Reversing Obesity - The French Approach

Obesity is a condition that is rapidly increasing and governments have begun to realize that measures have to be taken to control it to prevent disturbing health consequences.

The arrival of computers, mechanization of work , leisure and  transportation, easy access to films and  video games have caused activity levels to collapse and ‘passive’ weight to increase.

Unhealthy eating habits with high fat levels,and  low fruit and vegetable consumption increase obesity which in turn increases the occurrence of Non Communicable Diseases and reduces the quality of life. 

France , a country famous for its cooking traditions,is tackling the problem of overweight and obesity in children through a unique multi-sectoral approach involving  health, education, social service, transport and urban planning sectors in a national strategy that  largely works in  conjunction with local communities. 

The National Nutrition and Health programme which was launched in 2001 is working to change what children eat by improving food in schools, educating children about food and all about a balanced diet, hiring qualified nutritionists to  give advice about canteen menus and food preparation so that meals provided by nursery and primary schools are healthy. 

The health sector co -ordinates prevention and management of childhood obesity .School doctors are trained to screen for children who are over weight and refer them to their physicians. Overweight children along with their familiesare advised to follow a schedule that involves dietitians, psychologists and physical activity professionals .

After children leave school, it is even more difficult to get them to eat healthy food. Peer groups  influence what they eat.Children are surrounded by advertisements through social media encouraging them to eat foods high in fat, sugar and salt.With more mothers working and less time for home cooking, the requirement for processed foods has increased. All these result in a change in what they eat. 

Since a large majority of children watch TV on an average for more than 2 hours a day,France introduced a six point charter with broadcasters and advertisers in 2009 to support the propagation of TV and radio programs specifically aimed at young audiences on nutrition and physical activity that emphasize good eating habits and life style. 

A tax on soft drinks which has reduced the sales, a National Obesity Prevention program that improves screening for obesity and reaching out to the entire population are other French initiatives.

To monitor trends ,for comparative studies or to evaluate effectiveness of interventions, the WHO Regional Office for Europe launched its WHO European Childhood Obesity Surveillance Initiative in 2007. It issued growth standards for school age children and adolescents in 2007. These standards define children’s weight in terms of a distribution of values from 0-100 percentiles. The definition of overweight is the 85th percentile and above while for obesity it is the 97th percentile and above.Data is being collected using this.

(Source:  Europe’s Visible Epidemic. A Report by Gary Humphreys and Catherine Fiankan-Bokonya: Bulletin of the World Health Organization Volume 91, Issue 8, August 2013, 545- 620)

Protect Yourself with Insurance

With rising medical costs, it is very wise to invest in Health Insurance.   A Health Insurance Policy covers you and your family against medical expenses due to sickness or accident. The Insured in return has to pay a regular premium to the Insurer.

A Health Insurance Policy covers medical expenses only if you are hospitalised for more than 24 hours. There are some policies which cover day care procedures that do not require 24 hours hospitalisation, but only the ones mentioned in the policy document.

Insurance Cover for People with Diabetes

Diabetes not only has a tremendous effect on a person’s daily life, but also has a big impact on finances.  Today, there are more choices for people with diabetes than there was a decade ago.

Why diabetes insurance?
Diabetes is the root cause of many diseases and if left unattended, could lead to complications such as heart disease, stroke, kidney failure, major organ transplant, blindness and foot problems. Treatment for such complications is very expensive and so it is wise to have some form of protection against high costs. Diabetes insurance provides coverage for the diseases caused because of diabetes. An insurance policy safeguards a person from high costs of hospital treatment, consultancy fees, boarding and room charges, nursing, and medicines and drugs and so on.

Who can be covered?
Most insurance providers provide cover for Type II Diabetes mellitus. The sum assured of the protection policy could range from Rs. 50,000 to Rs. 10 lakhs, depending upon the need.

Cover providers 

Cover for diabetes is mostly provided by private insurers. Due to a Supreme Court ruling, companies from the government sector do not directly deny providing the cover. However, they charge, an extra ‘loading fee’ apart from the premium if the person applying for insurance is diagnosed with any special illness during medical examination. Every health insurance customer has to undergo a medical   examination before buying any policy. The key players providing diabetes insurance are  ICICI Prudential Life Insurance, Star Health Insurance, National Insurance and Bajaj Allianz General Insurance.

ICICI Prudential Life Insurance offers three different policies.

