Asking about if obesity is hereditary? Then, genes aren’t the most worrisome risk of obesity. An individual’s upbringing can be, the way the family raises, the daily food intake, importance placed on physical activity and how a person would take their behaviour model, are the bigger influences on likelihood of obesity than genes. Health is not valued till sickness comes, true isn’t? Obesity is not because it runs in the family!! It is because no one runs in the family!!!

Today, more than 95% of all chronic diseases is caused by food choice. Yes,being overweight is linked to a number of health and oral health diseases, including: heart disease, high blood pressure, diabetes, cancer, gallbladder and gallstones, breathing problems, such as sleep apnea (when a person stops breathing for a short time during sleep) and asthma, oral health problems such as caries, halitosis, poor oral hygiene, periodontal disease. Symptoms for obesity include breathlessness, Increased sweating, snoring, inability to cope with sudden physical activity, feeling tired, back and joint pain, low confidence and self-esteem, and feeling isolated.

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After being aware of the risks, proper health and oral hygiene should be maintained. And why is maintaining diet an important factor? Because a poor diet may result in lack of essential nutrients and vitamins thus potentially making it more difficult for your body to fight off an infection. A diet high in fat and calories, including large quantities of processed foods or sugar, and lack of physicalactivity, leads to obesity. Those same foods can cause oral health problems including gum disease, premature tooth loss and bad breath Our body craves for what is in our bloodstream. Wheat, sugar, alcohol, coffee and de-vitalized foods are designed to be addictive. Sugar being addictive – agreed. But how does sugar affect an individual’s health and oral health? Well, consuming sugar is bad for an individual, but consuming too much has become a norm and that can cause health issues. The only type of sugar the body needs is glucose, which it can make by breaking down carbohydrates, proteins and fats. When ingested, simple sugars are converted into plaque if not removed immediately. As plaque begins to accumulate on our teeth and gums, the risk of varying forms of gum diseases such a gingivitis and periodontitis, as well as tooth decay, may become inevitable.

In 2018, a study revealed that 170 children and young people have rotten teeth removed every day, undergoing general anaesthesia. That’s an unpleasant operation that is completely avoidable; we have got a lot of evidence to show that the main cause is excessive sugar. There are also links with type 2 diabetes, usually chronic disease seen in adults, but we are seeing more and more under the age of 25 these days.

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So, what an oral health care professional should be aware of? Dentists must be aware of how nutrition impacts general and oral health, and how dental treatment can impact patient’s nutritional status. Oral health is strongly influenced by the daily intake of food; on the other hand, oral health can also play a significant role in nutritional intake and general health status. The dental caries is also a chronic disease and may be depend on oral hygiene, high intake of sugar added to food, lifestyle factor, and host factors (salivary flow, buffer capacity and buccal microflora). Relationship between obesity and gum disease – we actually don’t know if this is a one-way or a two-way street. For example, conditions like diabetes, the relationship is bilateral. Periodontal disease will affect diabetes and diabetes will worsen periodontal disease, so that could be a possibility here. What are the other reasons of obesity affecting gums and what would be its risk factors? Because of various dietary habits and improper maintenance of oral hygiene, chronic periodontal infection is an inflammatory state that is described by a deviation in microbial environment and composition of subgingival plaque bio films and accelerated destruction of tooth supporting structures. Thus, low glycaemic diet may be beneficial to our oral health. Periodontal diseases are also influenced by various risk factors including aging, smoking, oral hygiene, socio-economic status, psycho social stress, osteopenia, osteoporosis and various systemic diseases, which signifies that periodontitis does not merely occur as a consequence of plaque deposition but is also coupled with various other host factors. Also, on examination, obese adolescents exhibited multiple carious teeth, higher plaque index, gingival inflammation, bleeding on probing and probing depth compared to normal weight subjects of similar age.

