Kegemukan atau Obesitas Dr. dr. Tinny Rasjad Indra, SpPK (K). Anindita Chandraintan Prathami, S.Gz, Dietisien

Learning objectives To understand the concept of body weight, overweight and obesity. To understand the different measures of body weight, i.e. weight against height, BMI, waist ratio. To understand the health risks of being overweight or obese. To understand the role of physical activity and diet.

Areas of fat storage People who have extra weight around their middle – ‘apple shaped’ are more at risk of some of these diseases than those who have most of the extra weight around their hips and thighs – ‘pear shaped’. This is called central or abdominal obesity. Men tend to be ‘apple shaped’ whereas woman tend to be ‘pear shaped’.

Obesitas atau kegemukan Definisi : Lemak tubuh/ body fat berlebihan Bukan hanya masalah kosmetik Mengancam kesehatan yg berakibat FATAL Jantung Diabetes Hipertensi dll Cara penurunan Mengubah pola makan Peningkatan aktivitas tubuh Perubahan perilaku Obat-obatan Akupuntur, hipnotis Pembedahan

Obesitas (WHO, 2015) Kegemukan dan obesitas didefinisikan sebagai akumulasi lemak abnormal atau berlebihan yang dapat mengganggu kesehatan

Apakah Saya Obesitas?

IMT (Index Massa Tubuh) untuk usia 20-65 thn

SUDIRMAN Weight: 78kg Height: 1.70m is overweight. BMI = weight (kg) height (m) x height (m) = . 78 . 1.70 x 1.70 = 27 is overweight. Recommended BMI range Underweight less than 18.5 Normal 18.5 - less than 25 Overweight 25 - less than 30 Obese 30 - 40 Very obese over 40

Batas Lingkar Pinggang (WHO 2008) – JAPI 2009 Laki-Laki Perempuan Kategori >78 >72 Waspada ≤ 90 cm ≤ 80 cm Normal > 90 cm > 80 cm Risiko tinggi terkait Obesitas

Overweight but not obese Being overweight (BMI 25-30), but not obese, is still a risk to health. People in this range should not gain anymore weight and ensure they participate in physical activity and eat a balanced diet to become a healthy weight. In many countries, there are cultural pressures for people, especially women, to be slim. People may try to lose weight even though they are in the normal weight range for their height or only slightly overweight. Severe weight loss may lead to development of an eating disorder, e.g. anorexia nervosa or bulimia.

PENYEBAB OBESITAS Genetik Kurang aktivitas Makan tidak sehat ( tinggi kalori, fast food, tidak sarapan, makan /ngemil malam, makan minum manis,) Kehamilan Kurang tidur Obat ( anti kejang, anti depresi, anti DM, steroid) Arthitis Thyroid Berhenti merokok Sosial ekonomi

Komplikasi Obesitas Kolesterol, Trigliserid tinggi Diabetes Hipertensi Metabolik sindrome Jantung/ stroke Susah tidur (sleep apnea) Depresi Peny ginjal Penurunan kesuburan Disfungsi ereksi Fatty lever Osteoarthritis

Unmet clinical need associated with abdominal obesity CV risk factors in a typical patient with abdominal obesity Patients with abdominal obesity (high waist circumference) often present with one or more additional CV risk factors Unmet clinical need associated with abdominal obesity Abdominal obesity (measured by high waist circumference) represents a major health threat, as it often presents in association with a cluster of cardiometabolic risk factors. Indeed, 86% of abdominally obese subjects have one or more cardiovascular risk factors, and 24% have at least two additional cardiovascular risk factors that identify them as having the metabolic syndrome.1 Clearly, abdominal obesity signifies a marked increase in overall cardiovascular risk that is often driven by the progression of multiple risk factors. New approaches to the management of cardiovascular risk that address this complex pathophysiology are needed. 1. NHANES 1999–2000. http://www.cdc.gov/nchs/nhanes. Data downloaded September 2004 using SAS software (Data on file)

Adverse cardiometabolic effects of products of adipocytes ↑ Lipoprotein lipase Hypertension ↑ IL-6 ↑ Agiotensinogen Inflammation ↑ Insulin Atherogenic dyslipidaemia ↑ FFA Adipose tissue ↑ TNFα ↑ Resistin ↑ Leptin ↑ Adipsin (Complement D) Adverse cardiometabolic effects of products of adipocytes This slide shows a more complete list of the bioactive substances secreted by adipocytes, that modulate insulin resistance and cardiovascular risk. Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology 2003;144:2195-200. Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92:347-55. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365:1415-28. ↑ Lactate Type 2 diabetes ↑ Plasminogen activator inhibitor-1 (PAI-1) ↓ Adiponectin Atherosclerosis Thrombosis Lyon 2003; Trayhurn et al 2004; Eckel et al 2005