Diabetes Care
Diabetes Care is a unique critical illness insurance policy for people with Type 2 Diabetes  mellitus and Pre-diabetes. Diabetes Care not only provides financial support but also helps to manage your condition more effectively. The policy covers six critical illnesses, including heart attack, coronary artery bypass surgery, kidney failure, stroke, cancer and major organ transplant caused due to diabetes.
Key Points

• A lump-sum payment is given to the policy holder on diagnosis of any one of the above mentioned illnesses.
• According to policy terms, in the first 6 months from the date policy is bought,  if any of the six mentioned critical illness is diagnosed, the policyholder will be only eligible for the premium paid till date as benefit amount. If the disease is diagnosed between 6-12 months, the policy holder will be eligible to get a maximum of 50% of the sum assured. A policy holder will get 100% of sum assured benefit on the disease only after completion of 12 months of policy period.
• Optional cover for eye & foot complications
• Reduced premium on display of good control
• Tie-ups with leading healthcare partners to help you Manage diabetes
• Web support for better diabetes control
• Tax benefit under Section 80D of the Income Tax Act

Diabetes Care Plus -
Diabetes Care Plus covers eye and foot problems along with other diseases covered under Diabetes Care. Full death benefit is also payable on death of the insured any time during the entire policy term, including 1st policy year. Compensation is paid in case of death of the policy holder. You have to pay  an additional premium to get this policy.

Key Notes

• A person between 25 and 60 years of age can buy these policies.
• Both policies are available with  sum assured options of Rs. 3 lakhs, 5 lakhs and 10 lakhs.
• The claim is payable only on survival for 28 days from the date of diagnosis of the critical illness.
• Under these policies, ICICI offers a wellness program which includes three free check-ups and a consultation with a doctor every year.
• After the lump-sum payout is made for the 1st critical illness, the policy stands terminated.
• There will be no reimbursement offered against drug purchases, insulin or insulin delivery mechanisms.
• If a policyholder display of good control over the disease during the policy period, he can enjoy a reduced premium.

Diabetic Assure -
This is a five-year term, regular premium policy and covers kidney failure, limb amputation due to diabetes, and laser treatment. Diabetic Assure does not cover   pre-existing disease.  Diabetic Assure is available with  sum assured options of Rs 2 lakhs, 3 lakhs, 4 lakhs and 5 lakhs and is  available in selected cities only.

Star Health and Allied Insurance Co. Ltd.
Diabetes Safe
The policy offers coverage against diabetic retinopathy which requires laser treatment , diabetic nephropathy leading to chronic renal failure  and diabetic foot ulcer. This policy is available with a sum assured options of Rs 50, 000, 1 lakhs, 2 lakhs, 3 lakhs, 4 lakhs and 5 lakhs. Any person between 26 years and 65 years of age diagnosed with Type II diabetes is eligible for this insurance. It can be renewed  till the policyholder is 70 years.
Diabetes Safe protects the insured for in-patient hospitalisation expenses for a minimum of 24 hours. However, for dialysis and laser procedure this minimum 24 hours does not apply.

Key Points

• People  who have already developed complications of the disease covered are not eligible .
• All applicants have to undergo a medical screening at a company nominated centre.
• The policy does not cover treatment of pre-existing diseases or conditions .
• The insurer is not liable to make any payment for expenses incurred towards the covered illness within 900 days from the date of commencement of this policy.
• Expenses on treatment of Diabetes Mellitus Type II and cost of immune-suppressive drugs or  medicines cannot be claimed under this policy.

National Insurance-  Varistha Mediclaim Policy -
Public sector General Insurer National Insurance has included diabetes in its VaristhaMediclaim Policy. This policy is available only for senior citizens. A person between 60 years and 80 years is eligible to get insured and the age limit for renewal of the policy can be extended to 90 years. It provides a policy for a maximum of Rs 3 lakhs   with Rs 1 lakh for health and Rs 2 lakh for critical illness. Critical illness should be selected to get coverage for diabetes.

Bajaj Allianz Critical Illness Policy-
By paying an additional premium, people with diabetes can get coverage through the Critical Illness Policy. Before giving diabetes cover, a patient has to go through a medical examination The policy does not provide any benefit if illness is diagnosed within the first 90 days. Sum assured for the policy is between Rs 1 lakh and 5 lakh, while age range of the policy is from  6 years to 59 years.

Note: All health insurance policies do not cover ‘pre-existing’ diseases i.e diseases that have been in existence at the time of getting the policy. 

Since all insurance contracts are contracts of good faith be honest about your condition with the insuring company or else the contract can be made void.

Mediclaim Solutions - Diabetes Exclusive Policy

Mediclaim Solutions offers special services with respect to diabetes insurance in the form of the  Diabetes Exclusive Policy Solutions . They help people with diabetes choose the best policy that is cost effective and suits individual requirements from among various policies offered by insurers .

