Obesity
Dr. S. Sachidaanda Kamath Dr. bobby K. Mathew
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What is obesity? A condition in which there is 10% or more increase in body weight than ideal weight is termed as overweight and if it is 20% or more above the ideal weight, it is obesity.
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What is ideal weight? This varies from person to person. It depends upon the individuals height, weight, BMI (Body Mass Index). The nature of his work etc.
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How can I find out my ideal weight? Standard height - weight chart is given below.
Height in Cm.
Ideal Wt. in Kg.
Male
Over Wt. Under Wt. Limit in Kg. Limit in Kg. Ideal Wt. in Kg.
Female
Over Wt. Under Wt. Limit in Kg. Limit in Kg.
148 152 156 160 164 168 172 176 180
47.5 49.0 51.5 53.5 56.0 59.5 62.0 65.6 68.5
57.0 59.0 62.0 64.0 67.0 69.5 74.5 78.5 82.0
38.0 39.0 41.0 43.0 45.0 49.5 52.4 55.5 57.5
46.4 48.5 50.5 52.5 55.0 58.0 60.5 64.0 67.0
56.0 58.0 60.5 63.0 66.0 69.0 72.5 77.0 80.5
37.0 39.0 40.5 42.0 44.0 46.5 48.5 51.5 53.5
But this may vary as said above. More scientific method to find your ideal weight is by finding out your Body Mass Index(BMI).
Welcare Hospital
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What is Body Mass Idex (BMI)?
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How do we put on weight? Our body needs energy for its normal function (Basic Metabolic Rate - BMR) and for various activities. It derives this energy from the food we consume. All humans have a recommended dietary allowance of nutrients (RDA) for its proper functioning. When we consume food in excess of our RDA, our body stores the excess energy as fat around our organs and beneath our skin. When we have excess accumulated fat we become obese.
BMI (BODY MASS INDEX) CHART
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How can we burn out the excess fat? Reduction in calorie rich foods + Increase in activity = Reduction in body fat.
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What are the nutrients we should avoid? We should not avoid any nutrients but by choosing our food sensibly, we can achieve weight loss.
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Do all people lose weight in the same way?
Plot your height and weight on to find out your BMI.
No, each individual is different and so the weight loss also will vary accordingly. For example, if you have any medical complication, your weight lose will be slower than a normal individual.
Drinking adequate quantity of water a day will help to keep fat away
Obesity may lead to :
1. Physical disability : a) Since legs have to carry extra weight, complications like osteoarthritis of knee, hips and lumbar spine are common. b) the abdominal muscles weakens hernia. 2. Metabolic disorders : a) Obesity has close association with diabetes. b) Plasmacholesterol level will increase, causing gall stones and arthrosclerosis c) Gout is also common in obese people. 3. Cardiovascular disorders : Apart from arthrosclerosis, obese people develop high blood pressure. Varicose veins etc.
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Advantages of Weight loss
Reduction in blood pressure Reduction in total cholesterol Increase in physical activity Weight loss reduces risk factors of diabetes, coronary heart disease and cancer
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4. Sleep apnea : A transitory cessation of breathing is increasingly identified in obese children and adolescents. 5. Prone to accidents : Due to imbalance and movement restriction. 6. Osteoarthritis : The weight bearing joints gets degenerated causing pain and disability. 7. Obstetrical risks reduced facility, gestational diabetes, blood pressure etc. are some of the problems. 8. Psychological disturbances : Inferiority feeling, self blame, withdrawal etc. are common in obese subjects. 9. Low life expectancy : Statistics of Metropolitan Life Insurance, USA shows that for a man aged 45, an increase of 12 kg. above standard weight reduced his life expectancy by 25%. 10. Cancer : Certain cancers like colon rectum and prostate in men. Uterus, billiary tract, breast, ovary in women, digestive tract disorders and skin disorders are more prevalent in the obese.
Reduction in skin problems Reduction in arthritis and joint pain Good balance and posture. Reduction in psychological problems makes people confident and beautiful.
