THIS HOUSE WOULD PRIORITIZE OBESITY TREATMENT IN INDONESIA

GOVERNMENT

FIRST SPEAKER

DEFINITION IN 3 KEYWORDS:-
A. THIS HOUSE : HEALTH MINISTRY AND PUBLIC.
B. PRIORITIZE : DESIGNATE OR TREAT (SOMETHING) AS MORE IMPORTANT THAN OTHER
THINGS.
C. OBESITY TREATMENT : Common treatments for overweight to lose weight include healthy
eating, being physically active, and making other changes to usual habits. If it is an extreme
obesity and related health problems, it may consider other treatments, such as bariatric
surgery.

BACKGROUND

Basically, obesity occurs when the number of calories consumed is more than that burned
through exercise and normal daily activities. As a result, the body will store these excess calories as
fat. Most Indonesians often get a high calorie intake from fast food and sugary drinks. Obesity and
central obesity have become serious public health problems in developing countries such as
Indonesia. Although 10 years have passed since the largest national health survey was conducted in
2007, no further analysis and publication concerning obesity and central obesity in Indonesia have
been conducted based on the survey. The aim of this study is to determine the prevalence of obesity
and central obesity, and its association with sociodemographic characteristics and comorbidities in
Indonesia. The result of this study is the prevalence of obesity and central obesity in the Indonesian
adult population are 23.1% and 28%, respectively. Both rates are higher in females than in males.
Obesity and central obesity are associated with the risk of diabetes and hypertension. So in
conclusion, Prevalence of obesity and central obesity is high in the Indonesian adult population.
Interventional programs are important to promote awareness of obesity and healthy lifestyle
changes in the community.

HEALTH ASPECT

Obesity rates in Indonesia are increasing rapidly in both rich and poor households as they shift
from traditional diets towards processed products that are often higher in fat and sugar, and less
expensive than wholesome foods. People living in urban areas are more likely to be overweight as
access to processed food is easier. City living is also associated with more sedentary lifestyles,
especially among women and girls, due to inadequate infrastructure such as narrow pavements and
a lack of parks, which limit opportunities for exercising.
“These data are a stark reminder that obesity is a global public health crisis today,” said WHO
Representative Dr N. Paranietharan. “WHO encourages countries to address the factors that are
contributing to obesity by enforcing disincentives on unhealthy consumption, promoting the
availability of healthy food and greater participation in active lifestyle.”

Cheap and easy access to unhealthy foods, along with exploitative marketing practices and
packaging, are directly linked to growing overweight and obesity. Among both adults and children,
the intake of ultra-processed foods is strongly associated with being overweight, with soda
consumption particularly linked to obesity among adult men. Instant noodles and sugary drinks also
lead to elevated levels of C-reactive protein – a marker of cardiovascular risk – according to research
using nationally representative data.

Ladies and gentleman, Why obesity treatment need to be prioritize? The Ministry of Health
(Kemenkes) admitted that it was worried about the increasing number of people with obesity in
Indonesia which continues to increase. Based on data from the Ministry of Health, one in three
Indonesian adults is obese, and one in five children aged 5 to 12 years is overweight and obese.
"Obesity in Indonesia is increasing with an alarming increase. According to the 2018 Basic Health
Research (Riskesdas), the prevalence of obesity among Indonesian adults has almost doubled from
19.1 percent in 2007 to 35.4 percent in 2018. We really have to pay attention to this tendency to
increase obesity," said the Head of the Organization of the Indonesian Obesity Study Association
(HISOBI) dr. Dicky Levenus Tahapary. Obesity has become a global epidemic. The stigma of obesity
also presents its own challenges in dealing with obesity. Stigma against weight includes negative
behaviors and attitudes directed towards a person related to his body weight. This stigma is
dangerous and everyone should understand that obesity is a disease. Obesity cannot be treated
simply by reducing food intake and more physical activity and it need a treatment. As we know that
diabetes are one of the reason and sickness that cause Indonesian people are dead, that’s why
treatment for obesity need to be prioritized.
SECOND SPEAKER

