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.

Also Read: Exclusive interview with Minister Dr Harsh Vardhan

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.

Also Read: A Right Gesture Saves Life

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.

Researchers measured insulin and C-peptide levels of 87 diabetics(67 men and 20 women). Actually, beta cells in the pancreas that make insulin also release the C-peptide-a polypeptide composing of 31 amino acids. Although C-peptide does not actually affect the blood sugar of a person, the doctors can measure its level to figure out how much insulin the person’s body is making.

What made researchers measure the C-peptide levels along with insulin levels in the diabetics under study? This is because C-peptide gets secreted at a more constant rate across time durations as compared to the insulin secretion. Also, C-peptide levels are more stable compared to the insulin levels (its half-life is nearly six times that of insulin)which facilitates testing of beta cells’ response, the study has pointed out. The results revealed that the persons included in the study had largely the features of adiposity characterised by high body fat, abdominal fat and fatty liver condition, which may not be visible from outside.

The study has concluded that nonobese (BMI below 25) and even lean (BMI below 19) Indians have high body fat, excess fat in the liver and skeletal muscles and lesser skeletal muscle mass. In particular, they have ectopic fat in the liver (non-alcoholic fatty liver disease) and pancreas (nonalcoholic pancreas disease), which may contribute to insulin resistance leading to diabetes even in young age.

Along with high body fat and visceral fat, researchers also found elevated levels of insulin and C-peptide in the 87 diabetic patients studied by them. Such patients would benefit better from pharmacotherapy using insulin sensitizers or weight loss therapy, the study noted.

Summarising the outcome of the study, Dr. Anoop Misra, chairman Fortis C-DOC who led the study, told India Science Wire: “Indians have normal weight-high body fat and low muscle mass. They are not overtly obese but have not only high body fat but fat which is located in the crucial organs of metabolism, i.e., liver and pancreas. Once this occurs, the action of the insulin hormone becomes jeopardized, and blood sugar startsincreasing.”

“Indian physicians should urge patients to lose weight even when they are in normal body mass index (BMI) category to maintain body habitus at leaner side. This could prevent diabetes in those who do not have it yet, and blood sugar levels are better managed in patients with diabetes.” he added.

Credits: India Science Wire

Nutrition And Cognitive Health

A child belonging to the lower socioeconomic status, not only has to struggle with a lack of educational opportunities but also a lack of healthy nutrition. This child will most likely go through their formative years having a poor diet which lacks most essential nutrients. This may lead to a lower academic performance throughout the school years, which in turn may lead to fewer job opportunities resulting in lower socioeconomic status. When the same child grows up and starts own family, the cycle continues to the next generation. On the other side of the socio-economic spectrum, a child belonging to an affluent urban family also deals with poor nutrition but in a very different way. More than one-third of such children and adolescents, aged 6yrs to 19yrs, are considered overweight or obese. This is because these children are overfed but remain undernourished. Studies show that more than 90% of children in urban areas, belonging to affluent families, consume more than the recommended amounts of saturated fats and added sugars. The consumption of fruits and vegetables in these children is also observed to be less than the recommended intake. Thus, even though they may appear to be well nourished, they have many underlying nutritional deficiencies. Some of these deficiencies impact the performance of these children in academics and extracurricular activities.

Relationship Between Breakfast And Academic Performance

There have been many studies that have looked at the relationship between breakfast consumption and academic performance in children, and most have concluded that eating breakfast improves cognitive functions like memory recall. A study was done in Norway which looked at 475 high school children, found that those who ate breakfast regularly had fewer difficulties in learning, especially mathematics, besides improved reading and writing. Another study carried out in China on kindergarten students found that kids who ate breakfast had higher IQs (intelligent quotients). This was independent of the education level of the parents, or the family’s socioeconomic status. Many similar studies carried out over the years have reported that skipping breakfast was associated with decreased cognitive performance (e.g., alertness, attention, memory, processing of complex visual display, problem-solving, etc.) among the students. Children who do not eat an adequate breakfast can also suffer from hunger pangs while in school, headaches, and stomach pains due to excessive acid, etc. This, besides being a source of distraction for children, can also lead to absence from classes, which in turn can affect academic performance in school.

