8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
1/42
OBESITY
BAGIAN GIZI FK UNDIP
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
2/42
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
3/42
OBESITY:
DEFINITION & EPIDEMIOLOGY
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
4/42
Who is too fatAncestors were not over fatExcess body fat is a by-product ofurbanization, ec!anization, asedentary "ifesty"e and abundant !i#!-ca"orie foodsBein# fat is beautifu" in so e societiesBein# fat represents a !i#! socio-econo ic c"assBeautifu" $ Barbie do""
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
5/42
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
6/42
Obesity De!"itio"
A condition of abnor a" or excessivefat accu u"ation in adipose tissue tot!e extent t!at !ea"t! ay be
i paired%easurin# body fat is di&cu"tsurro#ate easures suc! as B%I andwaist circu ference are co on"yused
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
7/42
Obesity De!"itio"
%etabo"ic disorder resu"tin# froc!ronic i ba"ance between ener#yupta'e and expenditure
(!ronic) "ife"on# treat ent re*uiredTreat ent contro"s do not curedisease
+o s!ort-ter so"utionsisease recurs after treat ent is
wit!drawn
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
8/42
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
9/42
OBESITY : T E.AT O/E+ESIS
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
10/42
01 /enetic factors in !u anobesity
Obesity te"#s to $%" i"fa i'ies( b%t #oes "ot )$o*ethe $o'e +e"eti, fa,to$s i" the#e*e'o) e"t of obesity-o.e*e$( so e )eo)'e a$e+e"eti,a''y o$e s%s,e)tib'eto e"*i$o" e"ta' fa,to$s.hi,h )$e#is)ose to obesity
St%#y i" $ats obesity is a$es%'t of a #efe,t i" a +e"e.hi,h sho%'# )$o#%,e 'e)ti"(b%t the $o'e of 'e)ti" $e ai"s%",'ea$
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
11/42
/Is it +e"eti,01
o b +e"e 2e+%'ates )$o#%,tio" of leptin Leptin is secreted by fat cells and has dual
activity of decreasing food intake andincreasing metabolic rate
Mi,e bo$" .itho%t the abi'ity to a3e 'e)ti"4ob5ob i,e6 eat .itho%t $est$ai"t
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
12/42
ob5ob o%se"o$ a' i,e
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
13/42
ob5ob o%se
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
14/42
ob5ob o%se
ob5ob o%i"7e,te# .i'e)ti"
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
15/42
So, 2ust #ive obese!u ans "eptin333
I" fa,t( this .o$3s i" 'e)ti"8#e!,ie"t h% a"s( b%t9
::;::< of obese h% a"s ha*e-IG- 'e*e's of 'e)ti"( b%t ha*ebe,o e i"se"siti*e to it;
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
16/42
-e$e#ita$y fa,to$s
The genetic contribution to body
weight is esti ate# to be bet.ee"
=> a"# ?> )e$,e"t 4.ith so e $a$e
,ases of se*e$e obesity 'i"3e# tos)e,i!, +e"e e$$o$s6
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
17/42
The e)i+e"eti,s of i",$easi"+ .ei+ht th$o%+h
the +e"e$atio"s 4/O"e hy)othesis is that
ate$"a' obesity befo$e a"# #%$i"+)$e+"a",y a e,ts the estab'ish e"t of bo#y
.ei+ht $e+%'ato$y e,ha"is s i" he$ baby;
Mate$"a' obesity ,o%'# )$o ote obesity i"the "e t +e"e$atio";C 4Wate$'a"#( >> 6
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
18/42
41 .!ysica" inactivity
• Data o" the ,o"t$ib%tio" of i"a,ti*ityto the ,%$$e"t e)i#e i, of obesity is'i ite#
• E*i#e",e – Peo)'e eat o$e tha" they #i# i" the
)ast – E"e$+y e )e"#it%$e i" a"%a' 'abo%$ o$
*i+o$o%s 'eis%$e a,ti*ity has #e,'i"e#.ith the i",$ease of T *ie.i"+ a"#'abo%$ sa*i"+ a))'ia",es
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
19/42
45 Years A#o Today
465 ca"ories 7 cups
.O.(O8+
0655ca"ories
40 cupsbuttered
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
20/42
Obese )eo)'e ha*e e"#o,$i"eab"o$ a'itiesPo'y,ysti, o*a$y sy"#$o e 4P OS6 isasso,iate# .ith obesity a"# o*a$ia"f%",tio" i )$o*es .ith .ei+ht 'ossLa,3 of e*i#e",e fo$ )$i a$ye"#o,$i"e #efe,t as the ,a%se ofobesity
91 Endocrine
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
21/42
E"#o,$i"e ha"+es
2009
There are various endocrine changes associated withoverweight.Changes in the reproductive system are among the most
common.Irregular menses and frequent anovular cycles arecommon.
