Eating disorders can lead to other complications later in life

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Eating disorders can lead to other complications later in life

Parents should encourage a healthy and balanced eating pattern in kids

New Delhi, 23 November 2017: As per a recent study, eating disorders could lead to higher body weight, larger waist circumference and lower psychological wellbeing as well as a lower self-evaluation of general health in later life. Disordered eating is detrimental to the physical and mental health of young adults both in the short and long term. As per the IMA, it is imperative for parents must focus on a healthy balanced lifestyle for their children instead of on weight or dieting in order to prevent eating disorders.

Eating disorders are serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Eating disorders generally appear in the teen years or young adulthood. However, given the increasing peer pressure today, many younger children are also developing these conditions. Eating disorders affect both genders, although the incidence is higher in women than men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular. Eating disorders can also be contagious. Most youngsters try to copy the eating fads of one another. Some follow each other and attempt weight loss programmes even if they are not scientifically proven.”

Calorie-counting diets can deprive growing teenagers of the energy they need and lead to symptoms of anorexia nervosa, and other such disorders, which may even become life-threatening.

Adding further, Dr Aggarwal, said, “It is important that parents help their children develop a healthy body image by encouraging a balanced diet and exercise for fitness, not weight loss. One should also not tease teenagers about their weight. Such comments can also be detrimental to a teenager’s health and lead to the development of eating disorders in them. Dissatisfaction with one’s weight and body image is associated with lower levels of physical activity and vomiting, and use of laxatives and diuretics to control weight.”

Here are some tips that can prevent the development of eating disorders in young adults.

  • Encourage healthy-eating habit This includes eating when hungry and a habit of eating together with the family.
  • Encourage questions Let the children talk about and question what he or she has seen or heard, especially from websites or other sources.
  • Promote a healthy body image Tell them about how healthy body shapes vary. Avoid making comments about another person based on his or her weight or body shape.
  • Foster self-esteem Respect and support their accomplishments and goals. Look for positive qualities and assure them that your love and acceptance is unconditional.
  • Educate them Tell them about the dangers of dieting and emotional eating. Educate them about the fact that eating or controlling diet is not a healthy way to cope with emotions.

