharra, mawa, and khainni are also all dry mixtures of lime, areca nut flakes, and powdered tobacco.
•Bidis: Those who smoke bidis have a three-fold higher risk of mouth cancer as compared to nonsmokers.

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2) Alcohol intake: People who take large amounts of alcohol and tobacco are at greater risk, especially when both products are used regularly.
Risk increases when both (tobacco and alcohol) taken together.
3) Other risk factors include:
HPV infection (a sexually transmitted virus)
• Chronic facial sun exposure
• Previous diagnosis of oral cancer
Family history of oral or other types of cancer
Sharp tooth
• Chronic Syphilis
Poor nutrition
• Being male
Age more than 40yrs

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There are studies, which indicate a diet low in fruits and vegetables could be a risk factor.
What are symptoms of oral cancer?
Symptoms of oral cancer include:
•a sore on the lip or mouth that does not heal
•a mass or growth anywhere in the mouth
• white or red patches in mouth or lips

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Credit: dentallecnotes.blogspot.in

•bleeding from the mouth
•pain or difficulty in swallowing
•loosening of teeth and difficulty in wearing dentures
•swelling in the neck
•ear pain that won’t go away
•sudden weight loss
•numbness in lower lip, face, neck, or chin
•Difficulty in opening mouth

If you notice any of these symptoms, especially if they persist, or you have more than one at a time, visit your dentist or doctor as soon as possible.
White/red patch in the oral cavity or thickening of inner side of cheek causing restricted mouth opening, are curable conditions. If left untreated can lead to cancer.
How is oral cancer diagnosed?
1) Thourough physical examination by doctor. This includes closely examining the whole the oral cavity. lips, tongue, cheek, gums, floor of the mouth, hard and soft palate.
2) If your doctor finds any abnormality, he may perform a biopsy. A tissue biopsy involves removing a piece of the tissue so it can be examined under a microscope for cancerous cells.

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Credit: oralcancernews.org

3) In addition, your doctor may perform one or more of the following tests:
•X-rays to see if cancer cells have spread to other parts of the body.
•CT scan to know further details of spread of cancer.
•OPG etc.
What are the stages of oral cancer?
There are 4 stages of oral cancer. early stages i.e. Stages 1 and 2 usually involve a small tumor. In these stages, cancer cells are limited and have better results.

Stages 3 and 4 are considered advanced stages of cancer. In these stages, tumors are large and the cancer cells usually spread other parts of the body. It has the worse outcome.
So early diagnosis and timely treatment are the key of good results.
How is oral cancer treated?
Treatment for oral cancer depends on the type, location, and stage of the cancer at the time of diagnosis.
●Early stages can be treated by surgery to remove the tumor and cancerous lymph nodes.
In addition, other tissues around the mouth and neck may be taken out.
●Radiotherapy where cancer cells are destroyed with radiations is another option.
●Chemotherapy is treatment with drugs that kill cancer cells. The medicines are given either orally or through an intravenous (IV) line.

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Jofs.in

●Proper nutrition is also an important part of your oral cancer treatment. As surgery or other treatment make it difficult or painful to eat and swallow, and poor appetite and weight loss are common getting proper nutrition is very important part of treatment.
●Last but not the least keeping good oral hygiene during treatment is very crucial.
●While recovering from oral cancer treatment reconstruction of mouth, bones may be required, which are removed during surgery for better cosmetics and functional purpose.
●Speech therapy can also be required after excising tongue or other mouth parts.
●Psychological support is utmost important during whole the process.
How to Prevent Oral Cancer?
To prevent oral cancer:
1. Don’t smoke or use any tobacco products
2. Stop drinking alcohol or drink in moderation
3. Eat a well-balanced diet.
4. Limit your exposure to the sun.
5. Conduct a self-exam at least once a month.

▪Using a bright light and a mirror, look and feel lips and front of gums.
▪Tilt head back and look at and feel the roof of mouth. See the cheeks.
▪Take out tongue and look at all sides. Examine the floor of mouth. Look at the back of the throat.
▪Feel for swelling orenlarged lymph nodes in both sides of neck and under your lower jaw.
6. Visit a doctor immediately if you notice any abnormality.
7. See your dentist on a regularly. Doctor is always the best person to identify any abnormality.
8. Second-hand smoke is also an issue so protect yourself from being a passive smoker.
9) maintain good oral hygiene.

I hope this blog will help you to understand and prevent this deadly disease.

Warning : click here to see the pictures of oral cancer patients. These pictures may cause distress to your mind. My poupose of showing these photos only to show you the graveness of this disease.