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Improves self esteem
Beware of junk foods
Food stuffs
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Harmful effects of junk foods
Food Ingredients
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Harmful ingredients Refined flour, mayonnaise, margarine, reheated oil, baking powder, high sodium content, red meat High sodium and potassium nitrate Reheated oil, high fat content, high sodium content Artificial colours, flavours, high amount of fat, gelling agents High in fat, aginomoto, fish sauce Sodium and potassium nitrates Cyclamte High sodium and fat content Artificial colours, ghee or vanaspati with argemone oil, artificial flavours
Bakery items, Burgers Pizza etc.
Effect in the body
Malignant bladder tumour and renal tubular acidosis
Cyclamate
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Pickles Chips and other fried snacks Ice creams and other desserts Chinese food items Bacons Soft drinks, squashes etc. Instant and ready to eat foods sweets
Excessive use of red meat Digestive tract and colon cancer Excessive use of fish sauce Gastric cancer Excessive fat intake Obesity, cardiovascular diseases, high blood pressure, prostrate cancer. Cancer Cardiovascular diseases and obesity numbness, general weakness, cancer
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Sodium and Potassium nitrates Excessive use of mayonnaise Excessive use of Mono sodium glutamate (ajinomoto)
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Ghee and oils adulterated Glaucoma and epidemic dropsy with argemone oil Excessive use of chillies High sodium content Reheated Oil Artificial colours and gelling agents Refined flour Peptic ulcer Oedema, high blood pressure Cancer Cancer Constipation, Intestinal disorder
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Myths and Facts
1. Taking honey will shed your weight. Honey has calories as in any other food item but if you take honey with lime in the morning it will detoxify your body and increase your metabolism. 2. Curd is not nutritionally good as milk. When compared to milk, curd and butter milk is easily digested and better utilised by our body. 3. Fruit juice is good for weight loss. When we take juice we lose the fibre part of the fruit which is good for weight loss and juice has concentrated calories than a single fruit. So it is better to take whole fruits than juices. 4. Refined oils are fat free. All oils are fat so reduce the amount of oil you consume even if it is refined. 5. Avoid using oily fishes. Oily fishes like sardine, mackerel etc. are rich in omega-3 fatty acids which reduces bad cholesterol in the blood, so include small fishes in your diet. 6. Daily exercises will cause weakness.
Daily exercise will tone your muscles, your BMR will increase and you will be active and get better sleep. 7. Drinking more water causes water retention. When your body has more salt concentration your body tends to accumulate water in its cells. If we drink more water the salt gets removed from our body through urine. So drinking water helps to reduce water retention. 8. Starving will cause weight loss. When we starve we loss our muscle mass and so our body fat is not burned. This is not desirable and when we start eating again our body fat will go up. 9. We should eat less often to get slim. Eating more often will raise our metabolic rate and thus more calories will be used. But we have to regulate the portion size and have more calorie less foods in order to be slim. 10. If women lift weight they get musculine and muscular. Women do not have enough of male steroid testo sterone in their body to grow big muscles. So if normal non-steoid taking women lift weights as prescribed in a good exercise programme they will tone and firm their muscles and become leaner and look more feminine.
Weight reducing diet
Nutrients : Less of More of Carbohydrates Refined forms like sugar, Whole cereals, fruits, maida and its products, vegetables and pulses sooji cornflower, root and starchy vegetables and sugar rich fruits B e e f , m u t t o n , s h e l l Egg white, pulses, small fishes, egg yolk, whole fishes, skimmed milk, chicken (skin and organs milk, organ meat etc. removed) Ghee, butter, cheese, Refined oil nuts like mayonmase, animal fats, almonds etc. in limited fried and fatty foods quantity. etc. Fruit juices, soft drinks, synthetic beverages, creamy soups, Ice cream shakes etc. 10-12 glasses of water including lightly salted lime juice, thin butter milk, clear vegetable soup, vegetable juices without sugar
Cholesterol Content of foods
Food Egg fried rice Prawn pulao Beef curry Chicken curry Butter chicken Chicken fried in butter Egg curry Fried fish Mutton curry Pork curry Prawn fried Cake plain Masala Dosa with butter Quantity 1 serving 1 serving 1 serving 1 serving 1 serving 1 serving 1 serving 1 serving 1 serving 1 serving 1 serving 40 gm 200 gm 50 gm 33 gm Cholesterol (mg) 248 150 100 70 160 217 248 50 95 80 150 30 42 248 248 290 200 gm (1 cup) 200 gm (1 cup) 200 225 gm 1 cup 150 gm 150 gm 150 gm 22 0.4 95 32.5 87 42.3 58 5
Proteins
Fats
Water
whole egg Egg Yolk Egg - fried/omlette/ scrambled using 1 table spoon butter) Whole milk
and
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Minerals, Vitamin, and fibre form : Fruits, Leafy and other vegetables, skimmed milk, cereals, pulses, small fishes etc.
