verweight and obesity lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. Some confusion of the consequences of obesity arise because researchers have used different BMI cut-offs, and because the presence of many medical conditions involved in the development of obesity may confuse the effects of obesity itself.
The non-fatal, but debilitating health problems associated with obesity include respiratory difficulties, chronic musculoskeletal problems, skin problems and infertility. The more life-threatening problems fall into four main areas: CVD problems; conditions associated with insulin resistance such as type 2 diabetes; certain types of cancers, especially the hormonally related and large-bowel cancers; and gallbladder disease.
The likelihood of developing Type 2 diabetes and hypertension rises steeply with increasing body fatness. Confined to older adults for most of the 20th century, this disease now affects obese children even before puberty. Approximately 85% of people with diabetes are type 2, and of these, 90% are obese or overweight. And this is increasingly becoming a developing world problem. In 1995, the Emerging Market Economies had the highest number of diabetics. If current trends continue, India and the Middle Eastern crescent will have taken over by 2025.Large increases would also be observed in China, Latin America and the Caribbean, and the rest of Asia.
Raised BMI also increases the risks of cancer of the breast, colon, prostate, endometroium, kidney and gallbladder. Chronic overweight and obesity contribute significantly to osteoarthritis, a major cause of disability in adults. Although obesity should be considered a disease in its own right, it is also one of the key risk factors for other chronic diseases together with smoking, high blood pressure and high blood cholesterol. In the analyses carried out for World Health Report 2002, approximately 58% of diabetes and 21% of ischaemic heart disease and 8-42% of certain cancers globally were attributable to a BMI above 21 kg/m2.
Overweight in Children and Adolescents
THE PROBLEM OF OVERWEIGHT IN CHILDREN AND ADOLESCENTS
* In 1999, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years in the United States were overweight. This prevalence has nearly tripled for adolescents in the past 2 decades.
* Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to children with a healthy weight.
* Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type 2 diabetes.
* Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese. Overweight or obese adults are at risk for a number of health problems including heart disease, type 2 diabetes, high blood pressure, and some forms of cancer.
* The most immediate consequence of overweight as perceived by the children themselves is social discrimination. This is associated with poor self-esteem and depression.
THE CAUSES OF OVERWEIGHT
* Overweight in children and adolescents is generally caused by lack of physical activity, unhealthy eating patterns, or a combination of the two, with genetics and lifestyle both playing important roles in determining a child's weight.
* Our society has become very sedentary. Television, computer and video games contribute to children's inactive lifestyles.
* 43% of adolescents watch more than 2 hours of television each day.
* Children, especially girls, become less active as they move through adolescence.
DETERMINATION OF OVERWEIGHT IN CHILDREN AND ADOLESCENTS
* Doctors and other health care professionals are the best people to determine whether your child or adolescent's weight is healthy, and they can help rule out rare medical problems as the cause of unhealthy weight.
* A Body Mass Index (BMI) can be calculated from measurements of height and weight. Health professionals often use a BMI "growth chart" to help them assess whether a child or adolescent is overweight.
* A physician will also consider your child or adolescent's age and growth patterns to determine whether his or her weight is healthy.
GENERAL SUGGESTIONS
* Let your child know he or she is loved and appreciated whatever his or her weight. An overweight child probably knows better than anyone else that he or she has a weight problem. Overweight children need support, acceptance, and encouragement from their parents.
* Focus on your child's health and positive qualities, not your child's weight.
* Try not to make your child feel different if he or she is overweight but focus on gradually changing your family's physical activity and eating habits.
* Be a good role model for your child. If your child sees you enjoying healthy foods and physical activity, he or she is more likely to do the same now and for the rest of his or her life.
* Realize that an appropriate goal for many overweight children is to maintain their current weight while growing normally in height.
PHYSICAL ACTIVITY SUGGESTIONS
* Be physically active. It is recommended that Americans accumulate at least 30 minutes (adults) or 60 minutes (children) of moderate physical activity most days of the week. Even greater amounts of physical activity may be necessary for the prevention of weight gain, for weight loss, or for sustaining weight loss.
* Plan family activities that provide everyone with exercise and enjoyment.
* Provide a safe environment for your children and their friends to play actively; encourage swimming, biking, skating, ball sports, and other fun activities.
* Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games. Limit TV time to less than 2 hours a day.
HEALTHY EATING SUGGESTIONS
* Follow the Dietary Guidelines for healthy eating (www.health.gov/dietaryguidelines).
* Guide your family's choices rather than dictate foods.
* Encourage your child to eat when hungry and to eat slowly.
* Eat meals together as a family as often as possible.
* Carefully cut down on the amount of fat and calories in your family's diet.
* Don't place your child on a restrictive diet.
* Avoid the use of food as a reward.
* Avoid withholding food as punishment.
* Children should be encouraged to drink water and to limit intake of beverages with added sugars, such as soft drinks, fruit juice drinks, and sports drinks.
* Plan for healthy snacks.
