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

WISH YOU A HAPPY NEW YEAR

 New Year Resolutions for people with Diabetes

The New Year is a time to make promises to take care of yourself so that you have a better tomorrow.  This year set goals to enhance your diabetes management and overall health. Your goals should be precise, not vague, assessable, measurable, true-to-life and should not take an indefinite time to achieve. 

• Visit your diabetologist, podiatrist and dietitian regularly.

• Follow your schedule for checking blood glucose levels.

• Follow exact instructions for every diabetes medication you take.

• Be aware of your A1C, blood pressure and cholesterol levels and keep them under control.

• Be active.

• Follow a well-balanced meal plan that is low in fat, concentrated sugars, and refined carbohydrates such as white bread and white rice and salt. Including  high fibre foods, such as oats, whole grains, fruits and vegetables will not only help reduce cholesterol, but also stabilize blood sugar level. Include proteins such as lean meats, seafood, low-fat dairy and plenty of water to your diet and stay away from alcohol.
  
  
  
• Don’t smoke.

• Monitor your blood pressure, blood cholesterol and kidney function regularly.

• Get your eyes and feet examined routinely. 

• If you have symptoms such as fatigue, unexplained weight loss, excessive thirst, urination or hunger, anxiety, blurred vision, frequent infections or have wounds that are slow to heal, go to your doctor immediately.

• Be familiar with the warning signs of high or low blood sugar and be prepared to counter it.

• Keep yourself up-to-date about advancements in the treatment of diabetes. For example, research has shown that getting 7 to 8 hours sleep every night can reduce the risk of diabetes, and that a person who smokes more than 20 cigarettes per day increases their risk of diabetes by almost half. Medications are always being reviewed. 

• Know your target glucose levels and monitor blood glucose regularly every day even if you have no symptoms.

• Take all your medications regularly.In addition to insulin or oral medications, a diabetic person may need other medicines, such as those necessary to control or regulate cholesterol or blood pressure. 

• Examine your feet for cuts and sores.

• Brush and floss your teeth.

• Control your weight and diabetes symptoms with exercise. There is a direct correlation between obesity, insulin levels, and diabetes… as well as many other diseases. So stay active, exercise and maintain a normal body weight.

Although diabetes is a life- long disease, following your New Year resolutions will helpreduce the risk of complications and make you feel good all through the year.
 

GUINNESS WORLD RECORD™ for largest diabetic foot screening programme on the occasion of World Diabetes Day

The Times of India, Novo Nordisk Education Foundation (NNEF) and the Diabetic Foot Society of India (DFSI) organized the world’s largest ‘Diabetic Foot Screening Programme’ all over India on 14, Novemberon the occasion of World Diabetes Day with screenings taking place across 27 locations in rural, urban  and remote  areas at the same time. It was a proud moment for the country as a total of 1676 people with diabetes were screened for foot care on one single day, which broke the existing GUINNESS WORLD RECORD of 561 screenings in 11 locations by Kaiser Permanente, San Diego, USA in March 17, 2011.MVH led with 171 screenings.

Fortuna Burke (right), adjudicator of the Guinness World records, presents the certificate to Melvin d’Souza (2nd from left) MD, Novo Nordisk.  Also seen are Dr.A.K.Das (left) , ex-president of DFSI, Dr.SanjeevKelkar (centre), President of DFSI, Dr.VijayViswanathan (3rd from right), Head & Chief Diabetologist, M.V.Hospital for Diabetes, Royapuram and Tamil film actor Mr.Basky (extreme right).

Diabetes is not a barrier:

The following are two instances of people with diabetes who have not allowed it to come in the way of their goals.

• Mr. N. Gajendran, B.Sc (Chem) (1962), AMIET, MICHE(USA) 1971, ISO 9000 Lead Auditor 1995, M.A Public Admin. 1985, MBA HRM 2013, has diabetes but he has managed both diabetes as well as varied activities all through his life. Apart from the many degrees, he also has certificates from the National Productivity Council in Supervision , and in Computer programming. He has participated in many activities such as Supervisory development and ISO 9000 training and attended many seminars, poster and essay competitions, MVH debate competition and has contributed articles to magazines. 

Mr.Gajendran with Dr. Vijay Viswanathan.

• Mr.Subramaniam  is 75 years old and has had diabetes for the past 30 years . Despite his condition he is active and represented Tamil Nadu in the 34th National Masters Athletic Championship 2013 held in Bangalore and won third place in Long jump, 2nd place in High jump and 2nd place in Triple jump events. 

Dr. Vijay with Mr. K. Subramanian

Autonomic Neuropathy

Devi.J&U.Rohini(Dietitians)
Diet Department

The kidneys remove unwanted salts, waste products, and other chemicals from the plasma along with the water in which they are dissolved. Nutrition is very important in maintaining a healthy life when diagnosed with kidney disease. Nutritional management is individualized. Nutrition may affect persons who have, or are at risk for developing renal disease. The intake of certain nutrients may influence the rate of progression of renal failure in persons with underlying renal disease. High-protein diets can strain the kidneys to the point of failure.

Why is nutrition so  important?