Skimmed milk Mutton cutlet Meat pizza - 1 small Chicken soup
One teaspoon of Sugar = 20 calorie
Paneer tikka Milk pudding Bread pudding
Approximate calorie content of common foods
Food Rice Pulao Chappathi Kadala Sambar Fruit Cake Suji Halwa Boiled Egg Butter Oil Honey Jaggery Coconut Groundnut Whole Milk (cow) Skimmed milk (cow) Butter Milk Apple Banana Dates Orange Papaya cucumber Ladies finger Potato Tomato Beer Brandy Whisky Rum Fried fish Mutton curry Prawn curry Medium size idly Dosa Puttu Appam Crab boiled without shell Beef Stew Chicken Roast Quantity 1/2 cup 1/2 cup 1 No. 1/2 cup 1/2 cup 1 piece 3/4 cup 1 No. 1 tsp. 1 tsp. 1 tsp 1 tsp. 10 gm 10 gm 200 ml 200 ml 200 ml 100 gm 120 gm 100 gm 100 gm 100 gm 150 gm 100 gm 60 gm 60 gm 240 ml 1 peg 30ml 1 peg 30ml 1 peg 30ml 85 gm 140 gm 1 kotori 1 No. 1 No. 100 gm 1 No. 100 gm 100 gm 100 gm Calorie 85 170 85 85 100 270 320 80 36 45 15 19 45 65 130 60 30 60 139 317 70 32 20 35 57 10 110 75 75 85 218 237 219 100 130 200 130 109 109 248
Restaurant Rules
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Eat something healthy before going to the restaurant Have a glass of water before ordering Search the menu for less fatty foods Order clear soups and green salads as refreshments
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Choose grilled, steamed or tandoor foods Specify to lessen butter and oil for your food Avoid desserts. If you cant resist have fruit cup, frozen yoghurt or fruit yoghurt.
Ideal couples
Combination to yield good protein
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Do
1.Walk as much as possible 2. Use stairs 3. Exaggerate your movements while at work 4. Play a lot with your children 5. Gardening, sweeping etc. 6. Go to a certified dietician and fitness trainer for help 7. Eat 5 small meals a day 8. Try low fat recipes 9. Have a regular time pattern for exercise 10. Grill, steam or bake 11. Wash vegetables before cutting 12. Use hung curd, skimmed milk paneer and olive oil
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Dont
1. Use vehicle for short distance 2.Use elevators 3. Sit for long periods at work
Appam + Kadala Iddly + Sambar Rice + Dal Chappathi + Skimmed milk paneer Wheat puttu + Soya chunks Ragi puttu + Green geam Wheat bread + Egg white Breakfast cereals + Skimmed milk
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5. Keep waiting for servant for sweeping and cleaning 6. Follow foul diets and irregular exercise 7. Starve yourself 8. Resort to emotional eating 9. Vary your exercise time too often. 10. Fry foods 11. Cut and wash 12. Use cream , cheese, butter etc.
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Cheers to happy life!
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Eat less - chew more Ride less - Run more Drive less - Walk more Talk less - Work more Sit less - move more Idle less - Think more Worry less - Laugh more Grouse less - smile more Hate less - Love more
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Make your diet change, A life style change
Family Support
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OBESITY
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It is one of the most important factor in a weight reduction programme.
What is obesity?
The family should :
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Obesity is the increase in adipose tissue mass (fat mass) in the body.
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appreciate their decision and help them in making right choices.
How is obesity assessed?
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Never tease them but give constant encouragement. Give them company for their daily exercise.