IMA Policy on Antimicrobial/Antibiotic Resistance

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Ensuring universal health coverage and achievement of Sustainable Development Goals Issuing Authority Indian Medical Association IMA Scope The policy covers use of antibiotics in human healthcare and applies to all IMA members. Contact Person Dr KK Aggarwal President Indian Medical Association Definitions Antimicrobial resistance for doctors Antibiotic resistance for public Preamble Growing antibiotic resistance has made it difficult to treat many bacterial infections such as gonnorhea typhoid and urinary tract infections. Within antimicrobial resistance AMR antibacterial resistance or antibiotic resistance as it is much better understood is the main focus of global efforts for its containment. The Ministry of Health Family Welfare MoHFW has identified AMR as one of the top 10 priorities for its collaborative work with WHO. India s National Action Plan on Antimicrobial Resistance NAP AMR 1 was launched at the Inter Ministerial Consultation on Antimicrobial Resistance AMR containment on April 19 2017. The Delhi Declaration on Antimicrobial Resistance 2 an inter ministerial consensus was also released at the end of the Inter Ministerial Consultation with a pledge to adopt a collaborative One Health approach towards prevention and containment of AMR in India. The NAP AMR identifies six strategic priorities 1. Improving awareness and understanding of AMR through effective communication education and training 2. Strengthening knowledge and evidence through surveillance 3. Reducing the incidence of infection through effective infection prevention and control 4. Optimizing the use of antimicrobial agents in health animals and food 5. Promoting investments for AMR activities research and innovations 6. Strengthening India s leadership on AMR Policy point 1 Etiology based treatment of infections to be adopted instead of syndromic management with focus on strengthening and utilizing microbiology laboratory services especially culture sensitivity. Policy point 2 Antibiotic information may also be included as a part of the informed consent process for medicolegal safety. Policy point 3 Any antibiotic prescribed to put in a box in patient prescriptions for ease of identification Policy point 4 Total number of antibiotic tablets capsules to be specified along with treatment duration Policy point 5 Antibiotics not to be prescribed for fever with rash cough or cold suspected or confirmed dengue malaria chikungunya viral hepatitis or any viral syndrome unless clinically warranted Policy point 6 Appropriate antibiotics to be prescribed at the earliest to manage suspected sepsis meningitis pneumonia or positive cases of tuberculosis Policy point 7 All prescriptions to be accompanied with a rider stating no refill without doctor s prescription could be printed on the prescription pad as footer Policy point 8 Every medical establishment to draw its own antibiotic policy IV to oral antibiotic switch antibiotic preference based on local antibiogram infection prevention and control reuse of medical devices and safe syringe practices Policy point 9 MDR TB and XDR TB to be notified to health authorities and surveillance teams IDSP Policy point 10 Ensure root cause analysis for any outbreak of MDR infection in hospital healthcare facility Policy point 11 Recommend shifting Schedule H antibiotics to H1 and H1 antibiotics to Schedule X Policy point 12 All food products must be labeled with Antibiotic status Policy point 13 Antibiotic waste disposal policy to be developed to prevent contamination of the environment preventing discharge of untreated waste into soil and rivers Remember Costlier and newer antibiotics do not necessarily mean they are more effective. Just as you do not start treatment in TB HIV HCV unless proven by laboratory based diagnosis wherever possible preferably initiate antibiotic therapy with a positive laboratory based diagnosis for bacterial infection s . Adhere to recommended immunization schedules and hygiene practices hand hygiene infection prevention and control practices sanitation in health care settings as well as in the community. Follow cough etiquettes and respiratory hygiene as well as inform your patients about the same. Earlier shift from broad spectrum to narrow spectrum targeted antibiotics based on culture and sensitivity reports. Educate patients about the principles of food hygiene heat it boil it cook it peel it or forget it . Before prescribing an antibiotic always ask yourself 5 questions 1. Is it necessary 2. What is the most effective antibiotic 3. What is the most affordable antibiotic 4. What is the most effective dose 5. What is the most effective duration for prescribing the antibiotic Clinical tips 1. It is the bacteria that develop resistance to antibiotics and not the human body. 2. Organisms sensitive to first and second generation cephalosporins will always be sensitive to higher generation cephalosporins. 