SOCIAL ASPECT

Ladies and gentleman, do you know that most of people obesity are because of their heredity?
The mantra in obesity treatment is ‘eat less and move more’. But a leading group of obesity experts
writing in a comment in The Lancet Diabetes & Endocrinology journal question the belief that this is
sufficient to treat obesity. They argue that obesity is a chronic disease with largely biological causes
that cannot be cured with just diet and exercise. Many people with obesity can lose weight for a few
months, but 80%–95% regain their lost weight eventually. One explanation for this limited long-term
success is that reducing caloric intake triggers several biological systems that drive us to eat high-
calorie foods and gain weight. These biological systems evolved when humans needed to survive
times of food scarcity. But in modern humans who have had obesity for some time, these biological
adaptations encourage calorie consumption and the storage of fat to protect an individual’s highest
sustained weight. Overriding this fat-loss defence does not appear possible for most individuals
through just lifestyle changes, say the authors, particularly in a 21st century environment that
promotes the consumption of calorically dense, high-fat foods along with low energy expenditure.

“Although lifestyle modifications may result in lasting weight loss in individuals who are overweight,
in those with chronic obesity, bodyweight seems to become biologically ‘stamped in’ and defended,”
explains Dr Christopher Ochner, lead author of the comment and Assistant Professor of Pediatrics
and Psychiatry at the Icahn School of Medicine at Mount Sinai in New York, USA.

“Therefore, the current advice to eat less and exercise more may be no more effective for most
individuals with obesity than a recommendation to avoid sharp objects for someone bleeding
profusely.”

Moreover, he point outs, recent evidence suggests that these biological adaptations could persist
indefinitely, even in formerly obese individuals who achieve a healthy bodyweight through dieting.
“Few individuals ever truly recover from obesity; rather they suffer from ‘obesity in remission’. They
are biologically very different from individuals of the same age and bodyweight who never had
obesity.”

The authors argue that if weight loss is to be sustained in the long-term, at least some of these
biological factors need to be addressed. However, current biologically based interventions are
limited to anti-obesity drugs, weight-loss surgery, and intra-abdominal vagal nerve blockage, which
do not permanently correct the biological factors that undermine weight-loss effort. To date, only
Roux-en-Y gastric bypass, a common surgical procedure for extreme obesity, has been shown to
reverse obesity-induced changes in appetite hormones and the brain’s response to food. This, say
the authors, might explain why bariatric surgery is the only treatment showing long-term
effectiveness in individuals with sustained obesity.

According to Dr Ochner, “Many clinicians are not aware of the reasons individuals with obesity
struggle to achieve and maintain weight loss. Obesity should be recognised as a chronic and often
treatment-resistant disease with both biological and behavioural causes that require a range of
medical interventions including biologically based interventions such as pharmacotherapy or surgery
as well as lifestyle modification.”
He adds, “Ignoring these biological factors and continuing to rely on behavioural modification will
surely result in the continued inability to treat obesity effectively and the premature death of
millions of individuals each year.”

PSYCHOLOGY ASPECT

Ladies and gentleman, in addition to affecting physical health, obesity also has a big impact on the
mental health or psychology of a person. It is because In addition to their physical challenges, people
living with obesity often struggle with mood and anxiety disorders. One study found that adults with
excess weight had a 55% higher risk of developing depression over their lifetime compared to people
that did not struggle with obesity. Other research linked being overweight with significant increases
in major depression, bipolar disorder, and panic disorder or agoraphobia. The question is How
Obesity Causes Mental Health Problems? There are a variety of practical and societal factors that can
lead to mental health issues for patients living with obesity. These include:

1.Quality of life: Men and women who carry significant extra weight often face problems related to
physical and occupational functioning, both due to their size and chronic ailments. Being physically
unable to do the things they love—such as attend fun events, travel, or visit with friends and family
—can lead to social isolation, loneliness, and more difficulty coping with life’s hardships. Chronic
pain on its own has been linked to depression.