* Stock the refrigerator with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks or snacks that are high in fat, calories, or added sugars and low in essential nutrients.
* Aim to eat at least 5 servings of fruits and vegetables each day.
* Discourage eating meals or snacks while watching TV.
* Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight.
IF YOUR CHILD IS OVERWEIGHT
* Many overweight children who are still growing will not need to lose weight, but can reduce their rate of weight gain so that they can "grow into" their weight.
* Your child's diet should be safe and nutritious. It should include all of the Recommended Dietary Allowances (RDAs) for vitamins, minerals, and protein and contain the foods from the major Food Guide Pyramid groups. Any weight-loss diet should be low in calories (energy) only, not in essential nutrients.
* Even with extremely overweight children, weight loss should be gradual.
* Crash diets and diet pills can compromise growth and are not recommended by many health care professionals.
* Weight lost during a diet is frequently regained unless children are motivated to change their eating habits and activity levels for a lifetime.
* Weight control must be considered a lifelong effort.
* Any weight management program for children should be supervised by a physician.
* In 1999, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years in the United States were overweight. This prevalence has nearly tripled for adolescents in the past 2 decades.
* Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to children with a healthy weight.
* Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type 2 diabetes.
* Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese. Overweight or obese adults are at risk for a number of health problems including heart disease, type 2 diabetes, high blood pressure, and some forms of cancer.
* The most immediate consequence of overweight as perceived by the children themselves is social discrimination. This is associated with poor self-esteem and depression.
THE CAUSES OF OVERWEIGHT
* Overweight in children and adolescents is generally caused by lack of physical activity, unhealthy eating patterns, or a combination of the two, with genetics and lifestyle both playing important roles in determining a child's weight.
* Our society has become very sedentary. Television, computer and video games contribute to children's inactive lifestyles.
* 43% of adolescents watch more than 2 hours of television each day.
* Children, especially girls, become less active as they move through adolescence.
DETERMINATION OF OVERWEIGHT IN CHILDREN AND ADOLESCENTS
* Doctors and other health care professionals are the best people to determine whether your child or adolescent's weight is healthy, and they can help rule out rare medical problems as the cause of unhealthy weight.
* A Body Mass Index (BMI) can be calculated from measurements of height and weight. Health professionals often use a BMI "growth chart" to help them assess whether a child or adolescent is overweight.
* A physician will also consider your child or adolescent's age and growth patterns to determine whether his or her weight is healthy.
GENERAL SUGGESTIONS
* Let your child know he or she is loved and appreciated whatever his or her weight. An overweight child probably knows better than anyone else that he or she has a weight problem. Overweight children need support, acceptance, and encouragement from their parents.
* Focus on your child's health and positive qualities, not your child's weight.
* Try not to make your child feel different if he or she is overweight but focus on gradually changing your family's physical activity and eating habits.
* Be a good role model for your child. If your child sees you enjoying healthy foods and physical activity, he or she is more likely to do the same now and for the rest of his or her life.
* Realize that an appropriate goal for many overweight children is to maintain their current weight while growing normally in height.
PHYSICAL ACTIVITY SUGGESTIONS
* Be physically active. It is recommended that Americans accumulate at least 30 minutes (adults) or 60 minutes (children) of moderate physical activity most days of the week. Even greater amounts of physical activity may be necessary for the prevention of weight gain, for weight loss, or for sustaining weight loss.
* Plan family activities that provide everyone with exercise and enjoyment.
* Provide a safe environment for your children and their friends to play actively; encourage swimming, biking, skating, ball sports, and other fun activities.
* Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games. Limit TV time to less than 2 hours a day.
HEALTHY EATING SUGGESTIONS
* Follow the Dietary Guidelines for healthy eating (www.health.gov/dietaryguidelines).
* Guide your family's choices rather than dictate foods.
* Encourage your child to eat when hungry and to eat slowly.
* Eat meals together as a family as often as possible.
* Carefully cut down on the amount of fat and calories in your family's diet.
* Don't place your child on a restrictive diet.
* Avoid the use of food as a reward.
* Avoid withholding food as punishment.
* Children should be encouraged to drink water and to limit intake of beverages with added sugars, such as soft drinks, fruit juice drinks, and sports drinks.
* Plan for healthy snacks.
* Stock the refrigerator with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks or snacks that are high in fat, calories, or added sugars and low in essential nutrients.
* Aim to eat at least 5 servings of fruits and vegetables each day.
* Discourage eating meals or snacks while watching TV.
* Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight.
IF YOUR CHILD IS OVERWEIGHT
* Many overweight children who are still growing will not need to lose weight, but can reduce their rate of weight gain so that they can "grow into" their weight.
* Your child's diet should be safe and nutritious. It should include all of the Recommended Dietary Allowances (RDAs) for vitamins, minerals, and protein and contain the foods from the major Food Guide Pyramid groups. Any weight-loss diet should be low in calories (energy) only, not in essential nutrients.
* Even with extremely overweight children, weight loss should be gradual.
* Crash diets and diet pills can compromise growth and are not recommended by many health care professionals.
