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People often attribute being over or underweight to their genes To some extent research has backed this assertion, suggesting that genetics contributes to obesity by influencing things like metabolism, body fat distribution, food cravings and tendency to eat food as a way to cope with stress. The latter two are the aspects that the mental health professionals focus on.

According to the world health organization, patients with a history of attention-deficit/hyperactivity disorder and schizophrenia, have a greater chance of becoming obese. Furthermore, a study found that obese patients suffered from depression as intense as those experiencing chronic pain. This led to the conclusion that a history of mental illness may increase the risk of obesity, while obesity may increase an individual’s chances of developing a psychiatric disorder.

Obesity is largely consequent upon overconsumption of energy-rich foods, and some of the medications prescribed for schizophrenia can enhance cravings for ‘junk’ food, as well as having other effects that add to the obesity risk profile. The link between psychiatric medication and obesity may be due to the fact that psychotropic drugs not only contribute to weight gain but also create changes in the sensitivity of the body to insulin. Psychiatric complaints can also cause obesity as a result of medication effects, hormone imbalances, and the behavioral issues that result from psychiatric disorders. So it needs to be ensured that psychiatrists do not risk their patients by exposing them to obesity by using medication known to be associated with substantial weight gain, unless there is no clinically sustainable alternative to cure the mental condition of the individual.

Age and gender of a patient can determine the strength of the link between obesity and mental illness. A study in South Africa conducted found that young women were most at risk for mental illness if obese. The researcher postulated that this is a result of women being inclined to be more distressed about the perception of being overweight than men, making them susceptible to mental illness.

Depression and low self-esteem have been observed in obese patients around the world, even when there has been no previous history of mental illness. Poor self-image, physical inactivity, the biological disruptions caused by obesity, and the social stigma related to being overweight all contribute to a predisposition to mental illness. So mentioned here are some lifestyle interventions that can help obese patients:

  1. Psycho-education and advice about diet and exercise involving experts, psychiatrists, and dieticians.
  2. Monitoring of weight, waist circumference and serum glucose, lipids levels
  3. Involving people in this process that can mentally influence them and in the process help them to take ownership of the problem and empower them.

However in some cases due to complex neurobiology processes mentioned above, lifestyle intervention may not be enough. Bariatric surgery in its current form is a relatively safe and effective intervention to treat obesity in mentally ill people.

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Are adolescent with Obesity at a higher risk of Hypertension?

Written By : Dr. Apurva Vyas
Youth hypertension with Obesity

Blood pressure is required for blood to flow and carry oxygen to vital organs of the human body. But it is when; this Blood pressure gets too high results into Hypertension. This may harm the arteries and cause the heart to work harder. More of adult medical conditions, but nowadays youth falling prey to it.

Risk Factors that lead to developing hypertension in adolescents include

  • Family history has been linked to a higher risk
  • Racial predilection has been seen, the African-American population is at higher risk
  • Increasing body mass index
  • Low birth weight and intra-uterine growth retardation
  • Increased sodium consumption

Diagnosis of Hypertension in teenager emphasizes on

  1. Going through Patient History: A thorough history is essential in guiding the evaluation and management of a hypertensive adolescent
  2. Physical Examination: A comprehensive physical examination could give hint about the underlying cause of hypertension in children and the presence of target organ damage.
  3. Blood Pressure Measurement: The American Academy of Pediatrics, the European Society of Hypertension and the European Society of Cardiology recommend regular blood pressure screening in children above the age of 3 years at routine health visits.
  4. Ambulatory blood pressure monitoring uses a device that can be worn for 24 hours. It takes multiple blood pressure readings and can help get a more accurate reading of overall blood pressure.

Management of Hypertension in Youth can be achieved by

  1. Therapeutic Lifestyle Modification: Enhances on dietary management, increased physical activity, stress reduction and avoidance of drug and tobacco use. Dietary management should include age appropriate, a salt-restricted diet with an emphasis on weight loss in overweight or obese children.
  2. Pharmacological Therapy: Children who are symptomatic, who have diabetes or end organ damage such as left ventricular hypertrophy should all be prescribed antihypertensive medication. In addition, children with persistent hypertension after 6–12 months of instituting a heart-healthy lifestyle should also be prescribed a medication to lower their BP.
  3. Antihypertensive medications: Combination of drugs recommended if BP control is not achieved with a single drug.

Reports show the reversal of target organ damage following the institution of antihypertensive therapy in children. Seeman et al reported a regression in Left Ventricular Hypertension in a small pediatric cohort treated with ramipril (Antihypertensive medication) monotherapy over a 6-month period.