2. Weight bias and discrimination: One of the biggest challenges for those struggling with weight
issues is society’s negative perspectives on obesity. Weight bias refers to the stereotypes and
attitudes that define people with obesity as unattractive, lazy, and undisciplined. These unfavorable
misperceptions can be widespread within families, among peers, in the workplace, and in medical
settings by healthcare providers. They can lead to discriminatory behavior that affects a person’s
self-esteem, employment opportunities, and even the quality of healthcare they receive.

3. Poor body image: Weight bias and poor body image tend to go hand-in-hand. Patients may
internalize society’s stigma against obesity, which causes them to feel embarrassed about their
weight and dissatisfied with their appearance. People who struggle with excess weight may also
experience anxiety over being judged for how they look.

4.Physiological issues: There are also obesity-related health factors that can negatively influence
mental health. Research suggests that excess body fat and poor eating habits increase inflammatory
markers. This heightened inflammation can lead to a higher risk of developing depression and also
plays a role in immune system health
THIRD SPEAKER

Ladies and gentleman, it is really” clear from my first and second speaker argument that obesity is a
disease that becomes the cause or source of all other dangerous diseases and that is the strongest
reason why Indonesia need to prioritize obesity treatment. The new rising health issue is
obesity that has not been only suffered by developed countries like U.S. but also appearing to
countries that are developing, like Indonesia ; not only urban area but also rural, it was an issue that
most of Indonesian people yes do not have strong awareness to solve this issue. The problem with
obesity is that its inherently harmful as it is a root of many degenerative or non infectious disease
diseases such as stroke, diabetes, High Blood Pressure, and those even can lead to death. Those
multiplier diseases are wasting the expenditures of the nation by the usage of medical machines that
day by day increases. Meaning, that we do not want to waste state spending that actually can
be benefit to other programs. Obesity should receive a prioritized treatment to peoples who suffer
this as a root dangerous multiplier diseases. Our goal is to do once for all by prioritizing treatments
of obesity, we think that by treating this health issue also can decrease the other issues that are the
effect of obesity. Thus we do not want nation to spend the dana uneffectively, and spend much
funding to health problems that actually can be cured by 1 step. To this, we want a better quality of
life of each individuals by not letting them less productive when facing obesity.

Prioritizing health issue is feasible as a country. The fact that obesity is a new issue that
appeared in Indonesia, it is justified that these problems are going to cause multiplier effect which
leads to many diseases and many treatments. We want this diseases to stop as our way to kill a
parasite from the root. As the government program, we want to make the efficiency by prioritizing
this disease. Evidence, if we can cure 1 big issue, meaning that other issue that is parallel to that will
be decreased. If obesity is given treatment well, then government do not need to expense the
funding of machines to cure diabetes, heart disease which those appear since obesity occur to
begin with. We admit that by prioritizing obesity other issues will likely to
beuncontrolled. But onder gov, we say this is will be less likely to happenbecause the issues that are
stunting / other infectious diseased has beenprogressive and empowered by the health workforce
who did NusantaraSehat to spread help to all over Indonesia in health aspects, we haveprofessional
doctors who did their best on certain cure. And even if ithappens, that is still okay because that also
happens in the late statusquoand the statusquo will be worsen if we don’t apply priritizement.

See? Obesity are really giving so much disadvantage for the people who get obesity, the fact that
obesity are the cause of almost all dangerous disease that can lead to death, there is no other
compliment that can argue our motion for today. If this disease are leading to so much problem
either our physical health, mental health and also social than we have mention before, we as the
government team will 100% support our motion for today. Besides, mental illness are affected by
obesity too. And without treatment, the consequences of mental illness for the individual and
society are staggering. Untreated mental health conditions can result in unnecessary disability,
unemployment, substance abuse, homelessness, inappropriate incarceration, and suicide, and poor
quality of life.