The commonest method to assess obesity is by BMI (Body Mass Index - weight in kg/ height in meters 2 .waist circumference > 80 cm in Indian female and > 90 cm in Indian male is considered abdominal obesity. Abdominal fat is the biggest risk factor for diabetes and heart disease. WHO Asian guidelines for obesity BMI 18.5 to 23 normal BMI - > 23 is overweight BMI> 27.5 is obesity
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What are the causes of obesity?
You had heavy food yesterday?
Detox your body by taking only fruits and vegetables for one day!
90% of obesity is due to imbalance between energy intake and expenditure (Exogenous obesity). That is your calorie intake by food does not match your energy spend by exercise you have weight gain. 7500 kilo calories are equivalent to one kilogram of body weight. That is suppose u have additional food intake of only 100 kcal per day you can gain 5 kg in an year. Weight gain is a slow process and we know that u have put on weight when you gain sufficient amount of weight only. Obesity is more common in women compared to men. Maximum weight gain in Indian women occurs during pregnancy and lactation . Average weight gain of Indian ladies during each preganancy is 6 to 8 kg.This weight gain is due to excess calorie intake and lack of exercise during pregnancy and breast feeding period in women.
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What is Metabolic syndrome or Syndrome X ? Metabolic syndrome has five major components
clinical features of androgen excess including seborrhea (oily skin), hirsutism and acne. Hypogonadism (sexual infantilism), short stature with growth hormone deficiency, hypothalamic tumors, insulinoma (insulin secreting tumors),and pseudohypoparathyroidism (hypocalcaemia mainly in children) can cause obesity in rare instances.
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1) abdominal obesity > 80- cm female ,> 90 cm male 2) fasting plasma sugar > 100 mg% 3) blood pressure > 130/85 4) triglyceride > 150 mg% 5) HDL cholesterol < 40 male and < 50 female If 3/5 of this is positive its metabolic syndrome. Its a symbolic indicator of obesity and related complications of diabetes , hypertension ,hyperlipidemia and heart disease .
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What are the drugs causing obesity?
What are the hormonal causes of obesity?
Hypothyroidism decreased thyroid function is a rare cause of obesity and causes a maximum weight gain of 4 kilogram in the most severe cases. Mild cases of hypothyroidism with TSH between 5 to 15 may cause weight gain less than one kilogram. Hypothyrodism is most commonly seen in females in the post pregnancy period and is the most common association of obese females and not the cause. Treatment of hypothyroidism is to keep TSH in normal range (0.5 to 2) and not to reduce body weight. Cushings syndrome steroid excess in the body can cause obesity. This most commonly occurs due to exogenous intake of steroids in any form- tablets, sprays, injection or ointments. Any form of medicine or powder given by the alternative form of medicine may contain steroid and should be carefully evaluated. Endogenous cause of steroid excess due to pituitary or adrenal tumors can rarely be the cause and need careful endocrine evaluation. Polycystic ovary syndrome is associated with obesity in 50% of cases. PCOS may present with obesity, infertilty, or
Steroids, all antipsychotic medications except bupropione hydrochloride, all the hypoglycemic agents used in treating diabetes except metformin and acarbose, all the antiepileptics agents except topiramate can cause obesity. Drugs may cause a modest weight gain of 2 to 3 kg and weight gain is mainly due to lack of exercise due to the disease condition
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Can family history of obesity cause obesity?
Obese parents have 50% chance of developing obese children and hence these children should have adequate lifestyle measures in childhood itself.50% of obese adolescents become obese adults. Low birth weight children ( < 2.5 kg) as well as macrocosmic children ( > 3.5 kg ) have increased chance of pubertal obesity. Children born to mothers with diabetes have increased chance of obesity Genetic factors of obesity Leptin, POMC, melanocortin 4 receptor, prohormone convertase gene mutation can account for 1% of cases of obesity.
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What is the main cause of obesity?
90% of obesity id due to exogenous causes ( dietary intake and sedentary lifestyle causing energy imbalance with energy intake more than the energy expenditure ).This is the most common cause of obesity but this is least acceptable to the
patients since it is a slow accumulating form of weight gain.
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What are treatment options for obesity?
