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Obesity

Obesity is a condition where a person has much greater body weight than is healthy. A person is said to be obese when he has a BMI above 30. When there is a BMI of 40 and more, it is morbid obesity. The world statistics show that there has been an alarming rise of nearly 50% in the number of obese adults. Another disturbing trend is the increase in the number of obese adolescents. Obesity occurs due to eating too much food coupled with lack of exercise. Sedentary lifestyle coupled with poor eating habits are most often to blame for obesity. A diet that includes processed foods, trans fat and too much alcohol will make a person overweight. Other factors contributing to obesity are stress, depression, medications, illness and emotional problems. Emotional comfort eating can pile on the weight.


Medical conditions such as Cushings' Syndrome and PCOS can lead to obesity. In some cases, hypothyroidism might be the cause for weight gain. Medications like antidepressants can lead to added weight. Health problems that can arise due to obesity are heart disease, high blood pressure, type 2 diabetes, osteoarthritis and sleep apnea. Obesity can be tackled by checking if there is any underlying medical condition. When dealing with an obese person, thyroid test and endocrine tests are done. Embark on a weight management program after checking with your health professional or nutritionist. A healthy body weight is a combination of exercise and good nutrition. Extreme diets and fad diets only worsen the condition by leading to yo-yo weight and improper nutrition. Weight that is lost by very low calorie diets is not permanent and has disastrous consequences.

Blount Disease

Blount's disease or 'tibia vara,' is a growth disorder in the shin bone that affects the bones of the lower leg causing the lower leg to angle inward. This resembles a bow leg.


Named after the American orthopedic surgeon, Putnam Blount (1900 - 1992), Blount's disease is characterized by progressive lower limb deformity. Though Blount can affect people at any time during the growing process, it is more common in kids younger than four and in teens. A lot of pressure is put on the growth plate on the top of the tibia. This portion is called the physis - made out of cartilage, weaker than bone. The function of the physis is to allow the bone to lengthen and grow.

Due to excess pressure, the bone does not grow normally and instead the lateral outer side of the tibia keeps growing whereas the medial or inner side of the bone does not. Because of uneven bone growth, the tibia tends to bend outward instead of growing straight. Blount is not the same as naturally bowed legs that babies and toddlers have which usually straighten out when they start walking.


Blount is described as two distinct forms, early or infantile and late or adolescent Blount disease.

Infantile Blount disease is diagnosed between age one and three years. The disease presents when a child begins to ambulate. This disease is often bilateral and is less commonly associated with obesity.

Quite unlike the infantile Blount, late onset of Blount disease occurs in older children and is commonly associated with obesity and is often unilateral.

A combination of mechanical and biological factors influences Blount's disease to varying degrees. The mechanical forces contributing to the disease are weight of the child, age at walking, and varus deformity. The compressive forces across the medial femoral physis lead to growth retardation. Adolescent Blount does not appear to be progressive, or as common as the infantile form.


Causes

The cause of Blount disease remains controversial but it is mostly due to a combination of hereditary and developmental factors. There is increased incidence of the disease in overweight children who walk at an early age. Certain theories that mechanical overload of the proximal tibia contribute to Blount disease has been found. This mechanical overload is attributed to obesity and varus deformity. But this alone cannot be a cause as the disease is also noticed in children with normal weight.

Increasingly it is more common in people of African heritage, where kids start walking at an early age and whose family member might have had it. There is a genetic component to the disease as well, though a direct pattern of inheritance has not been clearly revealed. Hence, Blount is multifactorial and may differ in the early or late onset forms of the disease.


Symptoms

It is imperative to understand that Blount disease starts in early childhood or late teen years, the curve can get worse if not treated. Hence early diagnosis is important. The most obvious sign of Blount is bowing of the leg below the knee. While in young kids it is usually not painful, it teens it can be. It can feel like a growing pain in the knee area. The pain may come and go and many teens resort to over-the-counter pain relievers. As the lower leg bears the weight of the body, other problems such as rotation of the tibia are noticed. This causes a condition called in-toeing, wherein the feet point inward instead of straight out. Blount disease, over several years, can lead to arthritis of the knee joint and trouble walking. One leg may become slightly shorter than the other.


