Physical activity Guidelines by WHO

WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs.

The recommendations address three age groups: 5–17 years old; 18–64 years old; and 65 years old and above.

Physical Activity and Young People (for children aged 5 - 17 years):

In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers:

1. Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
2. Amounts of physical activity greater than 60 minutes provide additional health benefits.
3. Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.

*For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

ü  These recommendations are relevant to all healthy children aged 5–17 years unless specific medical conditions indicate to the contrary.

ü  The concept of accumulation refers to meeting the goal of 60 minutes per day by performing activities in multiple shorter bouts spread throughout the day (e.g. 2 bouts of 30 minutes), then adding together the time spent during each of these bouts.

ü  For inactive children and youth, a progressive increase in activity to eventually achieve the target shown above is recommended. It is appropriate to start with smaller amounts of physical activity and gradually increase duration, frequency and intensity over time. It should also be noted that if children are currently doing no physical activity, doing amounts below the recommended levels will bring more benefits than doing none at all.

Physical Activity and Adults (physical activity for adults aged 18 - 64 years):

In order to improve cardiorespiratory and muscular fitness, bone health, reduce the risk of NCDs and depression:

1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
4. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

ü  These recommendations are relevant to all healthy adults aged 18–64 years unless specific medical conditions indicate to the contrary. They are applicable for all adults irrespective of gender, race, ethnicity or income level. They also apply to individuals in this age range with chronic non-communicable conditions not related to mobility such as hypertension or diabetes.

ü  There are multiple ways of accumulating the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.

ü  Pregnant, postpartum women and persons with cardiac events may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for this age group.

ü  Inactive adults or adults with disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.

Physical Activity and Older Adults (physical activity for adults aged 65 and above):

In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:

1. Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
4. Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
5. Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.
6. When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

ü  These guidelines are relevant to all healthy adults aged 65 years and above. They are also relevant to individuals in this age range with chronic NCD conditions. Individuals with specific health conditions, such as cardiovascular disease and diabetes, may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for older adults.

ü  There are a number of ways older adults can accumulate the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.

ü  Older adults who are inactive or who have some disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Older adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.

Note: These recommendations can be applied to people with disabilities. However, adjustments for each individual based on their exercise capacity and specific health risks or limitations may be needed.

Typhoid

Typhoid fever, also known as typhoid is an infection caused by a bacteria called Salmonella typhi (S. typhi) (1). The disease has received various names, such as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever or pythogenic fever. The name "typhoid" means "resembling typhus” and comes from the neuropsychiatric symptoms common to typhoid and typhus (2). Typhus comes from Greek word typhos meaning smoky or hazy, describing the state of mind of those affected with typhus (3).

Transmission:

It is transmitted mainly by faeco-oral route through poor hygiene habits and public sanitation conditions, and sometimes also by flying insects feeding on feces (2). A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others (2). Approximately 5% of people who contract typhoid continue to carry the disease after they recover (2).

The most famous asymptomatic carrier was Mary Mallon (commonly known as "Typhoid Mary"), a young cook who was responsible for infecting at least 53 people with typhoid, three of whom died from the disease. Mallon was the first apparently perfectly healthy person known to be responsible for an "epidemic" (4).

Many carriers of typhoid were locked into an isolation ward never to be released to prevent further typhoid cases. These people often deteriorated mentally, driven mad by the conditions they lived in — “For most people, the idea of being judged insane and held in a 1950s asylum is the stuff of nightmares. But to be locked up when you are sane would be regarded as an appalling injustice. And yet …. nearly 50 women were locked in an isolation ward in a mental asylum in Surrey - not because they had a mental illness - but because they carried typhoid and were deemed a public health risk. Many of those women - admitted sane - deteriorated mentally, driven mad by the conditions they lived in.   (5).”

Clinical features (6):

First week: Non specific features of malaise, headache, rising remitting fever (step wise fashion) with initial constipation followed by diarrhoea, mild cough with conjunctivitis.