3. Any organism sensitive to penicillin ampicillin amoxicillin would invariably be sensitive to amoxicillin clavulanic acid piperacillin tazobactam carbapenems and cephalosporins. 4. Restrict and minimize use of colistin polymyxin fosfomycin linezolid in practice. 5. Avoid prescribing quinolones ciprofloxacin levofloxacin moxifloxacin in routine practice. Quinolones are reserved as anti TB drugs. 6. Gram positive organisms Staphylococci Streptococci and Enterococci are inherently resistant to colistin polymyxin. 7. Gram negative organisms E. coli Klebsiella Pseudomonas Acinetobacter Proteus Salmonella Shigella are inherently resistant to vancomycin and teicoplanin. 8. Pseudomonas is invariably resistant to tigecycline doxycycline nitrofurantoin cefixime cefotaxime ceftriaxone trimethoprim sulfamethoxazole. 9. Proteus Serratia Providencia Morganella are resistant to tigecycline nitrofurantoin colistin. 10. MRSA is always resistant to penicillin ampicillin amoxicillin cephalosporins piperacillin tazobactam amoxicillin clavulanic acid carbapenems and generally sensitive to vancomycin teicoplanin linezolid daptomycin mupirocin. Annexure Background to the development of IMA policy on AMR antibiotic resistance Antibiotic resistance is a significant public health problem and has made it difficult to treat many infections such as TB typhoid pneumonia gonorrhea. Antibiotic resistance increases duration of hospitalization probability of adverse drug reactions as well as risk of therapeutic failure and associated mortality. No age group is exempt from antibiotic resistance. Second or third line drugs are expensive and result in increased costs of treatment. 2 These drugs may also be less effective and have more side effects. We are on the verge of a post antibiotic era because many antibiotics that were previously effective against bacteria are no more so. As a result many common infections can become life threatening and may bring us back to the pre antibiotic era. WHO s list of antibiotic resistant priority pathogens which included 12 classes of bacteria Box 1 that pose the greatest threat to human health aims to prioritize research against gram negative organisms especially those causing infections in the community. These pathogens are increasingly becoming resistant to existing antibiotics and in urgent need of newer treatments. Box 1 Global priority list of antibiotic resistant bacteria to guide research discovery and development of new antibiotics 3 Priority 1 Critical Acinetobacter baumannii carbapenem resistant Pseudomonas aeruginosa carbapenem resistant Enterobacteriaceae carbapenem resistant ESBL producing Priority 2 High Enterococcus faecium vancomycin resistant Staphylococcus aureus methicillin resistant vancomycin intermediate and resistant Helicobacter pylori clarithromycin resistant Campylobacter spp. fluoroquinolone resistant Salmonellae fluoroquinolone resistant Neisseria gonorrhoeae cephalosporin resistant fluoroquinolone resistant Priority 3 Medium Streptococcus pneumoniae penicillin non susceptible Haemophilus influenzae ampicillin resistant Shigella spp. fluoroquinolone resistant Key factors contributing to development of antibiotic resistance Human health o Prescribing antibiotics for viral infections like the common cold flu diarrhea o Administering broad spectrum antibiotics without a definitive diagnosis or indication for antimicrobial treatment Prescribing antibiotics for fungal infections invasive candidiasis chronic pulmonary aspergillosis in patients with smear negative pulmonary tuberculosis fungal asthma life threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease on account of incorrect diagnosis Overtreatment and undertreatment of Pneumocystis pneumonia in HIV positive patients. o Overprescribing antibiotics patient pressure and peer pressure o Inappropriate antibiotic use wrong drug wrong doses including subtherapeutic doses or antibiotic not required o Relying on syndromic approach to manage infections instead of evidence based prescribing.4 o Noncompliance to prescribed antibiotics not completing the entire antibiotic course missing doses accidently or deliberately o Antibiotic misuse due to ease of access over the counter availability unregulated supply chains leading to over medication and self medication by patients o Lack of compliance to infection prevention and control measures including poor hygiene have contributed to the propagation and spread of resistant bacteria strains. 6 Animal health and agriculture o Overuse of antibiotics as growth supplements in livestock and aquaculture o Antibiotic additives in agricultural farms The resistant bacteria in animals can spread to humans through the consumption of food or through direct contact with food producing animals or through environmental spread e.g. human sewage and runoff water from agricultural sites .4 Environment o The role of environment in the spread of antibiotic resistance is also being recognized.2 Soil is a reservoir of antibiotic resistance genes. Since most antibiotics are derived from soil microorganisms they are intrinsically resistant to many antibiotics. Soil also receives a large portion of excreted antibiotics through application of manure and sewage sludge as fertilizers.6 o Antibiotic resistant organisms can also spread via drinking water derived from surface water sources. 