One of the example is Christophe Legault. It's been three years since Christophe Legault, now 12,
was diagnosed with obesity and started treatment. He had been having trouble at school — his
grades were dropping, he was being bullied and he was struggling to participate in sports such as
basketball, his favourite. The program he's been following at Maison de Santé Prévention, a semi-
private, subsidized clinic in Montreal, involves intensive lifestyle and nutrition counselling, including
finding out what kinds of food and exercise work for him and his family, who pay for the treatment.
With help from doctors, nurses, nutritionists and other experts, the family made changes around the
kinds of foods they eat, and Christophe started walking to school instead of taking the bus. "It makes
me proud that I made a lot of progress," Legault said. "If I didn't have that treatment, it would have
been really hard."
OPPOSITION

HEALTH ASPECT

Ladies and gentleman, we as the opposition team really” disagree with our motion for today that
said this house would prioritize obesity treatment in Indonesia. According to the data that we
collect, obesity are not in the list of most sickness that cause death in Indonesia. According to the
CIA World Factbook, in 2020, 20.88 million Indonesians were above the age of 65 By 2025, 12.5% of
Indonesia’s population will comprise of the elderly, a 45% increase from 2015 (8.6%). The most
prevalent NCDs (non-communicable disease) in Indonesia are hypertension, heart disease, bronchial
asthma, chronic renal failure, diabetes, stroke, and cancer. The most deadly diseases in 2019 were
stroke, ischemic heart disease, and diabetes, which all experienced double digit percent increases
from their totals a decade earlier in 2009.

As the fourth most populous country in the world, Indonesia offers great potential for U.S.
exporters of medical devices and equipment. Although the Indonesian government has
implemented local content requirements and import tariffs, Indonesia continues to rely on imported
innovative medical devices. An increase in public awareness about the importance of healthcare, the
expansion of public and private hospitals, and the implementation of Indonesia’s public health
insurance system known as “BPJS-Kesehatan” (Jaminan Kesehatan Nasional, or JKN) in 2014, have
led to an increased demand for more sophisticated and modern medical devices. Per February 2022,
the membership coverage has reached 236.8 million people, or around 86% of the total population
in Indonesia. This program will increase the demand for advanced medical equipment and supplies.
U.S. manufacturers of medical equipment should take advantage of this growing market. This is one
of the prove that Indonesia should not prioritize obesity treatment than others.

World Health Organization (WHO) data shows that there are 10 diseases as the highest cause of
death in Indonesia. The first order is stroke with 131.8 cases of death per 100 thousand inhabitants.
Secondly, there is an ischemic heart or heart attack cause with 95.68 cases. In third place with a
fairly far gap is diabetes mellitus, which is 40.78 cases. Fourth, there was tuberculosis (TB) of 33.24
cases. Thin below the fifth there is cirrhosis of the liver with a percentage of 33.06 cases. In the last
place is neonatal or newborn mortality of 16.77 cases. WHO said monitoring the annual death toll
would help address the cause and adapt the health system to react effectively. This finding can also
be used as a basis for improving other sectors. For example, the transportation sector, to be more
able to overcome road traffic accidents. Food and agriculture, in order to provide food that can
overcome the prevalence of diabetes. Then it can also provide support to improve mental health.
Ladies and gentleman, based on our data that we have mention before, there is no obesity there, it
is proving that obesity doesn’t need too get a prioritized treatment from the health ministry. If
obesity treatment will be prioritized than how about the chronic disease that I have mention before.
Im not saying that obesity treatment is not important, buat according to the data and the fact that
there are more chronic disease in Indonesia that more dangerous than obesity, it would be so much
better the chronic disease that I have mention before get a prioritized treatment than the obesity.
SECOND SPEAKER

Education aspect

In the educational aspect, it would be better to prevent obesity than to cure it even to the point
of prioritizing the treatment of obesity itself. The most important thing for the government is to
increase education about the importance of healthy living from an early age. By doing this, he can
educate, train and accustom today's teenagers and children to always eat healthy food, maintain
health and be wiser in eating their food.

