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Healthy Lifestyle

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					Asyhadu anlaa ilaaha illalloh wa asyhadu anna Muhammadan rasuululloh Rodliitu billahi robbaa wa bil-islaami diinaa wa bi Muhammadin nabiyyaw wa rosuulaa Robbii zidni „ilmaa warzuqnii fahmaa Aamiin....

BISMILLAHIRRAHMANIRROHIM

HEALTHY LIFESTYLE
dr.Denny Anggoro Prakoso
Family Medicine Medical Faculty Universitas Muhammadiyah Yogyakarta INDONESIA

DEFINITION OF HEALTH


The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" . Recently, this statement has been modified to include the ability to lead a "socially and economically productive life." In the medical field, the technical term for health is homeostasis, an organism's ability to efficiently respond to challenges (stressors) and effectively restore and sustain a "state of balance". In the field of alternative medicine the term used to describe one's overall state of being is wellness.

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What is a healthy lifestyle?
“A healthy lifestyle is a way of living that lowers the risk of being seriously ill or dying early…it is also about physical, mental and social well-being.” (WHO,1999)

Components of a healthy lifestyle
Fitness
Activity levels
Emotional well-being Alcohol and drugs

Healthy well-being

Personal safety

Smoking

Nutrition

Chronic Disease
Coronary Arterial Disease  Hipertension  Ischemic Stroke  Diabetes  Certains Cancer


DOMINANT CAUSES MORBIDITY MORTALITY

PRIMARY DETERMINANTS
NOT GENETIC
ENVIROMENTAL FACTORS (DIET/LIFESTYLE)

RESEARCHERS
Reducing identified modifiable dietary and lifestyle risk factors could prevent most cases CAD, stroke, diabetes and many cancer among highincome population

Diseases are the result of modifiable lifestyle factors, not the invevitable consequence of modern society
(Willet,2002)

PREVENTION

CHANGES IN BEHAVIORS

RECOMMENDED LIFESTYLE CHANGES

1. AVOID TOBACCO USE
 

Leading preventable cause death and disability (USA 400.000 death) Smoking among teenage girls have increased

PATHOGENESIS
COMPLEX BEHAVIOR NOT COMPLETELY UNDERSTOOD

LEARNED BEHAVIOR HABIT BY SITUATION

CLINICAL MANIFESTATION
HISTORY
Smoker may present smoking related illness

PHYSICAL EXAMINATION
sign of underlying smoking related disease  Lesion Mouth and oral cavity (cancer)  Brownish discoloration of the tongue  Wheezing (COPD)  Peripheral pulses (Vascular disease)

TREATMENT

Nicotine replacement Bupropion Nicotine addiction Behavioral dependence

SAY NO TO SMOKE!!!

2. MAINTAIN A HEALTHY WEIGHT
Obesity
Obesity presence of an abnormally large amount of adipose tissue

Method to assess obesity
BMI (Dividing weight in Kg by the height in meters squared)
Underweight 16.5-18.5 Normal 18.5 -25 Overweight BMI 25-30 Obesity BMI > 30 Morbid Obesity > 40

Obesity is increasing in the worldwide
USA 20% men and 30% women Percentage of obese is increasing among children an adolescent

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Obesity is increasingly rapidly worldwide

Indonesia

Central obesity associated with more adverse health conditions
Calculating a waist-hip ratio Men > 1.0 Women > 0,85

pathogenesis
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People get weight when intake calori exceeds the body‟s expenditure. Many individuals have sedentary jobs and lifestyle that reduce or eliminate calorie-burning activities. Studies of identical twins indicate that energy expenditure and fat distribution appear to be influenced by hereditary Recent studies have also explored the role of leptin which can cause obesity.

Clinical manifestation


HISTORY
Generally have symptoms related to decreased exercise tolerance or to illness associated with obesity.

Condition associated with obesity
        

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   

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Cancer of the uterus, breast, prostate, and colon Degenaritve arthritis Fatty liver Gout Hypertension Low Back Pain Sleep apnea Tromboembolic disease Coronary disease Diabetes Gallbladder disease Hiperlipidemia Increased operative risk Reflux esophagitis Low self-esteem Intertrigo

PHYSICAL EXAMINATION
Should include the patient‟s blood pressure, height, weight, and BMI (Anthropometri) Visual assessment generally accurate Obesity-influenced condition

DIFFERENTIAL DIAGNOSIS
Can be either primary or secondary.
Secondary (< 1%) associated with medicines (triciclic antidepressants, beta blocker, phenothiazines, glucocorticoids, oral contraceptives, sulfonilurea, and insulin) Neuroendocrine problem (hypothyroidsm, cushing syndrome, hypothalamic diseaase)

DIAGNOSTIC EVALUATION
Laboratory evaluation will depend on the individual and his or her age (blood glucose, lipid profile)

TREATMENT
   

Chronic problem that can be frustating for both patient and the physicians Must be motivated to lose weight and to make lifestyle changes in diet and exercise Treatments include Diet, Exercise, Drugs, and Surgery. Most obese would like to achieve an “ideal body weight” Unfortunately the treatment 10% weight lose

The realistic goal To achieve the healthful weight rather than an ideal weight. (5% to 10% can be clinically significant)

DIET

 

The lose 1lb of fat requires a 3500 calorie deficit. Gradual dietary changes tend to produce better, longer lasting results. Simple suggestion include eating three meals a day, eating only a meal times, limiting portion to one serving.

