IMA DMA NDB Meet on “When does a pandemic end? Has this one ended? Obesity-the road to doom & gloom”

Speaker: Dr Nidhi Dhawan, May 1, 2022, Sunday 

• Certain guidelines help us to estimate as to when the pandemic will end such as when new cases are very low, when new hospitalizations are very low, when excess mortality due to the pandemic falls back to baseline, when the disease does not cause economic, civil or medical overload or when herd immunity (seroprevalence of 80-90%) makes further propagation of disease difficult or impossible.
• The actual risk reduction and perception of risk should be low for economical and civil activities to go on.
• Population immunity, population risk, immune exposure, available treatments, preventive measures and mortality reduction become key parameters.
• The disease has not ended, though the pandemic emphasis has ended.
• Excess mortality is death from all causes compared to the average deaths over the previous years.
• During the pandemic, the UK and US have had significant mortality in excess of their baseline. Israel too had ups and downs. High vaccination rates did not help these countries avert deaths.
• In terms of confirmed Covid-19 deaths as a share of excess deaths, Belgium had excess over 100%, this means that a major share of excess deaths was due to Covid-19 and other causes of death may have decreased. France had 97%, UK had 80%, while for Spain, Italy and Netherlands, it ranged between 60% and 67%.
• On 1^st February, Denmark announced that it was doing away will all pandemic measures, even though there was a rise in number of cases at that time. In January, Denmark had 51k new cases, which increased to 55k in February and declined to 30k at the end of February. On April 20, they had 2042 cases. On 28^th April, Denmark became the first country to temporary suspend its vaccination program, which will be reviewed when the flu season arrives.
• In India, the R0 had increased to above 1.5 almost a week back, when there had been a rise in cases, but it is now again falling close to 1.
• At the peak of Omicron wave (Jan. 25), Israel had 10k cases, while India had 223 cases.
• The BA.2 Omicron variant is dominant in the US, though BA.2.12.1 seems to be rising.
• In the US, cases and hospital admissions are increasing across the country. At least 78% of population of all ages has received at least one dose, while 66% has received both doses; 82% of ≥5 years age group have received one dose, while 70% have received both doses. In the 65 years and older age group, 95% have taken one dose, while 90% have taken both vaccine doses.
• In India, the new cases are more than the 7-day average as of 29^th April, 2022, indicating slow growth of cases.
• Out of the nearly 3600 cases, 1600 are in Delhi. Around 60% cases in Delhi are detected due to other disease. The new cases are more than the 7-day average. We need to be watchful of this rise in cases. But the bed occupancy is less than 2% with zero percent ICU occupancy in the last week.

Obesity

• Obesity is the leading cause of preventable death and the obese are 20% more likely to die of Covid.
• Obesity increases the risk of heart disease, stroke, depression, cancer, diabetes.
• Globally, around 1.9 billion people are overweight and 650 million are obese; 2.8 million deaths are directly linked to obesity.
• In India, >135 million are obese; the prevalence of central obesity is 31-36%. Rural obesity has increased from 2% in 1989 to 17% in 2012. 
• Factors such as urbanization, processed foods, increased automation, sedentary lifestyle, improved standard of living are contributing to the rising prevalence of obesity in India.
• 73% of urban Indians are overweight and almost half are obese.
• The maximum risk age is 28-38 years, when there is the highest risk of weight gain for both men and women. The average person goes from health at 26 to obese at 38 years.
• Childhood obesity is on the rise in India. About 10% children and adolescents are prediabetic and 4%have high cholesterol. States of Tamil Nadu and Goa had the highest number of overweight  an or obese adolescents.
• The average India needs to lose 11 kg to get healthy. A BMI >25 is obese according to guidelines by the Indian Health ministry.
• Mexico has the highest prevalence of adult obesity (33%) in the world followed by US (32%), Venezuela (31%), Argentina (29%), Chile (29%), Peru (20%).
• BMI is calculated by using the formula BMI= weight in kg / height in m2 (metric system) or 703 x weight in lbs / height in m2 (Imperial system).
• Normally, the essential fat in men is 2-5% and in women I tis 10-13%. In athletes, it is 6-13% and 14-20%, respectively. In obese, the essential fat in men is >25% and >32% in women.
• To measure the waist circumference, measure the narrowest part of the waist and the widest part of hips.
• In females, a waist circumference 31-35 inch is moderate risk and >35 inch is high risk.
• In males, a waist circumference 37-40 inch is moderate risk and >40 inch is high risk.
• Waist circumference, waist to height and waist to hip ratio are better predictors of obesity and metabolic health.
• A waist circumference of >102 cm for males and >88 cm for women is associated with increased risk of type 2 diabetes and heart disease.
• Waist to height ratio is predictive of insulin resistance. Height should be double of waist.
• Waist to hip ratio gives better idea of central obesity.
• One can start making a change today. Be aware of what you eat and move more.
• Increase in visceral fat is associated with poor mitochondrial health, poor insulin sensitivity and increased inflammation.
• One should be compassionate for somebody who cannot reduce weight. 
• The muscle mass makes the body heavier.
• One can be obese and still be insulin competent or not be obese and still be insulin resistant.
• Under exercising, overeating, carb loading with processed foods lead to metabolic syndrome.
• To monitor metabolic health, measure blood sugar both fasting and post prandial, glucose tolerance test, A1c, fasting insulin and CRP. If there is to be one parameter to judge metabolic health, it would be fasting insulin.

Excerpts from a presentation by Dr Nidhi Dhawan