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An obese patient, whose lungs are often not large enough to lift heavy chest walls, can have trouble during breathing, especially when active. Also, during sleep the person might breathe through his/her mouth instead of nose, thus jaw is forced into an unnatural position for a longer period of time. This can lead to teeth grinding and development of an overbite, over jet or spacing between the anterior teeth.How can we, as dentists, help the obese patients? Dentists should include the evaluation of BMI in routine patient examination and eventually refer obese periodontal adolescents for weight reduction interventions like diet therapy, behavioural therapy, pharmacotherapy, so that they can have better control over periodontal inflammation.What are the practical considerations in dentistry? It can be difficult carrying out dental care for an obese patient: the maximum lifting weight for modern dental chair is approximately 140kg (23 stones). The position of anatomical landmarks may be less obvious if surrounded by fatty tissue, the landmarks for placement of an inferior alveolar nerve block can be impossible to palpate through excess soft tissue. It may be impossible to palpate cervical lymph nodes in a large neck. Also due to constant secretion of saliva, the mouth and teeth are rinsed and kept free off food debris and foreign particles, thus excess of buccal pad of fat hinders with self-cleansing action in the mouth. Because of lack of saliva present in the mouth, it can lead to dry mouth. Sip water frequently throughout the day and use alcohol-free antiseptic mouthwash daily for cure. A normal sized mirror is unsafe for retraction of soft tissues: a ‘lax’ tongue retractor can be useful.What is the alternative to conventional dental chair? Refer the patient to the hospital environment where the patient may be treated on an operating table or trolley. Another possible solution for obese patients is a custom-made chair such as DIACO dental chair. What is the difficulty faced during conscious sedation? When thinking about conscious sedation for obese patients, the potential difficulties in airway management and intravenous cannulation should be considered. The provision of inhalation sedation with nitrous oxide during which oxygen levels are maintained at or above 30% may be more appropriate. If intravenous sedation with midazolam is proposed, the overall benefit to the patient must be carefully weighed up against the increased likelihood of significant respiratory depression and the difficulties in managing a respiratory complication. New research suggests that the health of your mouth mirrors the condition of your body as a whole. A healthy smile can surely transform our visual appearance and the positivity of our mind-set.

‘Eat every two hours, sleep eight hours, have plenty of water and pray to keep calm. Most importantly, carry a smile on your face.’

About the author

Dr. Vishaj S. Maru is a dental surgeon. She studied dentistry at the D.Y. Patil School of Dentistry. She does clinical practice in Mumbai with a keen interest in academia and clinical dentistry.

In India, some States have been issued a license to produce hemp either in collaboration with Industrial Association, CSIR based pharmaceutical initiatives or to fulfill the requirement of R&D based activity under AYUSH regulations. Hemp is considered as a source of biomass, fiber, and high-value oil. Fibers based textile market is legal in India, however, at present, it is facing fierce competition. The availability of cheaper yarn from Bangladesh (full exemption of basic customs duty) and China’s favor to Vietnam (by waiving import duty) is further fueling the competition. Indian hemp based textile industry is still in nascent stages. Despite high technological advancement available in India, the use of Hemp in providing CBD moieties for new global pharmacological formulations is still not a reality. Even our ecosystem is not ready due to the non-availability of legal backing; technological innovations for using Hemp based fabric for

new quality material; lack of standardization of hemp cultivation with targeted % of CBD as being done in other parts of the world and also state-wise variation in the implementation of the law.

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Industrial uses of Hemp provide significant business opportunity, for example some companies have developed Eco-friendly bricks made out of hemp. These bricks absorb carbon monoxide and are durable as cement bricks. The production of hemp bricks can provide economic benefit venture for Indian farmers. This brick-based material was used in preserving Ellora Caves for 1500 years. In India, the major problem in any such venture is ‘middlemen policy’ which makes end product expensive with least benefit to the farmer (licensing cost etc.). Permission for contract farming lacks legal support. India, unlike developed countries, neither has strict regulation nor it is relaxed enough to cater as uniform business opportunity. Furthermore ‘stigma’ attached to hemp cultivation (confusion with marijuana) and lack of industrial linkage to farming units with direct export potential further reduces its industrial potential.

