FAMILY MEDICINE

“ OVERWEIGHT” –

Physiology
basic science

Health
Physiolog
Care
ical
Maintena
factor
nce OVERWEIGHT
AND OBESITY

Weight
Managem Diagnosis
ent

Created by :
TIM DRAFT SOOCA PROXIMA
OVERVIEW OF THE CASE LEARNING OBJECTIVE

Identiity : Susan, 15 Y.0

• Review physiology basic science related to obesity
CC : Her mother noted that Susan has always been heavier than other children in her class and this is
becoming a concern socially for Susan • Describe the psychological factors contributing to obesity
• Review the diagnosis of overweight and obesity
HT PE
• Describe the health implication from overweight and obesity
Introvert and low confidence Height : 145cm • Describe weight management and the life cycle including:
Weight : 52 kg
• Physical activity
never goes for sport, only activity • Diet
in school.
Food intake: she eat three times a • Behavioural modification
day and many times for snack • Describe health care maintenance for teenager
especially when she feels stressed,
angry, anxious, or any other
uncomfortable emotions. She
rarely eats vegetables and fruits.
She prefers fast food, soft drinks,
crackers and noodles
Susan has a 10-year-old brother
who is a few Kg overweight, but is
very active playing football.

Diagnosis : Overweight

Management :
• Control meal pattern (food intake) and physical activity

Case 5: Osteoporosis
1. Etiology and Physiology Related to Obesity
Etiology:
1. Genetic : genes (ob, db, and Ay)
2. Life style
Pada kasus diketahui bahwa orang tua dari Susan memiliki
komposisi badan yang tidak gemuk, sehingga kemungkinan
faktor obesitas pada Susan disebabkan oleh lifestyle. Lalu,
karena kakak Susan mengalami kondisi yang sama, pola
asuh orang tua bisa saja menentukan hal tsb.
Physiology of obesity (Feedback model mechanism) :
Pengertian dari feedback model mechanism :
Merupakan elemen untuk menkontrol obesitas,
controlled system mengatur pencernaan,
memetabolisme serta menyimpan makanan ; Afferent
signals memberitahu otak (controller) tentang faktor
internal dan external (Sangat mempengaruhi dalam
rasa ingin makan) ; Controller (Brain) mengatur untuk
memberikan signal dari perifer menuju action ;
Efferent merupakan action system yang berfungsi
untuk memodulasi apa yang harus dilakukan oleh
controlled.
I. Energy Balance and Controlled system
Obesitas = Energy expenditure < Energy intake
Energy Expenditure dipengaruhi oleh 3 hal, yaitu :
1. Resting energy expenditure
Definisi : Merupakan kebutuhan energy untuk
mempertahankan kehidupan
Contoh : Detak jantung, bernafas dll
2. Physical Activity
Definisi : Merupakan pergerakan otot dan sistem penunjang
Pada pasien, diketahui aktivitas fisik pasien rendah
3. Thermic effect of food
Definisi : Merupakan jumlah energy yang digunakan untuk
pencernaan, penyerapan dan pemanfaatan konsumsi
II. Afferent signals 2. Psychological Factors Contributing to Obesity
1. Taste of fatty acids
Bagian oral dan penciuman merupakan lini pertama 1. Obesity as a Goal-Directed Behavior
dalam exposure terhadap makanan. Taste and smell A significant number of patients report they eat
dari polyunsaturated fatty acids diketahui dapat regularly in response to stress, anxiety, or boredom.
meningkatkan nafsu makan. They use food as a coping mechanism for most of their
Contoh makanan tsb adalah segala hal yang digoreng- lives. Eating becomes a learned response to reducing
goreng. That’s why gorengan itu enak HHE anxiety or stress
2. Peptide 2. Obesity from the life story perspective
3. Nutrients Strict parental attitudes of “cleaning your plate” or
4. Leptin childhood poverty, child abused from sexual activit.
Leptin merupakan afferent fat signal yang merupakan 3. Psychiatric comorbidities
signal utama antara body fat dan central controller. Obese patients have a heavy burden of low self-esteem,
Semakin meningkat jumlah lemak leptin pun akan poor functionality, reduced employment, and stigma, all
semakin meningkat of which predispose to depression. Obese patients
often respond to depression with comfort eating and
III. Efferent signals perpetuating a vicious cycle that entraps the patient in
its net.
1. Growth Hormone
2. Glucocorticoid the spell of a vicious cycle of obesity-stigma-depression-
3. Insulin comfort eating-obesity
4. Autonomic Nervous system
3. Diagnosis of Overweight

Cara diagnosis untuk mengetahui obesitas dan overweight

adalah dengan mengukur status nutrisi, baik itu dengan
anamnesis dan PE.

Tujuan : 1. evaluasi progress pertumbuhan

2. Deteksi under/overnutrition
3. pengukuran perubahan komposisi tubuh

Anamnesis,
1. Pola konsumsi
- 24H ReCall : menanyakan makanan yang dikonsumsi
24 jam kebelakang. Penggunaan 24H Recall ini hemat
biaya dan waktu, namun tidak memperlihatkan pola
makan pasien sehingga tidak akurat dan tergantung
ingatan pasien.
- Food record / diary
Dilakukan dalam periode waktu tertentu dengan
adanya waktu weekend dan weekdays, sehingga lebih
menggambarkan pola makan pasien, namun sering kali
menyebabkan pasien menjadi lebih memililih apa yang
akan dimakan.
- Food Frequency questionare
Merupakan retrospective spesifik food intake.
2. Pola aktivitas fisik
Tanyakan durasi serta frekuensi.

