Obesity is a Disease that Reduces Life Expectancy

People jogging. (Dr. Noorali Bharwani)
People jogging. (Dr. Noorali Bharwani)

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2). Ask your doctor where you stand.

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off. Habits that have been ingrained in your system since childhood.

Obesity is most commonly caused by a combination of excessive eating, lack of physical activity, and genetic susceptibility with hormonal or psychiatric disorders. Obesity increases the likelihood of various diseases, particularly heart disease, type-2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

What is the solution? Is there a way to stop this epidemic of obesity, which is a disease, a medical condition?

A political solution is needed, just like the laws against smoking, says an article in the Canadian Medical Association Journal (CMAJ November 18, 2014) titled, “A political prescription is needed to treat obesity” by Fletcher and Patrick.

Last year, World Health Organization (WHO) member states declared a target to stop the rise in obesity by 2025. A report from the Global Burden of Disease Study on global, regional and national trends in overweight and obesity has shown that obesity is still increasing worldwide, including in Canada, particularly among young people.

Governments must recognize that individual-level interventions, nutritional advice and activity guidance are not working, says the CMAJ editorial. Obesity will only be curbed by population-level measures supported by legislation. There is no disagreement among experts that physical activity is not enough to prevent or treat obesity, unless it is combined with some kind of dietary intervention.

The editorial says family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy.

Bariatric surgery (surgery for obesity) has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort.

Drugs to suppress your appetite may work to some extent, but may have nasty adverse effects.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level, says the editorial.

Experts agree there is no single solution to the problem of obesity. We should help people make better choices. People are addicted to sweet and high-fat foods that are inexpensive and easily available. We need to change our approach, says the article.

We should encourage school-based nutrition and activity, incentives for active commuting, restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products.

The editorial concludes by saying, “Our government needs to act to restrict the sale of high-calorie and nutrient-poor food products or reduce the incentive to buy them through increasing their prices via taxation.”

Can you think of a law that will make us exercise more, eat less and eat healthy? If yes, then a Nobel Prize may be waiting for you.

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Walking is Good for Balance and Preventing Falls

A dog waiting to go for a walk. (Dr. Noorali Bharwani)
A dog waiting to go for a walk. (Dr. Noorali Bharwani)

November is senior’s falls prevention month. Studies have shown that walking is good for balance. A good balance does help prevent falls.

Walking is not always easy. Changing weather and flu season is a hindrance to establish consistent walking habit. Icy roads and sidewalks are dangerous. People find indoor areas like malls and indoor walking trails in places like YMCA very helpful.

We do have many good days in spring, summer and fall. The majority of the people should be able to walk to most of the places. But the problem is we are always in a hurry to get to our destination and then rush back home. We never seem to stop and ask, “Why am I rushing? Why cannot I take my time and enjoy the walk?”

You can walk leisurely 30 minutes a day for general health benefits. You can walk briskly to improve cardiovascular fitness by walking 30 minutes a day five days a week. If you are trying to lose weight then you need to walk briskly for 45 to 60 minutes a day five days a week. And make your dinner slimmer.

Get serious about your walking. Pedometers are the easiest way to keep track and log your daily activity. UWALK recommends the Piezo StepX pedometers, however any pedometer will work – see UWALK website. You can also track and log your daily activity using other activity monitors.

In the United Kingdom and Ireland, the term walking is used to describe both walking in a park and trekking in the Alps. However, in Canada and the United States the term for a long, vigorous walk is hiking, while the word walking covers shorter walks, especially in an urban setting, says UWALK website.

Scientific literature suggests that regular, brisk exercise of any kind can improve confidence, stamina, energy, weight control and life expectancy and reduce stress. It can also reduce the risk of coronary heart disease, strokes, diabetes, high blood pressure, osteoporosis and other health problems.

There is no doubt or any disagreement in scientific literature that sustained walking sessions for a minimum period of 30 to 60 minutes a day, five days a week, reduce health risks and have various overall health benefits – physical and mental. Walking is seriously encouraged because these days people walk less than they used to. If you are not a regular walker then it is time to start. For seniors it certainly helps prevent falls.

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Is it Safe for Pregnant Women to Drive?

A lonely tree at Police Point Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)
A lonely tree at Police Point Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)

I found an interesting article in the Canadian Medical Association Journal (CMAJ July 8, 2014) regarding the above subject. Dr. Donald Redelmeier and his colleagues author the research paper titled, “Pregnancy and the risk of traffic crash.”

