Wednesday, November 28, 2007

Teen Weight Loss

Safe steps to a healthy weight


Healthy habits are the key to teen weight loss. Show your teen the way with this practical plan for success.

Teenage obesity is a dangerous — and growing — problem. There's no magic bullet for teen weight loss, but there's plenty you can do to help. Start by encouraging your teen to adopt healthy habits that can last a lifetime.

Have a heart-to-heart

If your teen is overweight, he or she is probably concerned about the excess weight, too. Aside from lifelong health risks such as high blood pressure and diabetes, the social and emotional fallout of being overweight can be devastating for a teenager. It can also be frustrating to attempt weight loss and have poor results. Offer support and gentle understanding — and a willingness to help your teen take control of the problem.

You might say, "I can't change your weight. That's up to you. But I can help you make the right decisions."

Dispute unrealistic images

Weight and body image can be delicate issues, especially for teenage girls. When it comes to teen weight loss, remind your teen that there's no single ideal and no perfect body. The right weight for one person might not be the right weight for another.

Rather than talking about "fat" and "thin," encourage your teen to focus on practicing the behaviors that promote a healthy weight. Your family doctor can help set realistic goals for body mass index and weight based on your teen's age, height and general health.

Resist quick fixes

Help your teen understand that losing weight — and keeping it off — is a lifetime commitment. Fad diets may rob your growing teen of iron, calcium and other essential nutrients. Weight-loss pills and other quick fixes don't address the root of the problem. And the effects are often short-lived. Without a permanent change in habits, any lost weight is likely to return — and then some.

Promote activity

Like adults, teens need about 60 minutes of physical activity a day. But that doesn't necessarily mean 60 solid minutes at a stretch. Shorter, repeated bursts of activity during the day can help burn calories, too. In fact, any physical activity counts.

Team sports through school or community programs are great ways to get active. If your teen isn't an athlete or is hesitant to participate in certain sports, that's OK. Encourage him or her to walk, bike or in-line skate to school, or to walk a few laps through the halls before class. Suggest trading one hour of after-school channel surfing for shooting baskets in the driveway, jumping rope or walking the dog. Even household chores such as vacuuming and washing the car have aerobic benefits.

Suggest breakfast

If your teen fights the alarm clock the way it is, getting up even earlier to eat breakfast may be a tough sell — but it's important. A nutritious breakfast will jump-start your teen's metabolism and give him or her energy to face the day ahead. Even better, it may keep your teen from eating too much during the rest of the day.

If your teen resists high-fiber cereal or whole-wheat toast, suggest last night's leftovers. Even a piece of string cheese or a small handful of nuts and a piece or two of fruit can do the job.

Encourage smart snacking

It can be tough to make healthy choices when school halls are lined with vending machines, but it's possible. Encourage your teen to replace even one bag of chips a day with a healthier grab-and-go option from home:

  • Frozen grapes
  • Oranges, strawberries or other fresh fruit
  • Sliced red, orange or yellow peppers
  • Cherry tomatoes
  • Baby carrots
  • Low-fat yogurt or pudding
  • Pretzels
  • Graham crackers
  • String cheese

Watch portion sizes

When it comes to portions, size matters. Encourage your teen to scale back and stop eating when he or she is full. It might take just one slice of pizza or half the pasta on the plate to feel full — and there's no shame in sharing a meal, ordering a smaller portion or taking home leftovers.

Count liquid calories

The average 12-ounce can of soda has more than 100 calories and 10 teaspoons of sugar. The calories and sugar in fruit juice, specialty coffees and other drinks can add up quickly as well. Drinking water instead of soda and other sugary drinks may spare your teen hundreds of calories and a day's worth of sugar — or even more. For variety, suggest flavored water, seltzer water or unsalted club soda.

Allow occasional treats

Late-night pizza with friends or nachos at the mall don't need to derail your teen's healthy-eating plan. Suggest a breadstick and marinara sauce instead of garlic bread dripping in butter and cheese, or a shared snack rather than a full-size order. Let your teen know that he or she is in control — and an occasional indulgence is OK. A trend toward healthier habits is what really matters.

