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Obesity is associated with hypertension

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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IVF Treatment Center

In Vitro fertilisation, also known as IVF, is a fertility treatment where in fertilisation takes place in the lab instead of the female body.

The basic steps involved in IVF technology is taking many eggs from female retrieved through transvaginal ultrasound-guided needle and placing in a petri-dish with cleanly washed sperm cells retrieved via masturbation or else sperm donor. The retrieved eggs will become fertilized by the sperm cells and become embryos. One of the healthy embryo is then transferred to the same female uterus. After process completion, bed rest is advised for at least 24 hrs.

An estimated 6.5 million IVF conceived babies have been born in the world since IVF conception in 1980s. Also famously known as test tube babies, produced by IVF are as healthy and normal as naturally conceived children.

Success rate of IVF, according to a study of approximately 156,000 women, the average live-birth rate for the first cycle was 29.5 percent, which is a comparable success ratio as that to couples with the natural cycle of fertility. Researchers in the UK have developed a prediction model to estimate the success rate of a live birth over multiple cycles of IVF. This prediction model can be personalized based on a number of variables (reproductive history, maternal age, the cause of infertility, and lifestyle factors) as well as their response to treatment for a realistic understanding of the long-term probability of success of IVF.

In Vitro fertilisation

IVF is the preferred choice of treatment in the following health conditions:

  1. Fallopian tube damage or pathology: women with blocked or removed fallopian tubes
  2. Unexplained infertility (idiopathic): irregular ovulation cycles 
  3. Male factor: low sperm count may turn to an intracytoplasmic sperm injection (ICSI) which only required 1 healthy sperm to fertilize an egg.
  4. Endometriosis
  5. Cervical factor / immunological infertility: polycystic ovarian syndrome (PCOS) 
  6. Hormonal disturbances

Further, obesity can also complicate IVF, making it harder for overweight women to have successful IVF with their own eggs. Obesity is associated with increased dose and duration of gonadotropin stimulation, lower peak E2 levels, and increased oocyte retrieval time.

A large study published in 2013 reviewed over 9,500 egg donation IVF treatments. The egg donors were all of normal weight, and the recipients were divided into four groups: underweight, normal, overweight and obese. The rates of embryo implantation reduced to 23%, pregnancy rate decreased by 19% and live birth percentage reduced by 27% as body mass index (BMI), increased to obese.

A recent study indicated that obese women may need different doses and dosing regimen and fertility drugs than normal-weight women in order to ensure that their eggs ripen at the right time and can be extracted for IVF.

Therefore, it is recommended that patients with a high BMI reduce their weight before IVF treatment. Bariatric surgical procedures can be a durable option for weight reduction. This study highlights 5 patients who underwent Roux-en-Y gastric bypass bariatric surgery followed by in vitro fertilisation (IVF). Overall, these patients tolerated IVF well, and four of the five went on to have term deliveries. Rapid weight loss and increased risk of nutritional deficiencies in the first year after bariatric surgery have led to recommendations that gastric bypass surgery patients should wait at least a year before attempting pregnancy. IVF after bariatric surgery can be safe and successful.

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spine problems

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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Joint Replacement Surgery

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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