Second week: Patient is toxic & apathetic; sustained high temperatures with relative bradycardia; rose spots on upper thorax; distended abdomen; hepatomegaly and/or splenomegaly.

Third week: Patient delirious with abdominal distension & profuse pea soup diarrhea.

*Remitting fever:  Temperature variation is >20C, but does not touch normal. E.g. Tuberculosis, viral fever, many bacterial infections etc (7).

*Step - ladder fever is the one where the temperature rises gradually to a higher level with every spike of temperature (7). So there is a step-like daily increase in temperature to 40-41°C (8).

*Bradycardia in an adult is any heart rate less than 60 beats per minute. Relative bradycardia is used in explaining a heart rate which, although not actually below 60 beats per minute, is still considered too slow for the individual's current medical condition (9). Usually there is a proportionate increase in heart rate with increase in temperature. But in typhoid, the increase in heart rate is less as compared to the rise in body temperature, so the condition is called Relative Bradycardia.

*Pea soup diarrhea: the stools are green with a characteristic smell, comparable to pea soup (2).

*Rose spots: Rose spots are red macules (rash) 2-4 millimeters in diameter. They appear as a rash between the seventh and twelfth day from the onset of symptoms. They occur in groups of five to ten lesions on the lower chest and upper abdomen. Rose spots typically last three to four days (10).

Differential Diagnosis: Typhoid may be confused with, Malaria, Visceral leishmaniasis (Kala -Azar), Dengue fever, Short term viral fevers, Hepatointestinal amoebiasis (6).

Diagnosis of Typhoid is made by any Blood, Bone marrow or stool cultures and with the Widal test. In epidemics and less wealthy countries, after excluding malaria, dysentery or pneumonia, a therapeutic trial time with Chloramphenicol is generally undertaken while awaiting the results of Widal test and cultures of the blood and stool (2).

Treatment of Typhoid:

Typhoid fever is treated with antibiotics that kill the Salmonella bacteria. Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. (Certain strains from South America show a significant resistance to some antibiotics.) Ciprofloxacin is frequently used for nonpregnant patients. Ceftriaxone, is an alternative for pregnant patients. Ampicillin and trimethoprim-sulfamethoxazole are frequently prescribed antibiotics although resistance has been reported in recent years (11).

With antibiotics and supportive care, mortality is around 1%-2% from the fatality rate was 20% which was seen prior to the use of antibiotics. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days (11).

Home based supportive care includes complete bed rest. Patient should be kept on a liquid diet of orange, barley juice and milk. Orange juice, especially, hastens recovery as it increases energy, promotes body immunity and increases urinary output. Administer warm water enema regularly. Apply cold compress to the forehead if temperature rises above 103 degrees Fahrenheit. Alternatively, wrap the body and legs twice with a sheet wrung in cold water and then cover it with a warm material. The pack should be kept for an hour and renewed after every 3 hours.  Fresh fruits and easily digestible foods can be given after once the fever subsides and body temperature comes down to normal. Plain water or unsweetened lemon water can be used for drinking. Gradually start a well-balanced diet (12).

Chronic carrier of Typhoid:

 Chronic carrier is a person excreting S.typhi in stools or urine (or has shown repeated positive bile or duodenal string cultures) for longer than one year after the onset of acute typhoid fever (6).

The chronic typhoid carrier state can occur following symptomatic or subclinical infections of Salmonella typhi. Chronic carriers of typhoid are, by definition, asymptomatic. Transmission may occur from person-to person or by ingestion of food or water contaminated by the urine or feces of acute cases or carriers. Humans are the only known reservoir for S. typhi. Among untreated cases, 10% will shed bacteria for three months after initial onset of symptoms and 2-5% will become chronic carriers. The chronic carrier state occurs most commonly among middle-aged women (13).