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EXERCISE
can be sustained if the exercise that the patient enjoys and can fit into his/her lifestyle (integrate into daily activities)

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DRUG
considered for morbidly obese include appetite supressant

PHENTERMINT side effect: insomnia,hipertension,tachycardia, nausea, diarrhea, and anxiety SIBUTRAMINE (serotonin-norepinephrine reuptake inhibitor) Side effect : insomnia, dry mouth, headache, constipation, and small increase in pulse/BP ORLISTAT (gastrointestinal lipase inhibitor) Side effect : oily stools, diarrhea, and leakage stool

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SURGERY
reserved for patient with morbid refractory obesity GASTRIC STAPLING LIPOSUCTION (can removed localized fat accumulation) Side effect : fat embolus, hemorrhage, even death.

Childhood obesity is increasing !!!!!!!

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Children who are overweight by age 6 are at much greater risk of being obese as adults than other children. Managing the diet and activity by the parents is very essentials.

3. MAINTAIN DAILY PHYSICAL ACTIVITY
and LIMIT TELEVISION WATCH


Contemporary life in developed nations has markedly reduced people‟s opportunities to expend energy, whether in moving from place to place, in the work environment, or at home (Kopland and Dietz, 1999). Increased availability of motorized transportation to replace walking and bicycle riding, and mechanization of labor.

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Regular physical activity is a key element in weight control and prevention of obesity
(IARC 2002; Swinburn and others 2004)

The number of hours of television watched per day is associated with increased obesity among both children and adults (Hernandez, et al 1999; Ruangdaraganon, et al 2002) and a higher risk of type 2 diabetes and gallstones (F.B Hu
Leitzmann, et al 2001)

Decreases in television watching reduce weight (Robinson 1999), and AAP recommends a maximum 2 hours of television watching per day.

4. EAT HEALTHY DIET
 Six

aspects of diet for which strong evidence indicates important health implications.

     

1. Replace saturated and trans fats with unsaturated fats, including sources of omega-3 fatty acids 2. Ensure generous consumptions of fruits and vegetables and adequate folic acid intake 3. Consume cereal products in their whole grain, higher fibre form. 4. Limit consumption of sugar and sugar based beverages 5. Limit excessive caloric intake from any source. 6. Limit sodium intake

5. AVOID ALCOHOL and SUBSTANCE ABUSE

 

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Alcohol and subtance abuse are among the most serious social and medical problems Effect all ages groups (in USA 100.000 deaths resulting from alcohol abuse, and another 20.000 deaths from using elicit substance) Associated with three leading causes of death in adolescents (homicide, suicide, motor vehicle accidents)

Pathogenesis
The etiology is most likely multifactorial  Genetic factors appear to have a role. Individuals with an alcoholic parent have (3-4 x) greater high risk becoming dependent alcohol  Nongenetic factors also play a role. Emotional or interpersonal stress serves a initiator or maintainer of alcohol abuse.
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Clinical manifestation


HISTORY

Vary greatly

PSYCHOSOCIAL COMPLAINTS
Absenteeism from work Antisocial behavior Anxiety Child abuse Depression Domestic violence Financial problem Interpersonal relationship problem Irritability Job-related problems Legal problems School related problems Suicidal ideation

PHYSICAL COMPLAINTS
Blackouts Falls\gastrointestinal problems Gout Headache History of trauma Motor vehicle accident injuries Muscle cramps Nasal congestion Nocturia Palpitation or chest pain Perpheral neuropathy Poor memory Recurrent infection Sleep disturbances Weight changes

Physical examination
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Cirrhosis, ascites, edema, palmar erythema, testicular atrophy, rosacea, cradiomegali, perpheral neuropathy  End stage alcoholism Nasal irritation, septal perforation, tachycardia, chest pain, paranoia  Cocaine Cough, dark-colored sputum  Marijuana Dilated pupils  Stimulant abuse Constricted pupil with sedation  opioid use

Diagnostic Evaluation
Liver enzymes abnormalities GGT (gamma glutamil tranferase)  The most sensitive indicator of alcohol induced liver damage MCV elevation  anemia

TREATMENT


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The goal of tratment is to reduce the consequences of the patient‟s substance abuse and prevent further substance abuse Goal of family physician  early diagnosis and treatment before irreversible health problems or major psychosocial consequences arise

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Outpatient theraphy is appropriate for patients with mild withdrawal symptoms and a supportive social structure. Inpatient care is needed for those with more severe symptoms, a history of severe withdrawal, or a poor social support network.

6. COPING STRESS


Researchers define stress as a physical, mental, or emotional response to events that causes bodily or mental tension. In other words, stress is any outside force or event that has an effect on our body or mind.

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Stress is the most incipient killer of people today. Stress is responsible for 70 to 80 percent of the disease in America. 75 to 90 % of all doctors office visits are for stress related ailments and conditions.

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Stress affects virtually everyone at some time in his or her life. Stress can come from many sources, such as trauma, pathogens, mental factors, allergies, heredity, habits,etc As well as the emotional and psychological disruption it causes, stress-related medical problems are becoming increasingly common. In modern world, we all need to learn how to cope with stress. Although stress itself does not cause a specific illness or disease, it can compromise the immune system and weaken areas of the body, which in turn, makes it easier for imbalance and illness to take hold. Stress may result from a large number of factors

Signs of Stress
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Signs of stress include: - Irritability - Constant fatique - Difficulty concentrating - Muscle Tension and cramps - No or low energy - Inability to wind down and relax - Poor Sleep - Difficulty waking - Aches and pains - Mild Depression - Loss of libido

Steps of Managing Stress
The first step is to begin to recognize the stress in your life.Then rest, repair and rejuvenate  Take a break each day and find something that you love to do
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Exercise is a great solution for stress  Key nutrients are essential for optimal functioning and for the day-to-day management of Stress
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ALHAMDULILLAHIROBBIL‟ALAMIN

You Can Live A
Healthy Lifestyle IN A HECTIC WORLD


				
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