Rates of fertility may also be reduced.
Endocrinol Metab Clin N Am. 2003; 32: 761-786
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
22/42
E"#o,$i"e ha"+esAsso,iate# .ith Obesity
2009
Increased cortisol productionInsulin resistanceDecreased sex hormone-binding globulin in women
Decreased progesterone levels in womenDecreased testosterone levels in menDecreased growth hormone production
Common hormonal abnormalities associated with obesity
Endocrinol Metab Clin N Am. 2003; 32: 761-786
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
23/42
Psy,ho'o+i,a' Diso$#e$sAsso,iatio"s .ith Obesity
2009
besity is associated with an impaired quality of life.!igher "#I values are associated with greater
adverse effects.$hen compared to obese men% obese women appearto be at a greater ris& for psychological dysfunction.This may be due to the societal pressure on women to
be thin.
Endocrinol Metab Clin N Am. 2003; 32: 761-786
J La tate Med oc .'(()* +), + / 01'-12.
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
24/42
Obesity is a $es%'t of e ,ess oftota' e"e$+y i"ta3e $e'ati*e toe"e$+y e )e"#it%$e $athe$ tha" a,e$tai" a,$o"%t$ie"t
71 %acronutrientba"ance
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
25/42
Ne%$o)e)ti#es a"# Le)ti" i" Foo#I"ta3e a"# Obesity
BW ho eostasis is ai"tai"e# *ia a se$ies of,o )'e i"te$a,tio"s of hy)otha'a %s a"# the)e$i)he$y *ia 'e)ti"
Le)ti" is sy"thesise# i" a"# se,$ete# f$oa#i)ose tiss%e( i"hibits o$e i+e"i, "e%$o)e)ti#esa"# th%s( #e,$easi"+ foo# i"ta3e a"# bo#y.ei+ht( i",$easi"+ fat o i#atio" a"# e"e$+y
e )e"#it%$e
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
26/42
O$e i+e"i, "e%$o)e)ti#es
Ne%$o)e)ti#es YMe'a"i" ,o",e"t$ati"+ ho$ o"O$e i" A a"# BO)ioi#s
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
27/42
A"o$e i+e"i, )e)ti#es
o,ai"e8 a"# A )heta i"e82e+%'ate# T$a"s,$i)t 4 A2T6
o$ti,ot$o)i"8$e'easi"+ -o$ o"e4 2-6H8Me'a"o,yte8sti %'ati"+ ho$ o"e
4H8MS-6
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
28/42
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
29/42
or a yei#!t, ;at istribution, and
Activity
2009
The following factors have been shown to increasemortality in individuals/
3xcess body weight Regional fat distribution $eight gain patterns 0edentary 4ifestyle
Endocrinol Metab Clin N Am. 2003; 32: 761-786
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
30/42
%orta"ity8e#iona" ;at istribution
2009
Regional fat distribution can contribute to mortality.
This was first noted in the beginning of the '(th
century.bese individuals with an android or apple distribution of
body fat are at a !reater ri"# for diabetes and heart diseasethan were those with a gynoid distribution pear .
Android $%noid
Endocrinol Metab Clin N Am. 2003; 32: 761-786
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
31/42
(entra"isation of Body ;at
Fat a,,% %'ates )$e#o i"a"t'y i",e"t$a' #e)osit
Se$*es as a" easi'y a*ai'ab'es%bst$ate fo$ i )o$ta"t 'i*e$ a"#)e$i)he$y f%",tio"s2ese$*e #e)ot fo$ )e$io#s .he" thes%$$o%"#i"+ i'ie% is th$eate"i"+
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
32/42
5ndroid fat distribution results inhigher free fatty acid levels%
higher glucose and insulin levels and reduced !D4levels.higher blood pressure and inflammatory mar&ers.