CHILDHOOD OBESITY
Obesity in children is rising in epidemic propotions. Indian studies have shown that 20% of school children in affluent population are overweight or obese. Youth onset type 2 diabetes now accounts for up to 8 to 45 % of youth onset diabetes. Most common cause of childhood obesity is decreased physical activity and changes in lifestyle and dietary habits (Exogenous obesity). Most common predisposing factors for childhood obesity include sedentary lifestyle, family history of obesity, history of macrosomia or IUGR at birth and exogenous exposure to steroids. Metabolic complication of obesity in children includes the triad of diabetes, hypertension and hyperlipidemia. Screening for DM in children should be done if they have weight more than 120% for age and sex/ BMI > 85% for the age with any of the following 2 risk factors (first or second degree relative with DM, high risk ethnic group, clinical features of insulin resistance (IR) which include acanthosis nigricans, PCOS, hyperlipidemia). Screening is done with FBS and post glucose blood sugar 2 hours after glucose load of 1.75 gram / kg body weight ( 2 hour OGTT ). Childhood onset diabetes can be due to type 1 DM (genetically mediated auto immune destruction of beta cells or type 2 DM due to obesity or overweight. Type 1DM may present with classical symptoms of diabetes of polydyspsia, polyuria and weight loss. Type 2DM maybe silent may be found out by routine screening by doing OGTT in suspected children.
Dietary intervention, physical activity, lifestyle, pharmacotherapy and bariatric surgery are the five arms of obesity treatment. Basic principle of dietary intervention is 7500 kcal is equivalent to 1 kg body weight. That is if you restrict your dietary intake by 1500 kcal per day you loose one kilogram in 5 days time. Dietary intervention alone cannot be sustained for long period and rebound weight gain occurs in 80% .Diet combined with physical activity to prevent the regain of diet induced weight loss is the best measure to loose weight. The only FDA approved oral drugs for weight loss are sibutramine and orlistat.sibutaramine is given in dose of 10 to 15 mg per day and acts by causing early satiety and has an independent effect in increasing metabolic rate.Orlistat is an intestinal lipase inhibitor and inhibits fat absorption .Both these agents helps in loosing weight of 7% by 6 months and rebound weight gain occurs on discontinuation of the drugs.Metformin an insulin sensitizing agent can be given in obese diabetic or Prediabetic person and reduces weight by 1 to 2 kg. Bariatric surgery can be considered in morbidly obese person with BMI > 40 and helps in rapid weight loss of 50 % in 6 months with near total remission of diabetes in 80%. liposuction has only cosmetic benefit since it removes only subcutaneous fat and not visceral fat and rebound fat gain occurs in majority. The best treatment of obesity is to prevent obesity rather than treating it.
Hypercholestolemia is also common in children can predispose to childhood myocardial infarction. Cholesterol lowering drugs ( statins and bile acid sequestrants ) have been approved for use in children above the age of 8 years with LDL cholesterol > 160 mg%.hypothyroidism and familial hypercholesterolemia should be ruled out in children with unexplained dyslipidemia.here can be an increase in BP by 2 to 5 mm for every 10% rise in body weight .High uric acid is common in obese children and is a marker of endothelial dysfunction and future cardiac event. Acanthosis nigricans-AN (velvety brownish thickening of nape of neck and other flexural areas) in children is highly suggestive of IR and is found in 90% of cases of youth onset type 2 DM. Up to 24% of children with AN has been fond to have diabetes or Prediabetes. Polycystic ovary syndrome is now on an epidemic rise with increase in pubertal obesity in females. PCOS presents with anovulatory irregular cycles, clinical features of androgen excess and virilisation. PCOS now complicates 5 to 10% of females of reproductive age group and is now the most common cause of anovulatioin, hirsutism and androgen excess in females Gynecomastia (breast enlargement in male) is more common and persistent in males with obesity and is due to increased aromatization of testosterone to Estradiol in subcutaneous fat. Less severe cases of Gynecomastia may respond to drugs ( tamoxifen, raloxifiene) and the more severe cases require surgical reduction mammoplasty.
