Sunday,  November 5, 2000		Keeping fit

A question of answers
By B.K. Sharma

In this article, the writer answers certain queries raised by readers.

I am grateful to the readers for their encouraging and positive response. I received a number of letters asking for various clarifications and suggesting new topics.

Readers who have offered suggestions and asked for various clarifications in writing are: Rajpal Oberoi, Yamunanagar; Mandip, Patiala; a reader AAA, Shimla; Deepak Verma, Chandigarh; Sheel Kumar Kapil, Nabha; Avtar Singh, Mohali; Vishva Mittal Tiwari, Ludhiana; P.L. Garg, Bathinda; R.K. Malhotra, Chandigarh.

As regards obesity, it has to be understood that hormonal disturbances can lead to disturbance of body weight. Abnormality of thyroid hormone (when thyroid works less than normal), adrenal glands (Cushing’s syndrome), the hypothalamic region of the brain and the neuro-hormonal mechanisms can lead to increased weight. The mechanism is complex. It can be due to the decreased rate of energy utilisation known as the metabolic rate as well as abnormal retention of salt in the body and loss of control of the Central Nervous System. Causes of overweight, because of these factors, are a medical problem and need specific diagnosis and treatment. They can not be dealt with by ordinary advice for weight reduction.

Regarding the diet of diabetics, a question has been asked whether a small snack like a biscuit can be taken with the bed tea. A diabetic should take the prescribed food in small meals, rather than in two or three meals. Dieticians refer to it as the ‘‘split diet’’. That enables the body to handle the load of carbohydrates easily. A patient can take a small amount of food with bed-tea, provided he sticks to the prescribed amount of food. In fact advice given to the diabetics is to split their food in at least five meals i.e. break fast, mid-morning (10 a.m.-11 a.m.), lunch, evening and dinner.

To the question about how anxiety and tension a trigger craving for food or over-eating. Out of a group of examinees, the set of students would virtually stop eating or eat less and lose weight. Another set of students would tend to eat more and gain weight. In the first group, overwhelming anxiety suppressed the appetite, whereas in the second one the craving for food is also a manifestation of anxiety. It is a rather complex relation. The triggering of two separate manifestations may be a result of complex interaction between the cerebral cortex of the brain and its hypothalamic centre which controls our food intake behaviour.

A readers has asked a question about bulimia. I did refer to the two disorders which are opposite to obesity. These disorders usually involve young females who are very conscious of their body image and weight. They often go overboard to lose body weight. Anorexia nervosa is a disease where a young female wants to lose weight rather desperately and eats very little. All investigations done do not reveal anything, but the disorder is a deep seated psychosocial phenomenon. Bulimia is a variant of the same disorder with slightly different manifestations. The word ‘bulimia’ literally means "ox-hunger’’ which means ingestion of very large amount of food with the awareness that eating is abnormal and will lead to gain of weight and is therefore accompanied by the sense of fear. These patients have a morbid fear of becoming fat but despite this they indulge in binge eating, followed by induced vomiting and sometime ingestion of laxatives. Binge eating can indeed, be phenomenal and ingestion of calories upto 50000 in eight hours have been recorded. Unlike anorexia nervosa, where patients are very thin and lean, patients of bulimia may be of normal weight, slightly overweight or underweight.

Both these disorders can be accompanied by low blood pressure and sometime cardiac disturbances and can lead to serious complications. The treatment is based more on psychological handling and supplementation of various salts and nutrients. Use of anti-depressants is helpful in treating some patients.