Obesitas

Arief Budiarto
Divisi Nutrisi Penyakit Metabolik
FK UNLAM
Obesitas

2
Riskesdas 2018
Riskesdas 2018
Obesitas
penimbunan jaringan lemak secara berlebihan akibat ketidak
seimbangan antara asupan energi (energy intake) dengan pemakaian
energi (energy expenditure)

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Patofisiologi

Primer Sekunder

Nutrisional hormonal

90% Sindrom/ defek genetik

10%
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 …Patofisiologi

Pengendalian rasa lapar

dan kenyang

Hipotalamus Laju pengeluaran energi

Regulasi sekresi hormon

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 …Patofisiologi

Pengendalian rasa lapar

Jaringan adipose
dan kenyang

Usus Hipotalamus Laju pengeluaran energi

Jaringan otot Regulasi sekresi hormon

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 …Patofisiologi

Jaringan adipose
Anabolik

- Meningkatkan rasa lapar

- Menurunkan pengeluaran
Usus Hipotalamus
energi

Katabolik
Jaringan otot
- Anoreksia
- Meningkatkan
pengeluaran energi 10
Richard, 2007
Richard, 2007
Causes of Childhood Obesity
1. Genetics.
• Some studies have found that BMI is 25–40% heritable
• The genetic factor accounts for less than 5% of cases of childhood obesity
• Anderson 2006
2. Basal metabolic rate.
• Basal metabolic rate is accountable for 60% of total energy expenditure in sedentary
adults
• Anderson 2006
3. Parental factors
• They note that children learn by modeling parents’ and peers’ preferences, intake
and willingness to try new foods.
• Patrick 2005
 Causes of Childhood Obesity

4. Dietary factors
• The dietary factors that have been examined include fast food consumption, sugary
beverages, snack foods, and portion sizes.
• Ebbelling 2004
5. Activity level
• The increased amount of time spent in sedentary behaviors has decreased the amount of
time spent in physical activity.
• Story 2002
6. Environmental factors
• The majority of children in the past walked or rode their bike to school.
• A study conducted in 2002 found that 53% of parents drove their children to school, 66%
said they drove their children to school since their homes were too far away from the school.
Other reasons parents gave for driving their children to school included no safe walking
route, fear of child predators, and out of convenience for the child.
• Anderson 2006
 Causes of Childhood Obesity

4. Socio-cultural factors
• Our society tends to use food as a reward, as a means to control others, and
as part of socializing.
• Budd 2008
5. Family factors
• The types of food available in the house and the food preferences of family
members can influence the foods that children eat.
• Moens 2009
 Causes of Childhood Obesity

9. Psychological factors
• Depression and anxiety
This relationship is not unidirectional; depression may be both a cause and a
consequence of obesity.
• Rawana 2010
• Self-esteem
Obese children have lower self-esteem while others do not.
• Renman 1999, Ackard 2003, Jansen 2008,
Some consensus in the literature that the global approach to self-esteem
measurement with children who are overweight/obese is misleading as the physical
and social domains of self-esteem seem to be where these children are most
vulnerable.
• Schwimmer 2003
 Causes of Childhood Obesity

• Body dissatisfaction
Research has consistently found that body satisfaction is higher in males than
females at all ages.
• O’Dea 2005
• Eating disorder symptoms
Traits associated with eating disorders appear to be common in adolescent
obese populations, particularly for girls
• Lundstedt 2006
A number of studies have shown higher prevalence of eating-related pathology
(i.e. Anorexia, Bulimia Nervosa, and impulse regulation) in obese
children/youth.
• Decaluwxe 2003(a), Decaluwxe 2003(b)
 Causes of Childhood Obesity

• Emotional problems
A review of 10 published studies over a 10-year period (1995-2005) reported
some level of psychosocial impact as a result of their weight status.
Being younger, female, and with an increased perceived lack of control over
eating seemed to heighten the psychosocial consequences.
• Cornette 2008
Consequences of childhood obesity
1. Medical consequences
Fatty liver disease, sleep apnea, Type 2 diabetes, asthma, hepatic steatosis
(fatty liver disease), cardiovascular disease, high cholesterol, cholelithiasis
(gallstones), glucose intolerance and insulin resistance, skin conditions,
menstrual abnormalities, impaired balance, and orthopedic problems.
• Niehoff 2009
 Consequences of childhood obesity