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On the other hand, without proper monitoring and uniform policy, relaxation of laws might aggravate the situation at ground level. As per understanding of Ayurvedic perspective, the plant resin (especially from wild plants at 2000 or 3000 m height) is charas which is an extremely powerful banned narcotic drug. However, its leaf based formulation bhang is used in Ayurvedic preparation as stimulant, aphrodisiac and also as sedative. The use of CBD in Indian Ayurvedic Formulations (with traditionally known 191 Ayurvedic preparations for 29 different diseases), regulated and approved by AYUSH after clinical testing, are still in a nascent stage. AYUSH medicines still need to bridge gap between their standards with globally accepted norms. The legal aspects of excise duties on medicinal or toilet preparation containing Indian Hemp limits its probable utility. It means when business is exploring its potential crossing excise department, agriculture department, narcotics department, there is no single window approach feasible. This environment-friendly, pest resistant and sustainable crop is self sustainable after few production cycles and can even be easily regulated by the provision of raw material i.e. seeds only via government sources.

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Keeping the vast market potential of hemp in both medical and food industry and significant pressure faced by Indian farmers, major attention from government sources is required. Firstly, amendments to existing regulations to tap complete potential of this industrial crop (especially regulated and controlled contract farming) is necessary. Secondly, the implementation of law requires adequate State machinery with upgradation of Indian Industrial Hemp Association to a forum for awareness, training and feedback platform. The integration of Central Digital Policy for linking of Aadhaar system to transfer benefits directly to farmers by controlling middlemen. Lastly, the development of uniform code throughout the country addressing excise, narcotics, medicinal, research and agriculture/export policy related to Indian Hemp multiple industrial uses with special focus on promising pharmacological relevance.

About the author

Dr. Sarita Jaiswal, Chief Scientific Officer at Carpere, University of Saskatchewan, Canada, is an accomplished Plat Scientist having 15+ years of R&D experience with specialization in cereal and pulse crop biochemistry and genomics. She has been awarded twice for the category of Young Scientist (Indian Society of Plant Physiology and amp; KK Nanda Foundation for Advancement of Plant Sciences).

About the author

Preetam Satish is the co-founder of a health-tech company Virtual Clinic. He is also a stakeholder in Maarga Hospital, a psychiatry hospital based in Bangalore. Mr. Satish is passionate about mental health and has written an article about the new and emerging treatments available for depression. He has also written about how Ketamine is important to fast track the availability of some of these known and well-entrenched therapies to address the needs of mental health in India.

About the Author

Dr. Alessio Degl’ Innocenti is an Associate Professor in Psychology and Head of Department at Sahlgrenska University Hospital, Sweden. He is associated with the Gothia Forum for clinical research. He graduated with a Ph.D. in Psychology from the University of Gothenburg in 1998, with a thesis on memory functioning in aging and depression.

Data Speaks Loudly

Mental illness contributes to 7% of the global average disease burden. The number of suicides in India is double than the global average of 11 persons per 100,000 population annually. Mental maladies affect about 15% of Indian (and world) population as per latest estimates. One in six people are victims of mental illness. Depression and anxiety disorders alone affect around 8% of us.

Among the young, suicide is the third biggest killer, with depression the leading cause of early-age disability globally. In fact, mental disorders are thought to affect younger people than statistics suggest.

It’s Complicated

People experiencing mental disorders resort to one of several coping strategies: discussing the problem with friends or family, social isolation to escape being noticed, or camouflage true emotions into acceptable actions for fear of being judged or abandoned. Unfortunately, the latter two are more popular, driving forces being social stigma and taboo. There is little or no support to sufferers and their families. Surveys reveal that society even feels fearful of the sufferers!

Undoubtedly, behaviors that indicate mental disturbances can sometimes be hard to pinpoint, passed as the simple quirkiness of character than a disorder of the mind. But is the matter really that straightforward?