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
33/42
Mortality and Morbidity Associated wit! Obesity
2009
The effects of excess weight on mortality andmorbidity have been recogni6ed for more than '%(((years.It was !ippocrates who recogni6ed that 7suddendeath is more common in those who are naturally fatthan in the lean.8
Endocrinol Metab Clin N Am. 2003; 32: 761-786
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
34/42
%orta"ityei#!t /ain
2009
In addition to overweight and centralfatness% the amount of weight gain afterages +9 to '( also predicts mortality.
The :urses; !ealth 0tudy and the !ealth
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
35/42
%orbidityAssociated wit! Obesity
bstructive sleep apneasteoarthritis
Cardiovascular disorders>astrointestinal disorders#etabolic disorders
3ndometrial% prostateand breast
cancersComplications of pregnancy#enstrual irregularities
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
36/42
a$#io*as,%'a$ Diso$#e$sAsso,iate# .ith Obesity
2009
!ypertension0tro&e
Coronary 5rtery Disease
bese individuals are at a greater ris& of developing thesecardiovascular disorders/
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
37/42
-y)e$te"sio"
2009
"lood pressure is often increased in overweight individuals.3stimates suggest that control of overweight would eliminate19? of the hypertension in Caucasians and '9? in5frican 5mericans.
verweight and hypertension interact with cardiacfunction% leading to thic&ening of the ventricular
wall and larger heart volume% and thus to agreater li&elihood of cardiac failure.
J La tate Med oc .'(()* +), + / 01'-12.
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
38/42
(o"on (ancer;indin#s 8e"atin# to Obesity
2009
Colon cancer has been shown to occur morefrequently in people who are obese than in people who are of a healthy weight.
5n increased ris& of colon cancer has beenconsistently reported for men with high "#Is.
$omen with high "#I are not at increased ris& ofcolon cancer.
There is evidence that abdominal obesity may beimportant in colon cancer risk.
:CI
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
39/42
/a""stones;indin#s 8e"ated to Obesity
2009
Obesity appears to be associated with the development of gallstones.More cholesterol is produced at higher body fat levels.Approximately 20 mg of additional cholesterol is synthesi ed for eachkg of extra body fat.!igh cholesterol concentrations relative to bile acids andphospholipids in bile increase the likelihood of precipitation ofcholesterol gallstones in the gallbladder.
Endocrinol Metab Clin N Am. 2003; 32: 761-786
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
40/42
/a""stones;indin#s 8e"ated to Obesity
2009
In the :urses; !ealth 0tudy% when compared to those having a "#I of '1 orless% $omen with a "#I @ A( &gBm' had a '-fold increased ris& for
symptomatic gallstones. $omen with a "#I @ 1) &gBm' had a ,-fold increased ris& for
symptomatic gallstones.
The relative increased ris& of symptomatic gallstone development withincreasing "#I appears to be less for men than for women.
J La tate Med oc .'(()* +), + / 01'-12.
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
41/42
(ancer;indin#s 8e"atin# to Obesity
2009
verweight and obesity are associated with anincreased ris& of/
esophageal% gallbladder% pancreatic% cervical%breast% uterine% renal% and prostate cancers.
besity and physical inactivity may account for 2&to 30 percent of several ma or cancers% including---colon% breast postmenopausal % endometrial%&idney% and cancer of the esophagus.
J La tate Med oc .'(()* +), + / 01'-12.
8/15/2019 Obesitas Modul 3.2 2015 (Salinan Berkonflik Home-PC 2015-11-22)
42/42
// Peo)'eJ #i+ thei$ +$a*esPeo)'eJ #i+ thei$ +$a*es.ith thei$ o." teeth a"#.ith thei$ o." teeth a"##ie o$e by those fata'#ie o$e by those fata'i"st$% e"ts tha" thei"st$% e"ts tha" the
.ea)o"s of thei$ e"e ies;1.ea)o"s of thei$ e"e ies;188 Tho as Mo ett(88 Tho as Mo ett(
>>>>