Relationship Between Specific Foods And Academic Performance

Interestingly, studies have not just found a positive association with breakfast consumption but also between the quality of meals and academic performance. A study carried out in Scotland investigated the consumption of sugary drinks, sweets, chocolates, pizza, savory snacks and hot dogs with learning abilities. The study found that children who had a higher consumption of these foods had increased mathematical difficulties as compared to children who had a more nutritious dietary intake. Another study found that children who ate healthier foods with a low glycemic index had better attention span, word recall and reaction time than children who consumed food with a higher glycemic index that leads to high blood glucose levels soon after consumption Sub-optimal intake of foods, such as fruits, vegetables, and dairy products, has also been associated with lower grades among students.

Relationship Between Physical Activity And Academic Performance

Physical activity is another very important factor that affects academic performance. Today, many mothers with children as young as 10 years old, feel that enrolling their children in extracurricular activities will take time away from their studies and result in poorer academic results. On the contrary, studies have shown that students who are physically active, perform better in school, compared to children who are physically inactive. These kids not only have better grades but also better attendance and fewer absenteeism, better memory recall, concentration during lessons and lesser disciplinary problems. Physically inactive children who gradually increased their activity showed improved memory and cognitive function than when they were physically inactive.

Relationship Between Specific Nutrients And Academics Performance

There are specific micro-nutrients that have been associated with better academic performance.

Children with deficiencies of micronutrients like vitamin A, B6, B12, folic acid, iron, zinc, and calcium, have shown to score lower grades and result in higher absenteeism. Two nutrients, known to have the strongest relation to school performance, are iron and zinc. Iron is an integral part of hemoglobin which is the oxygen-carrying molecule in the blood. Deficiency of iron is called anemia. Symptoms of iron deficiency include fatigue or tiredness, lethargy, slowed growth and development, poor appetite, abnormally rapid breathing, behavioral problems or disciplinary issues and susceptibility to frequent infections. All these individually and collectively can lead to increased absenteeism and thereby decreased academic performance. Iron deficiency also directly affects the ability to undertake physical activity, which in turn can further affect performance in school. Zinc is mainly needed for the body’s immune system to work properly. In addition, it is involved in cell growth, wound healing and for the sense of taste and smell. Symptoms of zinc deficiency are depression and psychological disorders, impaired immunity, impaired growth, diarrhea, delayed sexual maturation, alopecia or abnormal hair growth, impaired appetite, altered cognitive functions and altered sense of smell and taste. Zinc deficiency also leads to poorer performance in school. This can be due to the fact that children with zinc deficiency are more prone to catching an infection and falling sick, thereby missing classes, their ability to memorize is affected, there are psychological disorders that can affect learning, etc. So, how can parents ensure that they give their children the best advantage for improving academic performance? Some of the suggestions are as follows:

• Give them a nutritious breakfast.
• Always have healthy snacks stocked in your pantries, so that kids eat the right foods throughout the day.
• Don’t be fooled by “Low Fat” labels. Such products are usually loaded with sugar. Similarly, “natural” does not always mean whole grain or unrefined ingredients. Educate yourself about reading the labels and identifying what they mean.
• Encourage your children to be physically active, it will not only help them improve their academic performance but also help in building their overall personality.
• A good healthy balanced diet will ensure that your children do not suffer from any nutritional deficiencies.

Kanupriya Khanna, a Sr. Consultant Nutritionist & Dietitian specializing in pediatrics, is a private practitioner at Greater Kailash, New Delhi. For over 15 years, she has been working with mothers and children to create more wholesome food habits with the least restrictions and disruptions. She pioneers the science of healthy eating, using fresh ingredients and foods that are easily available and can be integrated easily into daily lives.

Women’s health in India has emerged as a major nutritional challenge with the country wrestling largest number of anemic women in the world and the other having to tackle diseases related with obesity –that is on the rise, warns the latest Global Nutrition Report, 2017. It says there is malnutrition among adults globally.A total of 614 million women aged between 15–49 years were affected by anemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia.In India and Pakistan, more than half of all women of reproductive age have anemia.

It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland. Obesity (body mass index (BMI) ≥30) is most common among North American men (33%) and women (34%), and lowest among Asian and African men (6%) and Asian women (9%).

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Overweight and obesity are increasing in almost every country and are a real concern for many low and middle income countries, not just high-income ones.The problem affects more women than men in all the world’s regions, reflecting a wider global gender disparity.