Make it a family affair

Rather than singling out your teen, adopt healthier habits as a family. After all, eating healthier foods and getting more exercise is good for everybody.

  • Encourage the entire family to eat more fruits, veggies and whole grains, such as whole-wheat bread, brown rice and oatmeal. Be sure to set a good example yourself.
  • Leave junk food at the grocery store. Healthy foods sometimes cost more, but it's an important investment.
  • Try new recipes or healthier alternatives to family favorites.
  • Banish food from the couch to curb mindless munching.
  • Plan active family outings, such as evening walks or weekend visits to a local recreation center.

Be positive

Being overweight doesn't inevitably lead to a lifetime of low self-esteem, but your acceptance is critical. Listen to your teen's concerns. Comment on his or her efforts, skills and accomplishments. Make it clear that your love is unconditional — not dependent on weight loss. Help your teen learn healthy ways to express his or her feelings, such as writing in a journal.

If your teen is struggling with low self-esteem or isn't able to cope with his or her weight in a healthy manner, consider a support group, formal weight-control program or professional counseling. Additional support may give your teen the tools to counter social pressure, cultivate more positive self-esteem and take control of his or her weight. The benefits will last a lifetime.

Tuesday, November 20, 2007

Anti-obesity Drugs Reduce Weight by less than 5kg

1) Taking anti-obesity drugs results in only 'modest’ weight loss
(Long term pharmacotherapy for obesity and overweight: updated meta-analysis)
BMJ Online First

(Editorial: Orlistat over the counter)
BMJ Online First

Children could have their cholesterol levels tested at about 15 months of age to prevent heart disease later in life, say doctors in a study published on today.

Patients taking anti-obesity drugs will only see "modest" weight loss and many will remain significantly obese or overweight, according to a study published on today.

The study, which looked at the long-term effectiveness of anti-obesity medications, found that three drugs recommended for long-term use - orlistat, sibutramine and rimonabant, reduced weight by less than 5kg (11 pounds). This equated to a loss of less than 5% of total body weight. Guidelines from the National Institute for Clinical Excellence recommend stopping the use of anti-obesity drugs if 5% of total body weight is not lost after three months.

While making changes to lifestyle and diet are recommended as the initial treatment for obesity, the use of anti-obesity drugs is common. It’s estimated that in 2005 global sales of anti-obesity drugs reached $1.2billion. Current UK guidelines recommend using drug therapy in addition to making lifestyle changes if a patient has a body mass index of greater than 30.

The Canadian researchers reviewed the evidence from thirty placebo-controlled trials where adults took anti-obesity drugs for a year or longer. The mean weight of the volunteers in all of the trials was 100kg (15.7 stone). The mean body mass index levels were 35 - 36.

Professor Raj Padwal and colleagues found orlistat reduced weight by 2.9kg, sibutramine by 4.2kg and rimonabant by 4.7kg. They also found that patients taking the weight loss pills were significantly more likely to achieve 5 - 10% weight loss, compared to those who took the placebo.

The health benefits associated with taking the drugs varied. For example, orlistat reduced the incidence of diabetes in one trial and all three drugs lowered patients’ levels of certain types of cholesterol. Adverse effects were recorded with all three drugs, in particular, rimonabant increased the risk of mood disorders such as depression or anxiety. The authors noted that no trials examined rates of death and disease as a result of taking anti-obesity pills. They recommend that trials looking at this should be carried out in the future.

The authors also noted that there were high drop-out levels in all the trials. On average 30 - 40% of patients failed to complete the trial. They say this suggests that a failure to properly adhere to the treatment could be a major factor limiting the effectiveness of anti-obesity drug therapy.

In an accompanying editorial, Professor Gareth Williams warns of the potential damage to society if anti-obesity drugs are licensed to be sold without prescription. This already happens in the United States, and as Glaxo Smith Kline (GSK) has applied to sell orlistat over the counter throughout Europe, it could happen here. He warns:

"Selling anti-obesity drugs over the counter will perpetuate the myth that obesity can be fixed simply by popping a pill and could further undermine the efforts to promote healthy living, which is the only long term escape from obesity."