Sindroma metabolik

Abdominal obesity: required for diagnosing the metabolic syndrome IDF criteria of the metabolic syndrome High waist circumference Plus any two of  Triglycerides ( 1.7 mmol/L [150 mg/dL])‡  HDL cholesterol‡ Men < 1.0 mmol/L (40 mg/dL) Women < 1.3 mmol/L (50 mg/dL)  Blood pressure  130 / >85 mm Hg‡  FPG ( 5.6 mmol/L [100 mg/dL]), or diabetes Abdominal obesity: required for diagnosing the metabolic syndrome The new criteria of the metabolic syndrome from the IDF requires the presence of high waist circumference, along with two other cardiovascular risk factors. Gender and ethnic-group specific values for waist circumference are provided on the next slide. The IDF criteria are generally reminiscent of the current NCEP ATP-III criteria, except that the diagnostic cut-offs for abdominal obesity and FPG are lower in the new IDF criteria. International Diabetes Federation. http://www.idf.org ‡or specific treatment for these conditions International Diabetes Federation (2005)

KAPAN KE DOKTER ? Kalau sudah merasa obese Kalau obese sudah mengganggu kesehatan PERSIAPAN SETELAH KONSULTASI : Apakah siap merubah gaya hidup anda Berapa besar komitmen anda untuk menurunkan BB Maukah anda melakukan apapun untuk menunjukkan komitmen anda ?

Kebiasaaan yang dapat membantu menurunkan berat badan

upaya penurunan bb Merubah pola makan Peningkatan aktivitas Peringatan Mulai mengatur makanan sehat Banyak sayur dan buah Menurunkan porsi makan Harus selalu sarapan Memantau kalori masuk dari makanan dan minuman Peningkatan aktivitas Bangun lebih pagi Jalan-jalan 30mt/hari Peringatan Diet yang tidak dapat menurunkan BB : Bila penurunan cepat dalam bbrp minggu /3 bulan ( mis dengan produk-produk diet populer )

DIET POPULER Cirinya.. (PNS, 2012) Meminta Anda mengurangi satu atau lebih kelompok bahan makanan Hasil cepat (lebih dari 2,5 kg/minggu) Ada testimoni personal yang dijadikan bukti Menawarkan makanan atau minuman tertentu yang memiliki manfaat spesial untuk penurunan berat badan Merekomendasikan suplemen atau pil sebagai bagian dari jadwal makan Ditulis atau dipopulerkan oleh selebriti Tidak ada bukti ilmiah yang medukung Olahraga dihilangkan atau diminimalkan Mendadak populer lalu tiba-tiba menghilang Memberikan daftar makanan yang boleh dan tidak boleh dikonsumsi Data riset disponsori oleh perusahaan pembuat diet tanpa ada review peneliti eksternal Hasilnya terlalu indah untuk jadi kenyataan

Jangan Makan atau Ngemil sambil melakukan kegiatan lain

Ketergantungan Gula

Hindari Piring makan terlalu besar

Jangan Melewatkan Sarapan

Hindari Ngemil sebelum tidur

Budaya Makanan Cepat Saji yang Tidak Sehat

Proporsi Piring Makan Sehat Makanan Pokok: Karbohidrat Kompleks Lauk Pauk: Protein rendah lemak Sayur dan Buah: Vitamin, mineral dan antioksidan

Makan terlalu cepat

Kontrol Porsi Makan Anda

Makan Penuh Kesadaran Sadari Amati Nikmati Rasanya Jangan Menghakimi Diri Anda Hadirlah Sepenuhnya

Perbanyak Aktifitas Kurangi Duduk Parkir lebih jauh Naik tangga Cuci Mobil

Olahraga di Kursi

Olahraga Penghilang Lemak Perut (Cardio) Jalan kaki Jogging Jalan cepat Lari Renang Bersepeda Low Impact*

Akupuntur & Hypnosis

Makanan Penurun kolesterol (dengan Porsi yang benar) Sayuran Hijau Oatmeal Ikan laut dan tawar Kacang-kacangan Biji-bijian Coklat (Cacao) tapi tinggi purin Minyak Zaitun Alpukat Teh Hijau Air Putih

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