PE (Antropometric index)
Membandingkan hasil pengukuran berat badan, tinggi badan
serta usia. Terdapat 2 chart pada status gizi pada anak, yaitu
WHO (usia 0 – 2 thn) dan CDC (usia 2 – 20 thn)

Jangan lupa untuk nentuin scorenya ada chartnya ya :D


4. The health implication from overweight and obesity
1.
Overweight and obesity are Obesity is associated with: 2.
known risk factors for:  High lood cholesterol 3.
 Diabetes  Complications of pregnancy
 Heart disease  Menstrual irregularities 4.
 Stroke  Hirsutism
 Stress incontinence 5.
 Hypertension  Depression 6.
 Gall bladder disease  Increased surgical risk
 Osteoarthritis 7.
 Sleep apnea
 Uterine, breast, colorectal
and gall bladder cancer Other benefits of exercise include:
 Improved blood sugar control
5. Weight Management and the Life Cycle
Weight management for loosing weight
Consuming sufficient calories to support a healthy weight
Eating a variety of foods to maximize nutritional value
Meeting macronutrient needs with food selection of high
nutritional values
Consuming at least one and preferably two servings of each of the
six categories of richly colored food each day (6-10 total
servings/day)
Drinking adequate amounts of clean, filtered water.
Protein content should range from 10% to 25% of calories, fats
30% carbs 40-55%
A diet high in fiber and low in sodium is commonly recommended
as part of healt-promoting eating plan.
PENTING
and increased insulin sensitivity
(decreased insulin resistance)
Roleof physical activity and exercise in obesity?
Physical activity and exercise help burn calories. The amount of
calories burned depends on the type, duration, and intensity of
the activity. It also depends on the weight of the person. A 200-
pound person will burn more calories running 1 mile than a
120-pound person, because the work of carrying those extra 80
pounds must be factored in. But exercise as a treatment for
obesity is most effective when combined with a diet and
weight-loss program. Exercise alone without dietary changes
will have a limited effect on weight because one has to exercise
a lot to simply lose one pound. However regular exercise is an
important part of a healthy lifestyle to maintain a healthy
weight for the long term. Another advantage of regular
exercise as part of a weight-loss program is a greater loss of
body fat versus lean muscle compared to those who diet alone.

Nutritional management for overweight :  Reduced triglyceride levels and

1. Behavioral modification to improve body image perseption
and awareness the nutritional status to comorbidity in the
later age.
2. Dietary recommendation to adequate quality and quantity
nutritional intake:
3. Assess nutritional requirement (total calorie, protein and
energy requirement, micronutrient), frequency, food
sources and food replacement.
4. Increase physical activity : frequency, low to moderate
intensity, and duration.
increased "good" HDL
cholesterol levels
 Lowered blood pressure
 A reduction in abdominal fat
 Reduced risk of heart disease.
Remember, these health benefits can
occur independently (with or
without) achieving weight loss.
Before starting an exercise program,
you should talk to your doctor about
the type and intensity of the exercise
program.
General exercise recommendations:
 20-30 minutes of moderate exercise 5 to 7 days a week, preferably daily. Types of exercise
include walking, stationary bicycling, walking or jogging on a treadmill, stair climbing machines,
jogging, and swimming.
 Exercise can be broken up into smaller 10-minute sessions.
 Start slowly and progress gradually to avoid injury, excessive soreness, or fatigue. Over time,
build up to 30 to 60 minutes of moderate to vigorous exercise every day.
 People are never too old to start exercising. Even frail, elderly individuals (ages 70-90 years) can
improve their strength and balance.
Exercise precautions:
The following people should consult a doctor before vigorous exercise:
 Men over age 40 or women over age 50.
 Individuals with heart or lung disease, asthma, arthritis, or osteoporosis.
 Individuals who experience chest pressure or pain with exertion, or who develop
fatigue or shortness of breath easily.
 Individuals with conditions or lifestyle factors that increase their risk of developing
coronary heart disease, such as high blood pressure, diabetes, cigarette smoking,
high blood cholesterol, or having family members with early onset heart attacks
and coronary heart disease.
 A patient who is obese

6. Health Care Maintenance for Teenager

HEALTH CARE MAINTENANCE FOR TEENAGER

Four major strategies have been used in the rapidly growing field of preventive medicine. These include health screening, lifestyle change, risk factor control and vaccination programs.
Screening Counseling Immunization Prophylaxis
 Obesity (BMI)  Injury prevention  Tetanus booster every 10  Pre-pregnancy Folic acid supplementation
 Hearing  Smoking/tobacco cessation years (prevent neural tube defects)  1 month before
 Vision  Other substance use  Premarital immunization conception until the end of the first trimester
 Blood pressure, every 1-2 years for age >  STD prevention and  Hepatitis B  Prevent osteoporosis: adequate calcium intake
21 years old contraception (reproductive  HPV (female)
 Anemia health)  Fluoride supplementation in area with inadequate
 Tuberculosis  Dietary advice fluoride
 Gynecologic problems (female), pap  Dental health
smear every 3 year for age > 18 years  Physical activity
old  Pre-Marriage counseling
 STD (Sexually active)
 Mental problems (drinking and smoking,
drug abuse, homicide, suicide)
 Urinalysis
 Blood screening
 Genetic screening