Other forms of therapy

The emerging trend of utilizing bariatric surgery for reversing morbid obesity in adolescents is gaining awareness. Teen-LABS consortium published the largest series of prospectively collected data on 242 adolescent patients with a mean age of 17.1 (+/−1.6) and BMI of 53. Here in the patient’s Mean weight decreased by 28% with gastric bypass and 26% with sleeve gastrectomy, which was sustained at 3 years. Weight loss, the first line treatment with obesity-related hypertension leads to a decrease in Symptomatic hyperactivity, thereby lowering BP, providing experimental evidence for effective treatment of obesity-related hypertension.

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Bariatric Surgery: The solution of Obesity surgery for Diabetes type 2

Written By : Dr. Apurva Vyas
Spine Problem

The term “Orthopaedics” signifies a medical specialty that focuses on the body’s musculoskeletal system. This includes bones, joints, muscles, ligaments, tendons, and nerves.

Pain that originates in the spine anywhere between the upper and lower back is the “back pain” we refer to in our daily lives, obesity caused ones are:-

  1. A herniated disc
  2. Spine osteoarthritis

It affects approximately three out of four adults during their lifetime. Many back-pain patients complain about symptoms like numbness and tingling sensations, stiffness, achiness, and weakness.

It is known that obese people are more prone to spinal issues than those who’re not. Deleterious weight stresses almost every organ in the body, so it is no surprise that it also increases the risk of back pain, joint pain, and muscle strain. Every extra inch adds strain to the muscles and ligaments in the back since the spine tends to become tilted and stressed unevenly to an extent that the back may even lose proper support.

Extra weight around the stomach pulls the pelvis forward which in turn strains the lower back thereby causing pain. The vertebral disc as well, of an obese individual, may get weak or damaged sooner. Excess weight is also known to worsen pre-existing spinal issues.

The four common disorders found out by researchers are:-

  1. Lower back pain
  2. Spondylosis (spine degeneration)
  3. Internal disc disruption (IDD)
  4. Neck problems unrelated to IDD or spondylosis

Due to Obesity, adipose tissue causes extra pressure on the lumbar spine and knee which exacerbates pain. Bariatric surgeries help weight loss thereby reducing pain intensity to as much as 75% to 80.8%  as cited by an article of Bariatric times. The pain score carried out in the study when compared to preoperative baseline, indicated significant symptomatic pain resolution of the pain of head, neck, shoulder and lower back. Pain relief was observed in day to day physical activities during sports as well as work. Use of Analgesic significantly reduced. An increase in Quality of life within 6 months to 1 year post operation was observed.  

As per UCLA Health article, Retrospective studies showed that after performing Bariatric surgeries, the frequency of back pain decreased in up to 83% of the patients, and lumbar back pain symptoms were reduced in 82–90% patients in a period of 6 months to one year.

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Obesity Causing Joint Problems

Written By : Dr. Apurva Vyas
Joint Problems

Our bones attach to each other at a joint, where strong tissues called tendons and ligaments help connect the bones. It is common for such joints to experience stress as we age. But it is pertinent to note that weight too plays a role along with age. Every pound of excess weight exerts about 4 pounds of extra pressure on knees. This means that if a person is 100 pounds overweight then the knees undergo 400 pounds of excess pressure. “Fat” itself is such an active tissue that releases such chemicals which promote inflammation. Researchers have also found that hand osteoarthritis (OA) is more common amongst obese people.

According to the Arthritis Foundation, the average onset of Rheumatoid arthritis (RA) is between the ages of 30 and 60, and children can also get it. RA is a chronic condition that progresses over time with periods of increased disease activity, called flares and periods of remission.

In 1971, the number of cases of arthritis primarily caused by obesity was at 3 %. By 2002, that number had increased six-fold to 18 %. An obese has a 60 % greater risk of getting arthritis than people who maintain healthy body weight. A study examined the factors contributing to total knee and hip replacements in people between the ages of 18 – 50. A remarkable 72 % of those who underwent joint replacement surgery were obese.

Bariatric or Metabolic surgery can prove to be very beneficial for joints too. For 0.5 kgs lost, 2.5 kgs of pressure on joints are reduced. Other benefits are pain reduction, increased mobility, better outcome after a joint replacement surgery etc. Bariatric surgery can be considered the best way for a joint replacement.

  1. Sleeve Gastrectomy- Reduces the stomach to approximately 15 % of its original size.
  2. Gastric Bypass-The surgery changes the absorption rate of food, as well as decreasing the amount that can be ingested.
  3. Robotic Surgery

Orthopaedic surgeons themselves are referring more patients for consideration of bariatric surgery in anticipation of future elective procedures.

Many patients pursue bariatric surgery for improvement in their physical image and somatic health improvement. Health-related quality of life improves after bariatric surgery & long-term improvements are positively associated with the long-term amount of weight reduction leading to less joint problems.

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How To Avoid Weight Gain After Bariatric Surgery (Weight loss surgery)

Written By : Dr. Apurva Vyas