Assistant Professor, Raj Padwal, University of Alberta, Canada
Editorial: Professor Gareth Williams, University of Bristol, UK

Sunday, November 11, 2007

Promote Healthy Eating Habits in children

Canadian Paediatric Society, 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8
Caring for Kids article

Mealtime means different things for babies, preschoolers and older children. Breastfeeding is best for babies and is the only food babies need until they are six months old. Solid foods are added to children's diets starting at 6 months of age. Preschoolers have special nutrition requirements. As children get older, their nutritional needs become more in line with those of adults.

Bottle-fed babies should be begin learning to drink from a training cup or glass at 12 to 15 months of age. Babies should not be put to bed with a bottle, because the liquid stays in the mouth and can cause tooth decay.

Ensure that infants and toddlers are always supervised during feeding.

What are some tips for developing good eating habits in children?
How can parents introduce children of all ages to a variety of foods?
What are other important tips to remember?

What are some tips for developing good eating habits in children?
While your children are young, they need to develop good eating habits that will last their lifetimes. Mealtime is the ideal opportunity to set an example by creating a positive atmosphere in which healthy food attitudes can be developed.

Canada's Food Guide to Healthy Eating contains basic nutrition messages. The guidelines show how to:

  • Enjoy a variety of foods.
  • Emphasize cereals, breads, and other grain products, vegetables and fruits.
  • Choose lower-fat dairy products, lean meats, and foods prepared with little or no fat.
  • Achieve and maintain a healthy body weight by enjoying regular physical activity and healthy eating.
  • Limit salt, alcohol and caffeine.

Some tips include:

  • Serve your child well-balanced meals. These meals are healthy and they offer a wide variety of tastes and textures that your child will find enjoyable.
  • Use nutritional information to guide you in the introduction of new foods and average amounts required.
  • Offer a variety of nutritional foods prepared in a variety of ways. Become familiar with Canada's Food Guide to Healthy Eating.
  • Ask an older child to help you do the shopping; this may spark an interest in food. The child can also help serve the food.

How can parents introduce children of all ages to a variety of foods?

  • Introduce only one food at a time.
  • Serve the new food with familiar foods.
  • Encourage the child to taste a new food but do not coax the child to eat it. If the new food is rejected, accept the refusal calmly and try again in a few weeks. As new foods and new taste experiences become more familiar, children become more adventurous.
  • Let children explore. The more they know about a food, such as where it grows and how to prepare it, the more they will enjoy eating it.
  • Be a role model for children. If they see adults enjoying foods, they are more likely to try them.
  • Hard small, and round, smooth and sticky foods are not recommended because they may cause choking and aspiration.

What are other important tips to remember?

  • Never use food as a reward or punishment.
  • When preparing food, always wash your hands, fresh fruits and vegetables, food containers, clean counters and utensils.
  • When storing foods use clean containers, refrigerate foods, and never return partly used food to a container.

Source: Adapted from Well Beings, 1999.

Last updated March 2005

This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.

Canadian Paediatric Society, 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8
Phone: 613-526-9397, fax: 613-526-3332

Friday, November 9, 2007

Foreign bodies in Ear Nose Throat

Am Fam Physician. 2007;76:1185-1189.

Clinical Context

Most patients presenting with foreign bodies in the ear, nose, or throat are children and adults who are intellectually challenged or mentally ill, and successful removal depends on location, type of object, whether the object is graspable, clinician dexterity, and patient cooperation. Foreign bodies in the ear often are lodged at the bony cartilaginous junction and attempts at removal may result in pushing the object farther into the auditory canal or damage to the tympanic membrane. Nasal foreign bodies tend to be lodged below the inferior turbinate or in the upper nasal fossa anterior to the middle turbinate. Pharyngeal foreign bodies may be lodged in the pharynx or hypopharynx.

This is a review of presentations of foreign bodies in the ear, nose, and throat and management strategies that are appropriate for removal.