2. Socio-emotional consequences
• “one of the most stigmatizing and least socially acceptable conditions in childhood.”
• Schwimmer 2003
• Overweight and obese children are often teased and/or bullied for their weight. And
has been found in children as young as 2 years old
• Budd 2008
• Obese children are often excluded from activities, particularly competitive activities
that require physical activity
• Niehoff 2009
• These negative social problems: low self esteem, low self confidence, and a negative
body image in children and can also affect academic performance.
• American Academy of Pediatrics. About childhood obesity.
http://www.aap.org/obesity/about. html
 Consequences of childhood obesity

• The social consequences of obesity may contribute to continuing difficulty

in weight management.
• Protect themselves from negative comments and attitudes by retreating to
safe places, such as their homes, where they may seek food as a comfort.
• Have fewer friends than normal weight children, which results in less social
interaction and play, and more time spent in sedentary activities.
• Physical activity is often more difficult for overweight and obese children as
they tend to get shortness of breath and often have a hard time keeping up
with their peers
àweight gain, as the amount of calories consumed exceeds the amount of energy
burned.
• Niehoff 2009
 Consequences of childhood obesity

3. Academic consequences
• A research study concluded that overweight and obese children were four
times more likely to report having problems at school than their normal
weight peers
• They are also more likely to miss school more frequently, especially those
with chronic health conditions such as diabetes and asthma, which can also
affect academic performance.
• Schwimmer 2003
 Gejala Klinis

Berdasarkan distribusi
jaringan lemak
• Apple shape body
(distribusi jaringan lemak
lebih banyak dibagian dada
dan pinggang)
• Pear shape
body/gynecoid
(distribusi jaringan lemak
lebih banyak dibagian pinggul
dan paha)

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 …gejala klinis

Ciri khas:
• wajah bulat dengan pipi tembem dan dagu rangkap
• leher relatif pendek
• dada membusung dengan payudara membesar
• perut membuncit (pendulous abdomen) dan striae abdomen
• pada anak laki-laki : Burried penis, gynaecomastia
• pubertas dini
• genu valgum (tungkai berbentuk X) dengan kedua pangkal paha bagian
dalam saling menempel dan
• bergesekan yang dapat menyebabkan laserasi kulit
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Cara pemeriksaan
1. Anamnesis
2. Pemeriksaan fisik
3. Pemeriksaan penunjang
4. Pemeriksaan antropometri

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 …cara pemeriksaan

1. Anamnesis
• Saat mulainya timbul obesitas : prenatal, early adiposity rebound, remaja
• Riwayat tumbuh kembang (mendukung obesitas endogenous)
• Adanya keluhan : ngorok (snoring), restless sleep, nyeri pinggul
• Riwayat gaya hidup :
• Pola makan/kebiasaan makan
• Pola aktifitas fisik : sering menonton televisi
• Riwayat keluarga dengan obesitas (faktor genetik), yang disertai dengan resiko
seperti penyakit kardiovaskuler di usia muda, hiperkolesterolemia, hipertensi
dan diabetes melitus tipe II

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 …cara pemeriksaan

2. Pemeriksaan fisik
• wajah bulat dengan pipi tembem dan dagu rangkap
• leher relatif pendek
• dada membusung dengan payudara membesar
• perut membuncit (pendulous abdomen) dan striae abdomen
• pada anak laki-laki : Burried penis, gynaecomastia
• pubertas dini
• genu valgum (tungkai berbentuk X) dengan kedua pangkal paha bagian dalam
saling menempel dan
• bergesekan yang dapat menyebabkan laserasi kulit

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 …cara pemeriksaan

3. Pemeriksaan penunjang
• Analisis diet
• Laboratoris
• Radiologis
• Ekokardiografi
• Tes fungsi paru

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 …cara pemeriksaan

3. Pemeriksaan antropometri
• Pengukuran berat badan (BB) dibandingkan berat badan ideal (BBI). Obesitas
bila BB > 120% BB Ideal.
• Pengukuran indeks massa tubuh (IMT). Obesitas bila IMT P > 95 kurva IMT
berdasarkan umur dan jenis kelamin dari CDC-WHO.
• Pengukuran lemak subkutan dengan mengukur skinfold thickness (tebal
lipatan kulit/TLK). Obesitas bila TLK Triceps P > 85.
• Pengukuran lemak secara laboratorik, misalnya densitometri, hidrometri