Lurking Around Dark Corners

As a society, we are usually shocked at the news of successful, high-performing, wealthy young individuals killing themselves. Celebrities like yesteryears’ actor Guru Dutt and Miss India 1997 turned VJ Nafisa Joseph took their own lives over strained personal relationships. On the other hand, when farmers drowning in debt kill themselves, the reasons are evident and understandable. Similarly, while some mental illnesses are conspicuous, others are not.

People closest to us know us the best; be it our habits, mood swings or fetishes. Yet, in this fast-paced life in the 21st century, signs of distress escape the friendly radars of our loved ones and our own selves. Besides the lack of free time, our reluctance to understand these complex phenomena, ignorance and social stigma worsen the situation for sufferers. Depressive bouts are confused with laziness, anxiety simply called lack of focus and attention deficit equated to incompetence. Such labels make a negative impact, especially on the young impressionable minds. In fact, half of all mental illnesses begin even before the age of fourteen!

Is It All In Our Heads?

Brains are complex machines. Scientists have been studying it for years to find neuropsychological causes and genetic bases of mental illnesses, which are many- depression, anxiety disorders, eating disorders, cognitive disability and so on. To understand where the problems lie, researchers dive deep into the workings of the brain. The clockwork includes a huge repertoire of chemical and electrical signals that pass between connected brain cells called neurons. Imbalances in signals between or within different parts of the brain result in myriad mental anomalies.

Anxiety is a result of an over-active amygdala- the fear center of the brain, resulting from an imbalance between excitatory and inhibitory signals for this area, making sufferers more nervous and fearful than normal people. Severe anxiety disorders such as panic and post-traumatic stress disorder (PTSD) involve the same parts of the brain, only different disturbances in the ongoing signaling.

Depression, on the other hand, appears to be more complex. Firstly, the levels of chemical signals (neurotransmitters) called serotonin and dopamine are abnormal. Serotonin signals well-being and happiness to our brains while dopamine induces motivation. Secondly, the brain tissue is sometimes shrunken. Third, the ability to form new neurons and connections or repair and modify old ones is impaired. Lastly, immunity modulators called cytokines, which induce sickness behavior like staying indoors, sleeping a lot and generally, low energy levels are found in excessively high amounts in depressed individuals. Cytokine signaling is in fact elevated under chronic stress. Though depression manifests as slow behavioral changes that evade our observation, often simply under the cloak of sadness, it is a serious medical issue.

These findings imply that maladies of the mind are just like those of the body, say cancer or diabetes- complex diseases that manifest upon an interplay of genetic predispositions and environmental triggers- preventable, manageable, treatable. Basically, balanced neurological circuitry is essential for mental health.

Interestingly, we have also witnessed that most people tide over adversities, but some are unable to- not every victim of bullies becomes mentally ill. What determines mental resilience? Environment? Education? Or simply will power? Studies suggest that a feeling of security, purpose in life and positive experiences are the foundations to mental resilience. The sooner one starts building it, the better, but there is never a wrong time to build resilience. These building blocks are present both within and around us.

Happiness is Health

Preventing chronic negative thoughts is the key to a healthy mind. Children especially need to be allowed more leisure time. Physical activities like exercise, sports and dancing are known to release feel-good hormone endorphin which benefits the brain. Pursuing hobbies, activities that make you happy or fulfilled and content can keep you motivated in low phases of life, teaching you to celebrate little victories. A hearty laugh works the same way.

Invest time in friends and family. Talking to and confiding in someone trustworthy helps you create a support system that you can summon in times of distress or crises. Give the children around you their due time and attention. Cuddling with a pet and playing with kids generates oxytocin- the bonding hormone. Above all, sleep well, for it helps your body and mind heal itself. Rejuvenate them both time to time using tools like meditation to keep serotonin and dopamine balanced.

If circumstances still catch you unaware, know that help is out there, if not in your home, at the touch of a button. Mental health foundations and support groups are at your disposal if only you call them for help. Phone helplines and online counseling portals like “Type a Thought” and “mystruggles.in” – that keep your identity anonymous, exist to resolve your distress. Sometimes simply talking to friends or family is enough to help you tide through. If none of the above helps, tap into professional psychiatrists. Taking medication to relieve yourself of sickness is not a shame. Do you think twice before taking a pill for cold? You might not even need medication. Interventions like Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming (NLP) can help you learn new thinking patterns, overcoming anxiety and fear.