Diagnosis

If there is knee pain that seems to be getting worse and cannot be traced to an injury, then the doctor might possibly consider Blount. A complete physical examination will be done, and X-rays of legs taken. The doctor will look for any abnormal growth pattern at the top of the tibia - a tell tale sign of Blount. This will help the doctor measure how severe the bowing is.


Treatment

Treatment for Blount depends on the age of the patient and how far the disease has progressed. Young kids are advised braces, which are long-legged and lock the knee and need to be worn whilst weight bearing. But bracing is usually unsuccessful in girls and those with obesity. Older kids and teens will need surgery. There are different types of surgeries to correct Blount disease. These involve cutting the tibia, realigning it and holding it in place with plate and screws. This procedure is called Osteotomy. Sometimes, the damaged growth plate is removed and a device called external fixator is used to hold bones in place from the outside. In case of a twisted toe, surgeons correct the cause of it. Surgery is done under general anesthesia, and the patient might wear a cast and use crutches for a while. Physical therapy will be needed after surgery.



Cardiometabolic Syndrome

Cardiometabolic syndrome occurs from metabolic dysfunctions like hypertension, impaired glucose tolerance, insulin resistance, dyslipidemia and central adiposity. It is a group of risk factors that increase the risk towards a serious illness. This syndrome is also known as insulin resistance syndrome.


The condition is a combination of metabolic disorders and/or risk factors that include a combination of diabetes mellitus, obesity, Hyperlipidemia and systemic hypertension. If any one of the risk factors is present in the body, then it is a major concern but when a combination of these risk factors are present in the body then they lead to severe health issues like cardio metabolic disease. The components of this syndrome either independently or interdependently are risk factors for high cardiovascular diseases.

Affected people are mostly overweight or obese. People suffering from this syndrome are more likely to suffer from coronary heart disease and heart attack. Central adiposity is a major contributor that increases cardiometabolic risks.


This syndrome is now recognized as a disease by WHO and is sometimes referred to as Metabolic Syndrome X. Most people with type 2 diabetes are likely to suffer from cardiometabolic disease. People above the age of 60 are also most likely to suffer from this syndrome.


Bringing the risk factors under control can be highly challenging. However exercise, diet, therapy and cardio-metabolic programs can help deal with the condition. Therapy includes assessing behavior and habits both in the cognitive and psychological level.

It is understood that 25% of the world population suffers from this syndrome. Rise in obesity in the world population and aging are identified as key contributors this syndrome.


Identifying Cardiometabolic disease

Though there is no visible symptom, a large waistline, elevated diabetic level, fatigue etc could be symptoms that may collectively indicate presence of the disorder. The condition cannot be diagnosed without a lab test or a health care provider because this syndrome is a cluster of conditions. To diagnose the condition, the health care provider may look for the presence of three or more of the following conditions:


  • Fasting glucose greater than 100mg/dL

  • Central or abdominal obesity (measure of waist circumference)

  • Men - greater than 40 inches, women - greater than 35 inches

  • Blood pressure greater than or equal to 130/85 mmHg

  • HDL Cholesterol

  • Men - less than 40mg/dL, Women - less than 50mg/dL

  • Triglycerides greater than or equal to 150mg/dL

Cause and Risk factors

Genetics and environment play a major role in the cause of this syndrome. Genetic factors influence each component of the syndrome. Progressive weight gain, sedentary lifestyle and low activity levels are equal contributors towards this condition. This condition is present in 5% of people with normal body weight, 22% of people who are overweight and 60% of people who are obese. Smoking, high carbohydrate diet, sedentary lifestyle and post-menopause also cause this syndrome.


Cardio metabolic disease risks


  • People with fat accumulation in the liver, fatty liver which leads to inflammation and most probably to cirrhosis.

  • Kidneys may also get affected as there is protein leak into the urine.

  • Sleep apnea

  • Polycystic ovary syndrome

  • Increased risk of dementia with the aged

Treating this syndrome requires addressing several risk factors together. The focus lies on reducing the person's risk of diabetes and heart disease. Lifestyle modification is the best possible way to handle this syndrome. Weight reduction, reducing smoking, reducing alcohol, getting more active physically, etc helps in handling the condition.


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Collection of Pages - Last revised Date: May 25, 2019