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…cara pemeriksaan

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Penyulit
1. Kardiovaskuler
2. Diabetes mellitus tipe 2
3. Obstructive sleep apnea
4. Gangguan ortopedik
5. Pseudotumor serebri
6. Problem psikososial

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Penatalaksanaan
1. Menetapkan target penurunan berat badan
2. Pengaturan diet
3. Pengaturan aktifitas fisik
4. Mengubah pola hidup/ perilaku
5. Peran serta orang tua, anggota keluarga, teman dan guru
6. Konseling problem psiokososial, utk peningkatan rasa percaya diri
7. Terapi intensif

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 …Penatalaksanaan

1. Menetapkan target penurunan berat badan

• Berdasarkan :
• Usia anak : 2-7 tahun dan diatas 7 tahun
• Derajat obesitas
• Ada tidaknya penyakit penyerta/komplikasi.
• Dibawah 7 tahun tanpa komplikasi à mempertahankan berat badan.
• Dibawah 7 tahun dengan komplikasi dan usia diatas 7 tahun (dengan/tanpa
komplikasi) dianjurkan untuk menurunkan berat badan (diet dan aktifitas
fisik).
• Target penurunan berat badan dengan kecepatan 0,5-2 kg per bulan, sampai
mencapai berat badan ideal

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 …Penatalaksanaan

2. Pengaturan diet
• Menurunkan berat badan dengan tetap mempertahankan pertumbuhan
normal.
• Diet seimbang dengan komposisi karbohidrat 50-60%, lemak 20-30% dengan
lemak jenuh < 10% dan protein 15-20% energi total serta kolesterol < 300 mg
per hari.
• Diet tinggi serat, dianjurkan pada anak usia > 2 tahun dengan penghitungan
dosis menggunakan rumus :(umur dalam tahun + 5) gram per hari.

BB ideal + [(BB aktual – BB ideal) x 0,25]

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 …Penatalaksanaan

3. Pengaturan aktifitas fisik

• Latihan fisik yang diberikan disesuaikan dengan tingkat perkembangan
motorik, kemampuan fisik dan umurnya.
• Aktifitas fisik untuk anak usia 6-12 tahun lebih tepat yang menggunakan
keterampilan otot,
è bersepeda, berenang, menari dan senam (20-30 menit per hari)

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 …Penatalaksanaan

4. Mengubah pola hidup/ perilaku

• Pengawasan sendiri terhadap: berat badan, asupan makanan dan aktifitas
fisik serta mencatat perkembangannya.
• Mengontrol rangsangan untuk makan. Orang tua diharapkan dapat
menyingkirkan rangsangan disekitar anak yang dapat memicu keinginan untuk
makan.
• Mengubah perilaku makan, dengan mengontrol porsi dan jenis makanan yang
dikonsumsi dan mengurangi makanan camilan.
• Memberikan penghargaan dan hukuman.
• Pengendalian diri, dengan menghindari makanan berkalori tinggi yang pada
umumnya lezat dan memilih makanan berkalori rendah.

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 …Penatalaksanaan

5. Peran serta orang tua, anggota keluarga, teman dan guru

• Orang tua menyediakan diet yang seimbang, rendah kalori dan sesuai
petunjuk ahli gizi.
• Anggota keluarga, guru dan teman ikut berpartisipasi dalam program diet,
mengubah perilaku makan dan aktifitas yang mendukung program diet

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 …Penatalaksanaan

6. Konseling problem psikososial à rasa percaya diri

7. Terapi intensif
• Terapi intensif diterapkan pada anak dengan obesitas berat dan yang disertai
komplikasi yang tidak memberikan respon pada terapi konvensional, à
diet berkalori sangat rendah (very low calorie diet), farmakoterapi dan
terapi bedah

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Neurocognitive model of obesity and obesity-related behaviors
J Liang 2014
Terima Kasih