Careers can be treated with Oral Amoxicillin- 3 Gms in adults (100 mg/kg in children in 3 divided doses) for 3 months or Trimethoprim /Sulphamethoxazole 8/40 mg twice daily for 3 months or Ciprofloxacin 750 mg twice daily for 4 weeks (6). Often, removal of the gallbladder, the site of chronic infection, cures the carrier state (11).

Prevention:

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals and therefore transmission is only from human to human. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Careful food preparation and washing of hands are crucial to preventing typhoid (2).

There are two vaccines licensed for use for the prevention of typhoid:  the live, oral Ty21a vaccine and the injectableTyphoid polysaccharide vaccine. Both are between 50% to 80% protective and are recommended for travelers to areas where typhoid is endemic. Boosters are recommended every five years for the oral vaccine and every two years for the injectable form (2).

References:

1.	Pubmed. [Online]. [cited 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002308/.
2.	[Online]. [cited 2012. Available from: http://en.wikipedia.org/wiki/Typhoid_fever.
3.	[Online]. Available from: http://en.wikipedia.org/wiki/Typhus.
4.	[Online]. Available from: http://en.wikipedia.org/wiki/Typhoid_Mary.
5.	Stickler A. [Online]. Available from: http://news.bbc.co.uk/today/hi/today/newsid_7523000/7523680.stm.
6.	[Online]. [cited 2012. Available from: http://mohfw.nic.in/NRHM/STG/PDF%20Content/STG%20Select%20Conditions/Enteric%20Fever.pdf.
7.	[Online]. Available from: http://www.rationalmedicine.org/fever.htm.
8.	[Online]. Available from: http://www.meditreatments.com/diseases/enteric-fevers.html.
9.	[Online]. Available from: http://en.wikipedia.org/wiki/Bradycardia.
10.	[Online]. Available from: http://en.wikipedia.org/wiki/Rose_spots.
11.	[Online]. Available from: http://www.medicinenet.com/typhoid_fever/page3.htm.
12.	[Online]. Available from: http://www.tandurust.com/natural-home-remedies/typhoid-fever.html.
13.	[Online]. Available from: http://publichealth.lacounty.gov/acd/diseases/Typhoid_Carrier.pdf.

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Dengue

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Kolkata is reeling under its worst bout of dengue this monsoon season. Many people have succumbed to the infection and government and private hospitals are flooded with dengue patients.  (1) The city is facing one of its worst dengue outbreaks in recent times.

Nine-year old Sreeja Das was the first dengue victim in the state. The epidemic first struck in the second week of August. Several people in and around Kolkata have been hospitalized since then with symptoms similar to dengue. Many patients have died from the disease and the number of confirmed cases has gone up to 638 (2) and still counting.

Dengue is a Public Health Menace which is better prevented rather than being treated as is the case with all diseases.

There has been a recent surge in Dengue cases not only in Kolkata, but in various other parts of the world as well. The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5 billion people (i.e. over 40% of the world's population) are now at risk from dengue. WHO currently estimates that there may be 50–100 million dengue infections worldwide every year (3).

Dengue also known as breakbone fever, is an infectious tropical disease caused by the dengue virus (4). There are four distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against that particular serotype. However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections by other serotypes increase the risk of developing severe dengue (3).

Dengue is transmitted by the Aedes aegypti mosquito which is the primary vector of dengue. The virus is transmitted to humans through the bites of infected female mosquitoes. 4–10 days after getting infected, a mosquito is capable of transmitting the virus for the rest of its life. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes (3).

The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Ae. aegypti is a daytime feeder; its peak biting periods are early in the morning and in the evening before dusk. Female Ae. aegypti bites multiple people during each feeding period (3).(Also called Fearless Day Biter.)