Snack Healthy...

For all people with diabetes, the amount, type, and time of food intake particularly carbs should be controlled to prevent fluctuations of blood glucose beyond the normal range. Space meals throughout the day instead of having heavy meals once or twice a day. In between meals have nuts, roasted chana, idli, poha, fruits, buttermilk, upma, grilled sandwich, thepla, steamed sprouts, paneer toast as snacks.

                                Beverages

                                Instead of:                                                         Have:

                       

                                Snacks

                                Instead of:                                                         Have:

                                Salads

                                Instead of:                                                          Have:

LOOK AFTER YOUR FEET…

P.Bamila
Dept. of Podiatry

As one grows older,  regular use and misuse of feet result in many changes  that affect their  shape, size and location of the fat pads on the underside, condition of the skin and toenails, health of the bones, movement and cartilage of the joints, circulation, and sensation in the feet. We rarely realize that we depend heavily on healthy feet to support ourselves and so foot problems should be prevented, or if they do happen, they should be treated  at the early stages. 

Common foot disorders in the older adult:











•     The big toe bends towards the other toes. A bunion may form on the outside edge of the knuckle of the big toe, and the big toe may lie on top of  the other toes.

•     The middle joint of the smaller toes may  protrude  and result in a painful callus on top of the joint due to friction and pressure of the shoe.

•    Pain in the joint, poor weight- bearing, and tenderness in the joint when pressure is applied may interfere with normal walking.

•    Blood vessels in the feet narrow due to circulation problems as a result of diabetes and vascular diseases. This can affect the skin and soft tissues and prevent healing of open wounds.

•     Foot problems are often related to footwear. We wear shoes to protect our feet, to keep feet clean, and for fashion. Shoes that do not support the foot properly cause foot deformities and pain because muscles become weak from disuse and allow supportive ligaments of the foot to stretch which permanently affects their structure.

•    Narrow, pointed toe boxes of shoes squeeze the toes together. This results in overlapping toes, pressure points, and decreased circulation. High heels also hurt the toes, make the ankle less stable, and the ball of the foot  has to bear too much of the  weight of the body. In addition, if used for a long time high heels can cause permanent damage to the heel cord, the toe extensor muscles on the top of the foot, and supportive structures in the arch of the foot. All these changes alter the structure and functional capacity of the foot.

Look after your feet so that you do not develop permanent foot problems.

BE SURE TO EXERCISE YOUR FEET! 

FOOT EXERCISES

1.  Sit in a chair, with feet flat on floor. Raise your toes off the floor several times. Keep the ball of the foot on floor. This helps maintain normal flexibility of the toe joints which is important for normal walking.

2.  Sit in a chair, with feet flat on floor. Slide foot back under the chair. Raise the heel, keeping the ball of the foot and the toes on the floor. This stretches tight muscles under the foot and maintains normal flexibility of the toe joints.

3 Sit in a chair, with feet flat on floor. Keeping the feet and toes flat on the floor, press the toes into the floor. Keep them straight as much as possible, not allowing them to curl. This strengthens small muscles of the toes that arise in the foot and are attached to the bones of the toes. 

4.  Sit in a chair, with feet dangling. Spread the toes apart as far as possible, then squeeze together as tight as possible. After practice, some people can put a wide rubber band around their toes and spread them against resistance, further increasing strength of the small muscles of the toes.

5.  Sit in a chair, with feet flat on the floor on the end of a bath towel. Curl the toes and draw the towel under the foot. As strength improves, add a weight to the other end of the towel.This strengthens small muscles of the toes.

6.  Sit in a chair. Place a marble on the floor, and pick it up with your toes. Strengthens small muscles of the toes.

7. Stand, holding lightly onto a counter top or heavy chair for balance. Rise up on your tip toes, then rock back to your heels, lifting your toes off the floor. This may also be done sitting if you cannot stand. This improves balance and leg strength when done standing, It  increases flexibility of foot and ankle and strengthens muscle on the front of your lower leg just to the outside of the shin bone. It is important to keep this muscle strong and your ankle flexible so that you can pick up your toes when you walk, and avoid tripping.

8.  Sit in a chair. Straighten one knee and flex the ankle. Point the toes toward the knee and feel the calf muscle stretch. Repeat 4 times on each leg, alternating legs.  This exercise will help avoid cramping in the lower leg.

Reference PUT YOUR BEST FOOT FORWARD!
by Lori McCormick, PT