When a woman is pregnant there are a number of changes occurring in the body. These changes may contribute to increased driving error. The authors of the CMAJ article compared the risk of a serious motor vehicle crash during the second trimester to the baseline risk before pregnancy.

The authors analyzed women who gave birth in Ontario between April 1, 2006, and March 31, 2011. Certain groups of women were excluded from the study. The primary outcome was a motor vehicle crash resulting in a visit to an emergency department.

After analyzing all the data from the study, the conclusion was that pregnancy is associated with a substantial risk of a serious motor vehicle crash during the second trimester. The authors further suggested that this risk merits attention for prenatal care.

In a commentary associated with the article under the title, “High risk of traffic crashes in pregnancy: Are there any explanations?” Stephen J. McCall, and Sohinee Bhattacharya say that the World Health Organization classifies maternal deaths due to traffic crashes as coincidental and not related to the state of pregnancy. Others have argued that pregnancy is the root cause of such deaths, because pregnant women are more susceptible to crashes.

McCall and Bhattacharya make the following key points in their CMAJ commentary:
-Normal physiologic changes during pregnancy may increase sleep deprivation and stress, which may increase the likelihood of human error.
-Epidemiologic studies have shown an increased risk of motor vehicle crashes among women in their second trimester of pregnancy; these studies should be interpreted with caution because data on duration and frequency of driving, and on shared responsibility for crashes, were lacking.
-Further research into the biological mechanisms that may link pregnancy to car crashes is warranted.

So, like many things in medicine the jury is still out debating whether we should allow pregnant women to drive, especially during second trimester. Suffice to say whether you are male or female, pregnant or not, just drive carefully.

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Good Health Requires a Healthy Mouth

A dog watching people go by at Echo Dale Park, Medicine Hat. (Dr. Noorali Bharwani)
A dog watching people go by at Echo Dale Park, Medicine Hat. (Dr. Noorali Bharwani)

An article in the Canadian Medical Association Journal (CMAJ September 2, 2014) titled, “Good health requires a healthy mouth: improving the oral health of Canada’s seniors” says one in six seniors decline recommended dental treatment because of cost.

The Canadian Health Measures Survey reported that one in six seniors aged 60 to 79 years in the community had untreated dental caries. More than half had periodontal disease, with 15 per cent having evidence of severe disease. About one in five had no remaining teeth.

Joan L Rush, Lawyer (retired) comments on the above article in the CMAJ. Rush’s letter is titled, “The dental profession fails those most in need.” She says more than 3.8 million Canadians are disabled, and 26 per cent of this group are defined to have very severe disabilities. These people face terrible barriers getting necessary dental treatment. This group is subject to inequality in oral health both in terms of prevalence of disease and unmet dental care.

As most of us know, dental and periodontal infection has serious health implications for all individuals but especially older people. Periodontal infection is associated with systemic diseases such as coronary artery disease, stroke and aspiration pneumonia. These are very serious conditions.

There is some evidence that dental disease has been linked with diabetes, rheumatoid arthritis and obesity, among other conditions, the strongest evidence for a relationship is found with cardiovascular disease, says the article.

Why do seniors have more dental problems?

Most seniors claim to brush and floss as regularly as younger people, says the article. But there are several factors contributing to an increased risk of poor oral health in this age group. For example, as the aging process proceeds, the salivary glands reduce the amount of saliva production and increase the bacterial load in the mouth.

Other oral issues, which may affect dental care in the seniors, are: attachment of gums to teeth loosens, mechanical difficulty with brushing and flossing, chronic diseases and poor nutrition contribute to reduced immunity against infection, leading to periodontal disease.

In Canada, only Alberta and Yukon Territories provide financial assistance for dental care to people over the age of 65 years who meet certain conditions. On retirement, most Canadians lose their dental benefits and many cannot afford private insurance. What is interesting is severe periodontal disease was most prevalent in those without health insurance. In fact, a lack of health insurance was the only factor that appeared to influence the prevalence of severe disease.

The authors of the article hope that the Canadian Dental Association will create a roadmap that will lead to tangible positive oral health outcomes for seniors. I wonder how long is that going to take. But there are measures that we can take to keep our teeth and gums healthy. Here is what the Mayo Clinic website recommends:
1. Brush your teeth at least twice a day.
2. Floss daily.
3. Eat a healthy diet and limit between-meal snacks.
4. Replace your toothbrush every three to four months or sooner if bristles are frayed.
5. Schedule regular dental checkups. Contact your dentist as soon as an oral health problem arises.

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