Prevention is the key to success for obesity control as many, but not all, obese children will
eventually become obese adults. “Tracking” or the likelihood of persistence of childhood obesity into
adulthood is related to the age. The management of obesity in adults is a difficult and often
unsuccessful feat especially in the absence of a known organic etiopathogenesis (eg, leptin
deficiency, other hormonal abnormalities). Prevention of childhood obesity on the other hand can
be more rewarding, providing better chances for reducing long-term complications. There are three
levels of prevention in dealing with childhood obesity:26–28

1. Primordial prevention: deals with keeping a healthy weight and a normal BMI throughout
childhood and into the teens.

2. Primary prevention: aims to prevent overweight children from becoming obese.

3. Secondary prevention: directed toward the treatment of obesity so as to reduce the comorbidities
and reverse overweight and obesity if possible.

Inculcating healthy practices like plant-based foods and fruit consumption and inclusion of exercises
and active lifestyle form the pillars of the prevention programme. All the previously mentioned
strategies when combined together can be put into practice sequentially from perinatal period to
adolescence as follows:

1. Perinatal: this includes adequate prenatal nutrition with optimal maternal weight gain, good blood
sugar control in diabetics, postpartum weight loss with exercises and nutritional counseling.32

2. Infancy: early initiation of breastfeeding, exclusive breastfeeding for 6 months followed by

inclusion of solid foods, providing a balanced diet with avoidance of unhealthy calorie-rich snacks
and close monitoring of weight gain.33–35

3. Preschool: providing nutritional education to parents and children so as to develop healthy eating
practices, offer healthy food preferences by giving early experience of different food and flavors, and
following closely the rate of weight gain to prevent early adiposity rebound.36

4. Childhood: monitoring both the weight and height, preventing excessive prepubertal adiposity,
provide nutritional counseling, and emphasis on daily physical activity.37

5. Adolescence: prevent the increase in weight after growth spurt, maintain healthy eating behavior,
and reinforcing the need for daily exercises and workouts.38–39

Physical activity is the key component for prevention and management of obesity.42,43 Preschool
children require unstructured activities and thus will benefit from outdoor play and games. On the
other hand, school going children and adolescents require at least 60 minutes of daily physical
activity out of which 30 minutes should be structured activities like sports and supervised
exercises.44–46 This has also been recommended by American Academy of Pediatrics.47 Simply
providing education on obesity-related health risks, nutrition, and physical activity is insufficient to
induce behavioral change. The best-established counseling techniques used for pediatric obesity
treatment use a behavioral change model, which includes the following elements:

Self-monitoring of target behaviors (logs of food, activity, or other behaviors recorded by patient or
family).

This allows the child and family to recognize the behaviors contributing to their weight gain. Clinician
feedback throughout the self-monitoring process is essential to monitor the behavior change. A
patient’s food log may also identify other contributors to eating behaviors, such as the meal-time
environment, boredom, and level of hunger, all of which can be valuable in the evaluation of
stimulus control.

Stimulus control to reduce environmental cues that contribute to unhealthy behaviors.

This includes reducing access to unhealthy behaviors (eg, removing some categories of food from
the house or removing a television from the bedroom) and also efforts to establish new, healthier
daily routines (such as making fruits and vegetables more accessible).

Goal-setting for healthy behaviors rather than strict weight goals.

Goal-setting is widely used for inspiring behavioral change. However, the process can be detrimental
if goals are not realistic and maintainable. Appropriate goals are Specific, Measurable, Attainable,
Realistic, and Timely (“SMART”).

Contracting for selected nutrition or activity goals.