The rapid transmission of the dengue virus this year in Kolkata has led experts to believe that a new vector is stalking the city along with the primary carrier Aedes aegypti, especially in Salt lake, the fringe areas of the city and along the EM Bypass where hundreds have been infected. Aedes albopictus or the Asian tiger mosquito is a secondary vector of the dengue virus and as lethal as the Aedes aegypti. (5).  Aedes albopictus has also spread to North America and Europe largely due to the international trade in used tyres (a breeding habitat) and other goods (e.g. lucky bamboo). Ae. albopictus is highly adaptive and therefore can survive in cooler temperate regions of Europe. Its spread is due to its tolerance to temperatures below freezing, hibernation, and ability to shelter in microhabitats (3).

Rampant construction activities and chopping of trees along the Bypass (Kolkata) are responsible for a spurt in the number of tiger mosquitoes this year. The albopictus prefers old buildings and tree crevices. With buildings being pulled down for high-rises and trees being chopped to make way for the Garia-Dum Dum Metro corridor along Bypass, the secondary vector has turned active. More than 1500 trees have been felled along the Bypass since 2010 to make way for Metro pillars. Green activists believe this has upset the ecosystem of the area and contributed to the spread of diseases like malaria and dengue (5).

Albopictus mosquito rests in the vicinity of human dwellings. They tend to move into houses quicker than other vectors and are hence more difficult to eliminate (5).

A case of dengue may present as (6):

•     Classical dengue fever
•     Dengue haemorrhagic fever
•     Dengue shock syndrome

Classical dengue fever:  Dengue fever can occur in epidemics which often start during the rainy season when the breeding of the vector mosquitoes  is  generally  abundant.

All ages and both sexes are susceptible to dengue fever. Children usually  have  a  milder  disease  than  adults. The onset of the disease is sudden with chills  and high fever,  intense headache, muscle  and  joint  pains. There may be pain behind the eyes (Retro orbital pain).

Other  common symptoms  include  extreme  weakness,  anorexia,  constipation, altered  taste  sensation,  pain in abdomen,  sore  throat  and  general depression.

Fever  is  usually  between  39°C  and  40°C and is associated with generalized pain and a headache; this usually lasts two to seven days. At this stage, a rash occurs in 50–80% of those with symptoms. It occurs in the first or second day of symptoms as flushed skin, or later in the course of illness (days 4–7), as a measles-like rash (4). The Rash starts on the chest and back and may spread to the extremities and rarely to the face.  It may  be accompanied  by  itching and hyperaesthesia. The rash  lasts  for  2  hours  to  several  days  and may  be  followed  by desquamation (6).

 Recovery is  usually  complete (6).

Dengue haemorrhagic fever:  Dengue haemorrhagic fever (DHF)    is a severe form of dengue fever, caused by infection with more than one dengue virus. The    severe    illness    is thought to    be    due    to    double infection with dengue viruses - the first infection probably sensitizes the patient, while the second appears to produce an immunological catastrophe. It presents with the following  clinical  manifestations :

(a)  Fever  -  acute  onset,  high,  continuous,  and  lasting  2  to  7 days.

(b)  Haemorrhagic manifestations like petechiae, purpura, ecchymosis, epistaxis, gum bleeding haematemesis and/or melaena.

(c)  Enlargement of liver.

Blood examinations reveal Thrombocytopenia (Platelet count 100,000/mm3 or less).

And Haemoconcentration (haemotocrit increased by 20 per cent or more of base-line value.)

Dengue shock syndrome (DSS):  It is DHF (Dengue Haemorrhagic fever) plus Shock-manifested by rapid and weak pulse with narrowing of  the  pulse  pressure  (20 mm Hg  or  less)  or  hypotension, with the presence of cold, clammy skin and restlessness.

The diagnosis of dengue is typically made clinically, on the basis of reported symptoms and physical examination.  A doctor should be consulted immediately if any of the symptoms as mentioned above appears especially in as endemic area or if the zone is under an ongoing epidemic.  The warning signs of Dengue involve Abdominal pain Ongoing vomiting, Liver enlargement, Mucosal bleeding, High hematocrit with low platelets and lethargy (7).