6 Large amounts of antibiotics are released into municipal wastewater due to incomplete metabolism in human beings or due to disposal of unused antibiotics.2 Evidence suggests that conventional wastewater treatment process is inadequate in removing resistant bacteria from municipal wastewater.6 o Exposure to dairy manure alters soil microbial communities and ecosystem function and leads to greater antibiotic resistance. 8 Research and development o The antibiotics R D pipeline is dry with very little new research being done on antibiotics. o A report released by WHO in September 2017 Antibacterial agents in clinical development an analysis of the antibacterial clinical development pipeline including tuberculosis shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance. Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short term solutions. o Teixobactin the first in a new class of antibiotics produced by soil microorganism provisionally named Eleftheria terrae has been reported. It is the first antibiotic to be discovered in three decades and is still at an early stage of development. Teixobactin has activity against Gram positive but not Gram negative organisms and mycobacteria and has a novel mode of action as it inhibits peptidoglycan biosynthesis. 7 AMR in India Facts Figures o Typhoid 5 10 resistance to chloramphenicol ampicillin trimethoprim sulfamethoxazole 20 to quinolones and 60 to nalidixic acid o Meningococcal infection 50 resistance to ciprofloxacin tetracycline trimethoprim sulfamethoxazole o Gonococcal infections 50 80 penicillin 20 80 ciprofloxacin 2 10 ceftriaxone o MDR TB 3 5 new cases 10 15 in treated cases o XDR TB 4 7 of MDR cases o MRSA 15 25 o Klebsiella ESBL 30 50 o Community E. coli ESBL production 15 carbapenem resistance 6 10 NDM1 3.2 4.5 o Sewage E. coli ESBL 20 60 carbapenem resistance 12 20 and NDM1 5 7.2 o E. coli in sewage 25 resistant in domestic waste 70 resistant in domestic and hospital waste 95 resistant to cephalosporins in hospital waste Recommendations for cross sectoral involvement One health approach recognizes that the health of people is connected to the health of animals and the environment and aims to achieve the best health for people animals and our environment through collaborative efforts of multiple stakeholders. The approach must be adopted to contain the growing problem of antibiotic resistance. New WHO guidelines on use of medically important antimicrobials in food producing animals November 2017 aim to help preserve the effectiveness of antibiotics that are important for human medicine by reducing their unnecessary use in animals. Healthy animals should only receive antibiotics to prevent disease if disease is diagnosed in other animals of the same flock herd or fish population. Where possible sick animals should be tested to determine the most effective and prudent antibiotic to treat their specific infection. Educating the patients and the general public about the dangers of misuse or noncompliance to antibiotics is also an important role to play. References 1. Meropol SB Haupt AA Debanne SM. Incidence and outcomes of infections caused by multidrug resistant Enterobacteriaceae in children 2007 2015. J Pediatric Infect Dis Soc. 2017 Feb 22. 2. Prestinaci F Pezzotti P Pantosti A. Antimicrobial resistance a global multifaceted phenomenon. Pathog Glob Health. 2015 109 7 309 18. 3. Saleh N Awada S Awwad R et al. Evaluation of antibiotic prescription in the Lebanese community a pilot study. Infect Ecol Epidemiol. 2015 5 27094. 4. Ayukekbong JA Ntemgwa M Atabe AN. The threat of antimicrobial resistance in developing countries causes and control strategies. Antimicrob Resist Infect Control. 2017 6 47. 5. Denning DW Perlin DS Muldoon EG et al. Delivering on antimicrobial resistance agenda not possible without improving fungal diagnostic capabilities. Emerg Infect Dis. 2017 23 2 177 83. 6. Fletcher S. Understanding the contribution of environmental factors in the spread of antimicrobial resistance. Environ Health Prev Med. 2015 20 4 243 52. 7. Piddock LJ. Teixobactin the first of a new class of antibiotics discovered by iChip technology J Antimicrob Chemother. 2015 70 10 2679 80. 8. Wepking C Avera B Badgley B et al. Exposure to dairy manure leads to greater antibiotic resistance and increased mass specific respiration in soil microbial communities. Proc Biol Sci. 2017 284 1851 . ________________________________________ 1 Accessible at http entity india topics antimicrobial_resistance nap_amr.pdf ua 1 2 Accessible at http entity india topics antimicrobial_resistance delhi_dec_amr.pdf ua 1 3 Accessible at http medicines publications global priority list antibiotic resistant bacteria en