Hypertension is most common (28%) among African women and European men, and lowest (11%) among North American women. A quarter of Asian and Latin American men suffered from raised blood pressure in 2015. While more women worldwide are affected by obesity, the case for diabetes and hypertension is mixed. There is more diabetes among men than women in Asia, Europe, Northern America and Oceania, and more hypertension among men than women in all regions except Africa.

The world now faces a serious nutrition- related challenge, whether stemming from under nutrition or obesity, states Global Nutrition Report 2017.

The report found the vast majority (88%) of countries studied face a serious burden of two or three of these forms of malnutrition. It highlights the damaging impact this burden is having on broader global development efforts.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Director of the Centre for Food Policy at City, University London. “We will not achieve any of the Global Goals for Sustainable Development (SDGs) by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

The Report calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change.

“We know that a well-nourished child is one-third more likely to escape poverty,” said Jessica Fanzo, Bloomberg Distinguished Professor of Global Food and Agriculture Policy Ethics at Johns Hopkins University and Global Nutrition Report CoChair.

• At least 41 million children under five are overweight, with the problem affecting high and lower income countries alike
• At least 10 million children in Africa are now classified as overweight
• One-third of North American men (33%) and women (34%) are obese
• 155 million under-fives are stunted; Africa is the only region where absolute numbers are rising, due to population growth
• 52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height

In all 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends:
1) childhood stunting-children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity,
2) anemia in women of reproductive age-a serious condition that can have long term health impacts for mother and child, and
3) overweight adult women-a rising concern as women are disproportionately affected by the global obesity epidemic.

“They will learn better in school, be healthier and grow into productive contributors to their economies. Good nutrition provides the brainpower, the ‘grey matter infrastructure’ to build the economies of the future.”

Rates of undernutrition in children are decreasing, the report said, with recent gains in some countries. But global progress is not fast enough to meet internationally agreed nutrition goals, including the Sustainable Development Goals (SDG) target 2.2 to end all forms of malnutrition by 2030.

EmornUdomkesmalee, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Senior Advisor, Institute of Nutrition, Mahidol University, Thailand, said, “It’s not just about more money – although that is important – it’s also about breaking down silos and addressing malnutrition in a more joined-up way alongside all the other drivers of development. There’s a powerful multiplier effect here that we have to harness.”

The report found that overweight and obesity are on the rise in almost every country.With 2 billion of the world’s 7 billion people are now overweight or obese and a less than 1 per cent chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Rising rates of anemiaamong women of reproductive age are also cited as a concern with almost one in three women affected worldwide and no country on track to meet global targets. “Historically, maternal anemia and child undernutrition have been separate problems to obesity and noncommunicable diseases,” said MsFanzo. “The reality is they are intimately connected and driven by inequalities everywhere in the world. That’s why governments and their partners need to tackle them holistically, not as distinct problems.” Donor funding for nutrition rose by just two per cent in 2015, to US$867 million, representing a slight fall in the overall percentage of global aid. The report says funding needs to be ‘turbo charged’ and calls for a tripling of global investments in nutrition, to $70bn for over next 10 years to tackle childhood stunting, wasting and anemia and to increase breastfeeding rates. Crucially, donors are only spending 0.01 per cent of official development assistance on diet related Non-Communicable Diseases, a ‘disturbingly low’ level.

Pledges to invest in nutrition must be ‘concrete’ and ‘acted upon’, not ‘empty rhetoric’, the report said. Of the 203 commitments made at the Nutrition for Growth Summit in 2013 those most likely to be classified as ‘on course’ are the UN agencies’ at 86 per cent, followed by ‘other organisations’ at 75 per cent and NGO policy commitments at 73 per cent.

The report found there is a critical need for better data on nutrition – many countries don’t have enough data to track the nutrition targets they signed up to and to identify who is being left behind.

Report says the world consumes too much salt. Intake varies by region, but no region had intakes within the WHO-recommended limits of 2 g/day of sodium. Asia has the highest intake (4.3 g/day of sodium), followed by Europe (4.0 g/day of sodium). At national level, only seven countries (Burundi, Comoros, Gabon, Jamaica, Kenya, Malawi and Rwanda) have sodium intakes within desirable limit).

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