The diagnosis should be considered in anyone who develops a fever within two week of being in the tropics or subtropics. The earliest change detectable on laboratory investigations is a low white blood cell count, which may then be followed by low platelets and metabolic acidosis (4).

Dengue fever may be diagnosed by microbiological laboratory testing (7). This can be done by virus isolation in cell cultures, nucleic acid detection by PCR, viral antigen detection or specific antibodies (serology) (8). Virus isolation and nucleic acid detection are more accurate than antigen detection, but these tests are not widely available due to their greater cost (7). All tests may be negative in the early stages of the disease (8). PCR and viral antigen detection are more accurate in the first seven days (9).

There are no specific treatments for dengue fever. Treatment depends on the symptoms, varying from oral rehydration therapy at home with close follow-up, to hospital admission with administration of intravenous fluids and/or blood transfusion (4). A decision for hospital admission is typically based on the presence of the "warning signs" discussed  above, especially in those with preexisting health conditions.

Dengue Shock Syndrome  is a medical emergency that  requires  hospitalization with prompt  and  vigorous  volume  replacement  therapy (6). Blood transfusion is initiated early in patients presenting with unstable vital signs in the face of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some predetermined "transfusion trigger" level (7).

The juice of the  papaya leaf has been seen to arrest the destruction of platelets that has been the cause for so many deaths from dengue. Chymopapin and papin - enzymes in the papaya leaf - help revive platelet count. The juice has to be prepared from fresh papaya leaves (10).

Prevention of Dengue infection depends on control of and protection from the bites of the mosquito that transmits it. The  vectors  of DF  and  DHF  (e.g.,  A.  aegypti)  breed  in  areas around houses and, in principle can be controlled by individual and community action, using various mosquito control measures (6). (The primary method of controlling A. aegypti is by eliminating its habitat. This is done by emptying containers of water or by adding insecticides or biological control agents to these areas.

The  personal  protection  measures  are like that of wearing  of  full sleeve shirts  and  full  pants;  use  of  mosquito  repellent  cream;  liquids,  coils, mats  etc.;  use  of  bed-nets  for  sleeping  infants  and young children during day time to prevent mosquito bites. So  far,  there  is  no  satisfactory  vaccine  and  no  immediate prospect of preventing the disease by immunization. (6).

The World Health Organization recommends an Integrated Vector Control program consisting of five elements to fight this menace:

• Advocacy, social mobilization and legislation to ensure that public health bodies and communities are strengthened,
• collaboration between the health and other sectors (public and private),
• an integrated approach to disease control to maximize use of resources,
• evidence-based decision making to ensure any interventions are targeted appropriately
• capacity-building to ensure an adequate response to the local situation (4).

References:

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1.	[Online]. [cited 2012. Available from: http://ibnlive.in.com/news/kolkata-faces-dengue-outbreak-govt-apathetic/288029-3-231.html.
2.	[Online]. [cited 2012. Available from: http://www.newstrackindia.com/newsdetails/2012/09/01/286--Bengal-dengue-toll-goes-up-to-3-confirmed-cases-638-.html.
3.	[Online]. [cited 2012. Available from: http://www.who.int/mediacentre/factsheets/fs117/en/.
4.	[Online]. Available from: http://en.wikipedia.org/wiki/Dengue_fever.
5.	[Online]. [cited 2012. Available from: http://articles.timesofindia.indiatimes.com/2012-09-04/kolkata/33581433_1_dengue-virus-aedes-albopictus.
6.	Park K. Textbook of Preventive and Social Medicine.
7.	[Online]. Available from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf.
8.	[Online]. [cited 2012. Available from: http://www.nature.com/nrmicro/journal/v8/n12_supp/full/nrmicro2460.html.
9.	[Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22494122.
10.	[Online]. Available from: http://articles.timesofindia.indiatimes.com/2012-09-12/kolkata/33788187_1_platelet-dengue-patients-papaya.