Contracting is the explicit agreement to give a reward for the achievement of a specific goal. This
helps children focus on specific behaviors and provides structure and incentive to their goal-setting
process.
THIRD SPEAKER
Ladies and gentleman, based on my first speaker argument, we as the opposition team really”
disagree with the motion and we advising not to prioritize obesity treatment but prioritize other
chronic disease such as diabetes, heart attack, tuberculosis, NTDs and neonatal death, because
according to the data that we collect these are the most common diseases that suffered by the
Indoesian people. Here are some explanation about the treatment that should be prioritizeed in
Indonesia. Firstly is TUBERCULOSIS In Indonesia, there are an estimated 842,000 new TB cases and
100,000 TB-related deaths each year. Drug Resistant TB (DR-TB), which cannot be treated with
commonly available TB drugs, is on the rise. To address this growing crisis, USAID partners with
Indonesia’s National TB Program, the goal of which is to eliminate TB by 2030, to expand Indonesia’s
ability to detect and treat more TB cases, improve laboratory services, open more treatment
facilities, and ensure a quality supply of much-needed medicines. To enhance the government’s
efforts to cultivate greater private sector participation in the National TB Program, USAID advances
solutions to the chronic under-reporting of privately treated cases, helps improve the quality of care
at private facilities, supports the continuity of TB services during the COVID-19 pandemic, and
strengthens support networks for DR-TB patients. USAID also expands Indonesia’s use of GeneXpert,
a diagnostic machine that reduces DR-TB diagnosis time from months to hours, by training local
health workers how to operate it. With the Muhammadiyah network of health facilities, we expand
Indonesians’ access to DR-TB treatment, care, and services in highly populated provinces.

The nest is NTDs. NEGLECTED TROPICAL DISEASES (NTDs) Over 45 million Indonesians – about one-
sixth of the population – are at risk for lymphatic filariasis (elephantiasis), and intestinal worms are
nationally endemic. These and other NTDs hurt the poorest members of society the most,
perpetuating poverty, slowing children’s development, and inhibiting economic productivity. Safe
and inexpensive single-dose medicines, however, can treat many NTDs and stop transmission
altogether. USAID’s NTD programs enhance GOI efforts to map disease burdens, develop a national
strategy for disease control and elimination and implement community-based campaigns to bring
these preventative treatments to millions of people.

We also need to REDUCING PREVENTABLE DEATHS OF MOTHERS AND NEWBORNS In Indonesia.

Indonesia has some of the highest maternal and neonatal death rates in Southeast Asia; two
mothers and eight newborns die every hour from mostly preventable causes. USAID builds
Indonesia’s self-reliance in tackling the complex and interconnected factors causing preventable
death among maternal and newborns. USAID’s engagement catalyzes collaborative problem-solving
as well as financially viable partnerships to improve quality of care, emergency referrals, use of data,
financial protections, local governance, and health services for the poorest and most vulnerable
families. USAID also leverages public private partnership for greater scale, sustainability, and
effectiveness of maternal and newborn health outcomes.

According to my second speaker argument, we also agree and believe that obesity don’t need to
be treated but we better prevent it in an early age. That’s why education are really” important to be
applied since their still a kid, because it is one of the important factor that will determine their
health in the future. By teaching them to eat healthy food in an early age can decide their future
health. Besides for children, there is also some tips that may he an adult to prevent them from
obesity. Broadly speaking, how to prevent obesity in adults is not much different from how to
prevent obesity in children. The bottom line is eating a healthy diet and doing more physical activity
can help prevent obesity. Here are some good things adults do as a way to prevent obesity:
1. Reduce the consumption of "bad" fats and more "good" fats. It should be understood, not all fats
are bad. A study published in Nutrition Journal in 2017 showed that healthy intake of dietary fats,
such as polyunsaturated fatty acids (PUFA) can increase levels of good cholesterol (LDL) and reduce
the risk of obesity.

2. Eat a lot of dietary fiber. Studies continue to show that dietary fiber plays a role in weight
maintenance. For example, a published studyObesity (Silver Spring) in 2012 found that people who
took complex fiber supplements three times a day for 12 weeks lost up to 5 percent of their body
weight.

3. Do aerobic exercise regularly. Incorporating regular physical activity into the daily routine is
important for maintaining or losing weight, among other benefits. The CDC recommends 150
minutes of moderate aerobic activity or 75 minutes of strenuous aerobic activity per week for
healthy adults.

4. Focus on reducing daily stress. Stress can have a lot of impact on the body and mind. A study
published Current Obesity Reports in 2012 showed that stress can trigger brain responses that
change diet and cause a desire to eat high-calorie foods. While, eating too many high-calorie foods
can contribute to the development of obesity.