Pseudo tumor cerebri (benign intracranial hypertension) with headache and pappiledema are common in obese children. Up to 50 to 80% of obese children may have asympotmatic fatty liver disease (NAFLD) and may predispose cryptogenic cirrhosis in later life.Upto 25% may have elevated liver enzymes ( SGPT > SGOT ) which may cause alarm o doctors as well as parents . Obstructive sleep apnea syndrome with snoring (OSAS) in children can predispose to poor concentration and decreased school performance. Bronchial asthma can be caused as well as exacerbated by obesity. Mechanical factors, cytokines and reflux esophagitis (GERD ) can contribute to asthma . Treatment of childhood obesity is mainly aimed at dietary intervention, physical activity and lifestyle changes. The only two FDA approved drugs (sibutaramine and orlistat) for the long-term treatment of obesity are contraindicated in children less than 12 years . Metformin is approved for use in children with youth onset type 2 DM who are above 10 years of age and may cause weight loss of up to 2 kg. Prevention of childhood obesity rather than treatment should be the primary aim.
Diabetes Mellitus (DM)
DM is a silent killer. 50% of patients start treating DM when they loose an organ (after they have eye, foot, kidney or heart disease).Complications of DM depends on the diabetic control and the duration of diabetes. So start treating earlier so that you dont damage any of your organs. Type 2 Diabetes is not blood sugar alone .DM is a triad of blood sugar, high cholesterol and blood pressure.80% of patients with DM die of silent heart disease, so the equal importance to cholesterol , blood pressure and aspirin prophylaxis along with sugar control. TARGETS OF CONTROL FOR DM BY ADA (AMERICAN DIABETES ASSOCIATION) GLYCEMIC CONTROL Fasting blood sugar (FBS) Normal < 100 (90 -130 in a diabetic patient) Post prandial sugar (PPBS) Normal < 140 diabetic patient) HBAIC - < 6 Non diabetic 6 6.5 Prediabetic > 6.5 - Diabetes mellitus Diabetic goal AIC < 7 AIC > 8 Poor diabetic control Repeat HBAIC 3 monthly TARGETS OF LIPID CONTROL Total cholesterol - < 135 (< 180 in a
LDL (bad cholesterol) - <100 HDL (good cholesterol) > 40 in Men, > 50 In Women Triglyceride < 150 Cholesterol lowering drug is to be started in every diabetic patient with LDL > 100 or triglyceride > 400 TARGET FOR BLOOD PRESSURE CONTROL Optimal blood pressure < 120/80 Blood pressure treatment should be started in all diabetes patient with BP > 130/80 ASPIRIN PROPHYLAXIS in every diabetic above the age of 40 or above 21 years with risk factors unless contraindicated Check annually the eyes for diabetic retinopathy and cataract and annual urine micro -albumin for diabetic kidney screening. TMT test for cardiac function should be done in every patient with typical or atypical chest pain or resting ECG changes or with risk factors because diabetes causes silent heart attack and sudden death. 50% of diabetic men have sexual dysfunction with diabetes which is treatable with good sugar and metabolic control and testosterone replacement when needed. Ultimate aim of diabetes treatment is sugar control with HBAIC < 7. If you cant control your blood sugar with oral drugs alone add on insulin as insulin is the safest drug discovered till date for diabetes treatment.
Changes in menstrual cycle in PCOS
POLYCYSTIC OVARY SYNDROME (PCOS)
Pcos is the most common cause of irregular menstrual cycle, hirsutism, androgen excess and infertility in females of reproductive age group. PCOS affects 5 to 10% of females of this age group.
What is PCOS?
PCOS consists of the following Clinical and or biochemical features of testosterone excess Irregular menstrual cycles Ultrasound evidence of polycystic ovary Presence of two out of these three in the presence of normal thyroid function tests, prolactin, non classical CAH, virilizing tumors, Cushings syndrome and Acromegaly makes diagnosis of PCOS
Normal menstrual cycle in females ranges from 24 to 35 days. A normal female has at least 10 cycles per year.80% of females with PCOS has intermenstrual duration greater than 35 days or less than 8 cycles per year. Majority of females have excessive bleeding during their cycles.75% of cases of irregular menstrual cycles in females of reproductive age group is due to PCOS.
Ultrasound diagnosis of PCOS
Ultrasound alone is insufficient and unnecessary to make a diagnosis of PCOS.Ultrasound evidence of PCOS can be seen in 8 to 25 % of females with normal cycles and in 75% of females with chronic anovulatioin (irregular cycles) due to any other cause. Ultrasound shows polycystic ovaries in only 50% of females with PCOS.