Study Highlights

  • Foreign bodies in the ear:
    • 75% occur in children younger than 8 years.
    • These objects are usually asymptomatic and are often an incidental finding in children.
    • The most common foreign bodies are beads, plastic toys, pebbles, and popcorn kernels; insects are more common in children older than 10 years.
    • In 30% of children younger than 7 years, the object requires removal with the child under general anesthesia.
    • Graspable foreign bodies (foam rubber, paper) have higher rates of success for removal under direct visualization.
    • Options for removal include water irrigation, forceps, cerumen loops, right-angle ball hooks, and suction catheters.
    • Live insects can be rapidly killed before removal by instilling alcohol, 2% lidocaine, or mineral oil into the ear canal, but this should not be done if the tympanic membrane is perforated.
    • Irrigation should be avoided in patients with button batteries because of the risk for liquefaction tissue necrosis.
    • Acetone may be used to dissolve Styrofoam foreign bodies or to loosen cyanoacrylate (eg, Super Glue adhesive).
    • After the first failed attempt at removal, complications increase and success rate falls.
    • Otolaryngologic referral should be made for patients requiring general anesthesia.
    • After removal of a foreign body, all orifices should be examined for other objects.
    • Otic antibiotic drops are required for concurrent otitis externa or when trauma is present.
  • Foreign bodies in the nose:
    • Nasal foreign bodies tend to be located on the floor of the nasal passage, and most can easily be removed in the office or emergency department.
    • Patients often present with foul-smelling unilateral nasal discharge.
    • Before removal, 0.5% phenylephrine should be used to reduce edema, and topical lidocaine should be used to provide analgesia.
    • Techniques include forceps, curved hooks, cerumen loops, or suction catheters.
    • In addition, a thin, lubricated, balloon-tip catheter (5- or 6-French Foley) can be passed past the foreign body, the balloon inflated, and removal completed by pulling the inflated catheter balloon forward.
    • Button batteries must be removed from the nose immediately because of the danger of liquefaction necrosis of the surrounding tissue.
    • Sedation is discouraged for removal because of the risk for increased complications from reducing the gag and cough reflex.
    • Patients may be able to expel the foreign body by blowing their nose while blocking the other nostril.
    • If this fails in a young child, positive pressure ventilation can be delivered through the child's mouth, with the rare potential complication of barotraumas to the ear.
    • Appropriate infection control should be exercised as the foreign body will be expelled through the cheek.
  • Foreign bodies in the throat:
    • All pharyngeal foreign bodies are medical emergencies that require airway protection.
    • Common obstructing objects in children include balloons, soft plastic, and food particles or boluses.
    • Patients with nonobstructing or partially obstructing foreign bodies present with choking, dysphagia, odynophagia, or dysphonia, whereas those with complete airway obstruction present with immediate respiratory distress, and emergency intervention is essential.
    • Other presentations include undiagnosed coughing, stridor, or hoarseness.
    • Clinicians must have a high index of suspicion in patients with unexplained upper airway symptoms, especially in children with a history of choking.
    • Early consultation with an otolaryngologist is advisable because foreign bodies are difficult to visualize without endoscopy.
    • Sedation is required for endoscopic removal.

Pearls for Practice

  • Foreign bodies in the ear, nose, or throat are most likely to present in children. Foreign bodies in the ear tend to be asymptomatic, nasal foreign bodies present with unilateral foul-smelling discharge, and pharyngeal foreign bodies show symptoms and signs of complete or partial obstruction.
  • Obstructing pharyngeal foreign bodies are a medical emergency, whereas attempts at removal of foreign bodies from the ear and nose depend on location, type of object, whether the object is graspable, clinician dexterity, and patient cooperation.

Thursday, November 8, 2007

Healthy Foods for Healthy Kids

Dr. Harvey Fineberg, President of the Institute of Medicine

(article from Medscape Pediatrics Oct 2007).

More than one third of children and adolescents are overweight or obese, and the problem is getting worse every year. In schools, the number of vending machines, snack bars, and other food options has increased strikingly in recent years. When kids eat at school, traditional breakfast and lunch programs are often less appealing than a soda and a bag of chips.

Many children's diets consist of foods that are high in fat and sugar. It is up to us to improve the nutritional value of our children's meals and snacks.

In its report Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth (,[1] the Institute of Medicine recommends limiting food options that are not part of the school's healthy breakfast and lunch programs. When these other foods are available, they should follow a high nutrition standard.