* Weight lost during a diet is frequently regained unless children are motivated to change their eating habits and activity levels for a lifetime.
* Weight control must be considered a lifelong effort.
* Any weight management program for children should be supervised by a physician.
Migraine Headache
A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain.
Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this activation causes many of the symptoms associated with migraine attacks; for example, the increased sympathetic nervous activity in the intestine causes nausea, vomiting, and diarrhea.
* Sympathetic activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed.
* The impaired absorption of oral medications is a common reason for the ineffectiveness of medications taken to treat migraine headaches.
* The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet.
* The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.
Migraine afflicts 28 million Americans, with females suffering more frequently (17%) than males (6%). Missed work and lost productivity from migraine create a significant public burden. Nevertheless, migraine still remains largely underdiagnosed and undertreated. Less than half of individuals with migraine are diagnosed by their doctors.
Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this activation causes many of the symptoms associated with migraine attacks; for example, the increased sympathetic nervous activity in the intestine causes nausea, vomiting, and diarrhea.
* Sympathetic activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed.
* The impaired absorption of oral medications is a common reason for the ineffectiveness of medications taken to treat migraine headaches.
* The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet.
* The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.
Migraine afflicts 28 million Americans, with females suffering more frequently (17%) than males (6%). Missed work and lost productivity from migraine create a significant public burden. Nevertheless, migraine still remains largely underdiagnosed and undertreated. Less than half of individuals with migraine are diagnosed by their doctors.
control obesity
A new study has shown that friends also may influence how much adolescents eat.
"Consider a person who usually comes home alone after school and eats out of boredom," said Dr Sarah-Jeanne Salvy, assistant professor of pediatrics in the University at Buffalo''s Division of Behavioural Medicine and first author on the study.
"But on this day, she has a play date with a friend and socializes instead of eating. In this case, socializing is acting as a substitute for eating. Identifying substitutes provides a potential way to reduce behaviour.
"Our findings underscore the importance of considering the child''s social network in studying youth''s motivation to eat.
"Previous attempts to find substitutes for food and eating have not been very successful. To our knowledge, no research has studied whether social interactions can be a substitute for food in children," she added.
Salvy said that youth''s social network might be uniquely relevant and influential to eating behaviour and choice of activities.
"Peer rejection and ostracism are obvious costs imposed on social interactions. Even the unavailability of one''s peers or friends can limit youth''s access to social settings and situations," she said.
"As a result, children may choose to engage in eating and sedentary activities when social alternatives are unavailable," she added.
The study is published in Annals of Behavioural Medicine.
"Consider a person who usually comes home alone after school and eats out of boredom," said Dr Sarah-Jeanne Salvy, assistant professor of pediatrics in the University at Buffalo''s Division of Behavioural Medicine and first author on the study.
"But on this day, she has a play date with a friend and socializes instead of eating. In this case, socializing is acting as a substitute for eating. Identifying substitutes provides a potential way to reduce behaviour.
"Our findings underscore the importance of considering the child''s social network in studying youth''s motivation to eat.
"Previous attempts to find substitutes for food and eating have not been very successful. To our knowledge, no research has studied whether social interactions can be a substitute for food in children," she added.
Salvy said that youth''s social network might be uniquely relevant and influential to eating behaviour and choice of activities.
"Peer rejection and ostracism are obvious costs imposed on social interactions. Even the unavailability of one''s peers or friends can limit youth''s access to social settings and situations," she said.
"As a result, children may choose to engage in eating and sedentary activities when social alternatives are unavailable," she added.
The study is published in Annals of Behavioural Medicine.
Proper way to use preventive medications
* Doctors familiar with the treatment of migraine headaches should prescribe preventive medications.
* Decisions about which preventive medication to use are based on the side effects of the medication and the presence of any medical conditions.
* Propranolol (Inderal) often is used first, provided that the individual does not have asthma, COPD, or heart disease. Amitriptyline (Elavil, Endep) also is used commonly.
* Preventive medications are begun at low doses and gradually increased to higher doses if needed. This minimizes side effects from the medications. Preventive medications are to be taken daily for months to years. When they are stopped, the dose needs to be gradually reduced rather than abruptly stopped. Abruptly stopping preventive medications can lead to headaches.
* In some instances, more than one drug may be needed. Non-medication and behavioral therapies also may be needed.
* Decisions about which preventive medication to use are based on the side effects of the medication and the presence of any medical conditions.
* Propranolol (Inderal) often is used first, provided that the individual does not have asthma, COPD, or heart disease. Amitriptyline (Elavil, Endep) also is used commonly.
* Preventive medications are begun at low doses and gradually increased to higher doses if needed. This minimizes side effects from the medications. Preventive medications are to be taken daily for months to years. When they are stopped, the dose needs to be gradually reduced rather than abruptly stopped. Abruptly stopping preventive medications can lead to headaches.
* In some instances, more than one drug may be needed. Non-medication and behavioral therapies also may be needed.