What other conditions can mimic PCOS
Symptoms similar to PCOS can be produced by hypothyroidism, hyperprolactineima, Cushings syndrome and ovarian or adrenal tumors. All these have to be ruled out by laboratory or clinical examination before making diagnosis of PCOS.
What are the clinical features of testosterone excess in females
Seborrhea, hirsutism and acne are the most common features of androgen excess in females. Females with very much excessive increase in androgens as in ovarian and adrenal tumors can have increased muscle mass, loss of female body habitus, thickening of voice, bitemporal baldness and clitoreomegaly.80% of patients with PCOS has clinical features of androgen excess.95% of females with hirsutism have underlying PCOS.
What is the relation between PCOS and obesity?
50% of females with PCOS are obese, but remaining 50% has normal or lean body habitus. Obese females with Pcos have more severe clinical features and complications of PCOS.PCOS is most commonly a disease of pubertal onset but can occur in later age in females who are obese.
What is the orgin of PCOS?
Genetic factors, intrauterine growth retardation has been found to lead to PCOS in later life.50% of patients with PCOS has first degree relatives with PCOS, functional hyperandrogeneism, syndrome x or male pattern baldness.
What is the mechanism of PCOS?
Insulin resistance has been found to be the key culprit of Pcos.Excessive insulin causes increase in LH production from pituitary which inturn causes cyst formation in ovary and increased androgen production from ovary and adrenal.
What is the treatment for PCOS?
Obese patients with PCOS benefit by weight loss. 5 to 10% weight loss can regularize cycles in 80% of patients. Insulin sensitizing drugs Metformin and pioglitazone can correct cycles in up to 50% of patients.Hirsuitsm can be corrected by anti androgens like spironolactone and cryproterone.
MEASUREMENT CHART
Tummy
Thighs
Chest
Waist
Neck
Date
Arm
Hip
Do exercise and burn excess fat
There are two types of exercises : a) Aerobic exercise and b) anaerobic exercise Aerobic Running Walking Cycling Swimming Dancing Anaerobic Weight lifting Sprinting Jump rope Tennis, Basket Ball Foot Ball etc.
NAME AGE SEX ADDRESS
PERSONAL DETAILS
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PHONE NO.
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HEALTH ANALYSIS CHART
CALORIE EXPENDITURE FOR VARIOUS WORK OUTS
30 minute workout Moderate Walking Brisk Walking Jogging 6.7 mph Running 8.5 mph Basket ball Swimming Weight lifting Stationary biking Jumping rope Tennis Female 56 kgs 94 115 419 545 250 250 81 250 376 292 Female 66 kgs 116 141 499 648 300 300 101 300 449 349 Female 76 kgs 138 166 570 750 350 350 121 350 521 407 Male 68 111 136 505 659 300 300 96 300 300 352 Male 76 128 156 568 740 340 340 111 340 511 397 Male 84 145 176 632 821 379 379 126 379 568 442
DATE HEIGHT WEIGHT BMI IDEAL WEIGHT WEIGHT TO LOSE
: : : : : :
OPTIMUM PULSE RATE :
HABIT ANALYSIS
1. OVERWEIGHT SINCE . . . . . . . . . . . . . . . . . . . . . . . . 2. YOU ARE A Vegetarian Yes Non-Vegetarian No Ovo-Vegetarian 3. Do you skip any meals? 4. If yes which one? . . . . . . . . . . . . . . . . . . . . . . . . . 5. Which is your heartiest meal? . . . . . . . . . . . . . . . . . 6. Frequency of eating out : . . . . . . . . . . . . . . . . . . . . 7. You are fond of: Pickles and Pappad White meat Cream and Butter Fried Foods Icecream Dry Fruits Sweets Fruits Chocolates Desserts Salads Tea/Coffee
Medical Examination :
PR BP Systemic Examination :
8. Any food allergies? . . . . . . . . . . . . . . . . . . . . . . . . . 9. The excercise you prefer . . . . . . . . . . . . . . . . . . . . . 10. Family history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.P. Fluid retention Allergy PCOD arthritis Gout DM Asthma Cholesterol Hypothycoid Surgery Kidney Problem 11. Medical history :
Medical Advice :
Diet advice :
Activity Advice
Life style modification
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