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Television and Obesity

How things have changed!!!

Studies have repeatedly found that there is a positive correlation between watching television and obesity.

The Nurses’ Health Study (Hu et al, 2003), for example, looked at 50,000 women, ages 30-55, to see if there was a relationship between prolonged TV watching and obesity. The study found strong evidence that television viewing and obesity were definitely linked, concluding that women had a 23% increased chance of obesity for every additional 2 hours of television time they watched.

The association between TV viewing and body weight is not observed only in adults; the relationship is actually more evident in children. Bener’s 2010 study, titled “Obesity and low vision as a result of excessive Internet use and television viewing”, points out that school students who spend prolonged hours in front of television tend to be overweight or obese.

Common reasons of weight gain while watching TV:

1. Eating Junk Food (Commercials Promote Unhealthy Eating) 

If you see an advertisement on television for food, chances are it’s not going to be promoting eating spinach. Typically, within one hour of television watching you will be exposed to approximately at least 10 food and beverage commercials!!! 

When we are constantly bombarded with images of food that aren’t good for us but oh-so-tasty, we begin to crave those foods. Those cravings turn into snacking in front of the television or going out to buy the advertised food, which means consuming calories you don’t need.

2. Eating More – Watching TV Increases Your Energy Intake 

There is a reason why we have the propensity to eat more while we are watching television. TV has a way of distracting us, especially when we’re really absorbed in a good program. When we are munching and watching TV at the same time, we do not necessarily pay attention to what we are doing; overeating is common. Eating when you’re not hungry is common. 

Some people will eat out of habit, simply because they always eat while watching TV.

3. We Spend Less Energy – Being a TV Couch Potato Doesn’t Burn Calories 

Watching television increases inactivity and lowers your metabolic rate. 

People who tend to watch a lot of TV every day usually don’t squeeze in the time to exercise.

But even if you can manage to juggle your TV time with exercise, the fact remains that people tend to eat in front of the TV, and it’s that kind of unhealthy snacking that packs on the calories, and consequently contributes to weight gain.

4. You Consume More Food at Subsequent Meals 

Television viewing is associated with an increase in eating during meals that follow. One study specifically found that television watching during lunch time increases afternoon snack intake. This increases the overall daily calorie intake, which, when combined with the lower metabolic rate that results from watching TV, leads to weight gain.(usually attributed to the distractibility caused by TV).

Further Reading:

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1.	William H. Dietz Jr SLG. [Online]. Available from: http://pediatrics.aappublications.org/content/75/5/807.short.
2.	Manasi A. Tirodkar AJ. [Online]. [cited 2012. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447760/.
3.	WH D. Television, Obesity, and Eating Disorders. .
4.	Sarah Harvey O’Brien RHECR. [Online]. [cited 2012. Available from: http://www.pediatricsdigest.mobi/content/114/2/e154.short.
5.	Robert C. Klesges MLSLMK. [Online]. [cited 2012. Available from: http://www.pediatricsdigest.mobi/content/91/2/281.short.
6.	Robinson TN. [Online]. [cited 2012. Available from: http://jama.jamanetwork.com/article.aspx?articleid=192031.
7.	Robert W Jeffery aSAF. [Online]. Available from: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.88.2.277.
8.	Frank B. Hu MP, Tricia Y. Li M, Graham A. Colditz MD, Walter C. Willett MD, JoAnn E. Manson MD. [Online]. [cited 2012. Available from: http://jama.jamanetwork.com/article.aspx?articleid=196345.
9.	Hernández B GSCGPKLNPCS. [Online]. [cited 2012. Available from: http://ukpmc.ac.uk/abstract/MED/10490786/reload=0;jsessionid=isOKWZ259GU0XYjmSR7T.4.
10.	Thomas N. Robinson LDHDMWJDKHCKCHCBT. [Online]. [cited 2012. Available from: http://pediatrics.aappublications.org/content/91/2/273.short.

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