For example:

  • The best foods for establishing healthy eating habits in children are fruits, vegetables, whole grains, and healthy dairy products. Snacks, foods, and beverages available to students should have limited calories from fats or sugars.

  • Lowfat and nonfat milk and 100% juice should be chosen over beverages with nonnutritive sweeteners, like sugar substitutes. These sweeteners are not proven weight management tools. Plain, unflavored water should be more readily available than carbonated or fortified waters.

  • After-school and fundraising activities should apply these nutritional standards, rather than relying on candy; other high-sugar foods; and carbonated, caffeinated beverages.

By replacing unhealthy foods in our schools with nutritional alternatives, we will help children to meet nutrition standards, lose weight, encourage better eating habits, and lead healthier lives. Speak out in your local school district about changing their food options today.

That's my opinion. I'm Dr. Harvey Fineberg, President of the Institute of Medicine.

Thursday, November 1, 2007

Baby Healthcare Reference for Parents & Medics

Congratulations, You're a Mum & Dad is a compilation of all the reference material collected over 20 years of training medical students and doctors preparing for their postgraduate pediatric exams. It is currently used by nursing trainees & medical students as a locally relevant pediatric textbook.

Written in simple English, (272pages) the book provides new parents and grandparents accurate medical information on how their newborn should feed, grow and develop, on vaccinations and the diseases they help prevent, on breast feeding and formulae options, and daily nutritional requirements. You will also learn about thermometers, which ones to buy, how to deal with fever, cough, diarrhea and many of the common conditions that affect kids as they grow.

The 2nd edition (2007)book is on sale throughout Malaysia (distributed by University Book Distributors - check out the book shop nearest to you ) and S'pore. It retails at Rm45/-

You may order by emailing or phone 082 572020 or 082 573020 (tel/fx) during clinic hours. Postage will be added to cost.
If u are a book retailer or ordering for medical or nursing students in bulk, a special rate can be negotiated.

Monday, Wed 830 - 12, 200 - 400, 7 - 830pm
Tues, Thurs 930 - 12, 200 - 400, 7-830pm
Fri - Sat 830 - 12, 230 - 430 pm closed nights
Sun 7 - 830 pm only

The following are comments on the first edition (2004)

…The good doctor has given much of her time to training and educating and this book is meant to help parents optimize the use of doctors. In fact this is just the sort of book that should share pride of place next to the first aid box. Dr Tan used to train medical personnel for a living. Here she puts that very same experience to print. It wouldn’t surprise me if even doctors find this book a helpful reference source - Book review by Yahya M Iskandar Sarawak Tribune (6 March 2006)

It is indeed timely to receive your book as my eldest daughter is giving birth to her first child in a few months time. The book will certainly be very useful to her. My heartiest congratulations to you for your noble contribution towards the medical field. YB Datuk Lee Kim Shin, Assistant Minister of Infrastructure, Development and Communications , Sarawak (22 April 2005)

Well done, I am sure it will benefit the doctors and other medical professionals and the parents as well. Please keep it up. You have done a lot for the medical profession and the public in many of your endeavors. I will forward a copy to our Health Minister. YB Dr Soon Choon Teck, Assistant Minister of Housing, Sarawak (12 April 2005)

It is indeed a very informative and useful book. I definitely will find time to read it and share with others as well. YB Lily Yong Lee Lee, Dewan Undangan Negeri Sarawak (26 April 2005)

….. a valuable source of health and medical references – sincerest appreciation and gratitude for gift. YABhg Toh Puan Datuk Patinggi Hajah Norkiah, Astana, Sarawak (26 April 2005)

Congratulations on the second edition of your book. Personally I wish to recommend all newly weds and young parents to have a copy! I have known Dr Tan since my youngest daughter Farah was a few years old. She was the doctor responsible for detecting and curing her of ITP. I cherish all that she had done. My family is forever grateful to a very caring, hardworking and dedicated doctor, our family doctor. This book is the proof of her credibility, total dedication and much experience. Happy reading! YB Datuk Hajjah Rohani bte Hj Abdul Karim, Parliamentary Secretary to the Ministry of Agriculture and Agrobased Industries, Malaysia (20 March 2007)