When food is broken down in the stomach and intestines, wastes are formed. These wastes are removed by the kidneys. However, if kidneys are not functioning properly, these waste products will build up in the bloodstream and you may feel weak, tired, nauseated and become ill. The other balancing act the kidneys perform is the regulation of the body's fluid balance. Some patients with kidney disease may retain fluid, leading to puffiness, swollen ankles, hands and feet and breathlessness

Treatment of renal disease may demand severe dietary restrictions or induce nutrient losses. Dietary management of this condition, therefore, must provide protein, energy, and other essential nutrients in amounts adequate to avoid deficiencies but sufficiently restricted to avoid stressing the diminished excretory capacity of the diseased kidney.

The goals of nutritional therapy for both acute and chronic renal failure are to maintain optimal nutritional status, to minimize the toxic effects of excess urea in the blood, to prevent loss of lean body mass, to promote patient well-being, to retard the progression of renal failure, and to postpone initiation of dialysis.

Carbohydrates and fat

Maintaining a healthy weight is important for everyone. If protein has been restricted in your diet, your energy requirements may need to be met by increasing the amount of fats (polyunsaturated and  monounsaturated) and carbohydrates in your diet. Otherwise, you will lose weight and continue to do so, which is undesirable. Once dialysis is commenced, your protein requirements increase, as some proteins are lost from the body during each dialysis session. As your feeling of well- being and appetite improves, you will find it easier to incorporate a greater variety of foods to meet your requirements.

Protein

Protein builds, repairs and maintains body tissues. It also helps the body fight infections and heal wounds. Urea is a waste product which is formed when the body breaks down protein. Your eating plan should be designed to provide enough protein for your body without causing excessive amounts of urea and thus overloading the kidneys.

Too little protein may cause:

• loss of muscle bulk and wasting
• lack of energy

Too much protein forms excess urea which may cause :

• tiredness
• nausea and vomiting
• headaches
• a bad taste in the mouth
• bad breath
• poor memory and concentration

 










Foods high in protein include :

• meat
• chicken
• fish
• eggs
• cheese, milk and other dairy foods (yoghurt, cheese)
• nuts, seeds and legumes

Sodium

Salt affects the amount of fluid the body retains. Salt also increases thirst, which can lead to drinking more fluid than your kidneys can excrete, leading to fluid retention.

This excess fluid may cause:

• high blood pressure
• swelling of ankles, feet, hands and puffiness under the eyes
• shortness of breath

In most cases, the amount of salt in your diet will need to be reduced. Your doctor and dietitian can advise about this.

Foods high in salt include:
• processed foods such as ham, sausage and meats
• dry, canned and pickles made with fish and prawns
• fast food eg. pizza, pies, hamburgers, sausage rolls
• salty snacks eg.papads , chips, salted nuts
• sauces and pickles
• salted seasonings e.g. stock cubes, celery and vegetable salts

Beware of salt substitutes as some contain potassium instead of sodium.
Potassium

Potassium is an essential mineral in the body which helps nerve endings and muscles work well. If the level of potassium is too high or low in the blood, it can cause irregularity of your heart beat. In fact, potassium levels outside the normal range may cause the heart to stop. How much potassium you can you have? This depends on your blood results, as well as the amount of urine you are passing.

Foods high in potassium include:
• dhal, whole grams and its washed and cook
• tinned and homemade soup
• red wine, cider, stout
• bananas, avocados, apricots, rock melons, spinach, mushrooms
• dried peas, beans, baked beans
• potatoes, potato crisps, pumpkin
• chocolates, cocoa,
• tomato pastes and purees
• fruit and vegetable juices
• dried fruit and fruit cake
• stone fruits
• nuts and seeds

A tip for reducing potassium intake is to cut the vegetables into small pieces, boil them and drain off the water. Not all fruits and vegetables have the same amounts of potassium. Ask your dietitian to outline what is appropriate for you.

Phosphate
The amount of phosphate allowed depends on your blood tests.

Foods high in phosphate include:
• nuts, seeds and peanut butter
• dried peas and beans and baked beans
• processed bran cereals
• sardines and fish pastes
• cheese, milk and other dairy products

Fluids

When kidney function deteriorates, the body can retain fluid. Some people may need to limit their fluid intake to minimize this. Your recommended fluid intake will be dependent on your urine output, fluid build-up and your blood pressure. The usual allowance is equal to the urine output plus 500mls.

Fluids  include:
• water and ice
• tea, coffee, juices, milk and milk products
• gravy, sauces and soups
• ice cream, jelly, custard and yoghurt

Some tips for restricting fluids:

• suck ice cubes to quench thirst
• sip small amounts throughout the day
• use smaller cups and glasses

Remember that foods containing fluids need to be included in your fluid allowance.

Other points to remember

• Nutritional care plan needs to be individualized based on degree of renal function.
• It may be difficult to meet vitamin requirements orally and  doctor may prescribe a supplement.
• Ask questions till  you understand about  your diet.
• Initially you may need to measure foods and fluids; for greater accuracy, measure with a cup or scale and don't guess.
• Take your medication as prescribed.
• Organize for regular reviews / follow-up with your dietitian.
• Follow your trends in body weight, blood pressure and blood values.
• Inform your doctor or dietitian if you are losing weight or have any concerns about your diet.
• Following the suggested nutritional care plan may not treat or cure your kidney problem but it could help you reduce some of the symptoms and hence improve your general feeling of well being.