If only we as a community realize that mental illnesses are not chosen by those who are ill, like any other ailment, and fulfill our roles as parents, teachers, and caregivers, healthy and happy youth is not a distant dream. If only we would give children enough time, attention and affection, they would not grow up as broken individuals. If only we learn to ask “How are you?” and really mean it; if only someone were to ask us “Are you alright?” at our most terrible times; if only we accepted the differences among people; if only no one shamed the fat teenager; if only we didn’t burden our children with our ambitions and expectations (and maybe instead followed them ourselves), we could save lakhs of lives. And that would be a life worth living. Wouldn’t it?

We must remember, childhood and adolescence are tender, confusing and ruthless, all at the same time. Young minds need a sense of belonging, affection, and appreciation to grow up normally with nurture, cautious prodding and guidance at every step. This journey translates into meaning and purpose around which their entire adult life would revolve. Many mental illness victims report feeling unloved, unnoticed, or worse – blamed, bullied, beaten and shamed as a youth. So, if we want to save more people from mental disorders, the younger we catch them, the better.

About the Author

Nishtha Bhargava is a Senior Research Fellow at CSIR-IGIB. When not in the lab, she likes to listen and dance to her favorite music, read books and dream about the future. She believes animals, children, and drunk people never lie and that science has the power to change the world.

Dr. Vincent Lin, the corresponding author said: “This study is the first to look at and quantify the number of noise people are exposed to, during their daily commute, specifically on the Toronto Transit System. We are now starting to understand that chronic excessive noise exposure leads to significant systemic pathology, such as depression, anxiety, increased risk of chronic diseases and increased accident risk. Short, intense noise exposure has been demonstrated to be as injurious as longer, less intense noise exposure.”

Dr. Lin said: “We were surprised at the overall average noise exposure commuters experience on a daily basis, especially the peak noise intensity not only on trains but also on buses. Planners need to be more considerate of noise exposure in the future planning of public spaces and public transit routes. Toronto in particular, as the transit network expands, needs to consider ways to reduce noise exposure as a preventive measure for future health risks.”

According to thresholds recommended by the US Environmental Protection Agency (EPA), exposure to 114 A-weighted decibels (dBA) for longer than four seconds, exposure to 117 dBA for longer than two seconds and exposure to 120 dBA for longer than 20 seconds may put people at risk of noise-induced hearing loss. A-weighted decibels express the relative loudness of sounds experienced by the human ear; taking into account that sensitivity to noise differs depending on noise frequency. Peak noise levels in dBA across both public and personal transport exceeded the EPA recommended thresholds. The average noise levels by bike were greater than any level caused by modes of public transit.

To measure noise exposure, the researchers used noise dosimeters, which they carried on their shirt collars about two inches away from their ears. The researchers collected 210 measurements in total, comparing the noise on subways, buses, and streetcars, while driving a car, cycling, and walking. They measured in-vehicle noise and outside or boarding platform noise for all modes of private and public transportation.

The authors found that 19.9% of the loudest noises (peak noise) measured on the subway were greater than 114 dBA, while 20% of the loudest noises inside streetcars were greater than 120 dBA. 85% of peak noise measurements from bus platforms were greater than 114 dBA, while 54% were greater than 120 dBA. All peak noise exposures while riding a bike exceeded 117 dBA, with 85% being greater than 120 dBA.

When the authors extrapolated the EPA recommended noise thresholds for an average Toronto commuter who uses public transport, the recommended level of noise exposure was exceeded in 9% of the subway, 12% of bus and 14% of biking measurements but not when using streetcars, bikes or when walking.

The authors caution that the number of measurements taken for individual modes of transport is relatively low and that the cross-sectional nature of the study does not allow for conclusions about cause and effect. Further studies are needed to investigate other factors that may contribute to noise exposure such as the use of music players and lengthy transit times.