PATOFISIOLOGI DAN

DIAGNOSA OBESITAS
Bambang Suprapto
OBESITAS
DEFINISI
KLASIFIKASI
SIAPA OBESE?
KOMPLIKASI
PENURUNAN BERAT BADAN
PATOFISIOLOGI
DIAGNOSA
DEFISINSI OBESITAS
BMI >25 (ASIA)
BMI>30 (EROPA + AMERIKA)
KELEBIHAN LEMAK:
- WANITA: N = 20 -27% BB
- PRIA : N = 12 15% BB
BODY MASS INDEX
BMI = BB (kg) : TB (m)
2

BB = Berat badan
TB = Tinggi badan
LEMAK TUBUH
(Deurenberg et al, 1991)
% lemak = 1,2 (BMI) + 0,23(umur) 10,8
(gender) 5,4


% lemak= persen lemak tubuh
BMI = kg/m2
Umur = tahun
Gender: laki-laki = 1
wanita = 0
KLASIFIKASI OBESITAS
(1)
BMI (kg/m2) WHO (1995) Deskripsi populer
<18,0 Underweight Kurus
18,5 - 24,9 - Normal
25,0 29,9 Grade 1 overweight Kelebihan berat badan
30,0 39,9 Grade 2 overweight Kegemukan
40 Grade 3 overweight Sangat gemuk

(Sumber: Seidell, 2005)

KLASIFIKASI OBESITAS
(2)
WHO (2000) WPRO (2000)
< 18,5 UNDERWEIGHT < 18,5
18,5 24,9 NORMAL 18,5 22,9
25,0 29,9 Pre-obese/overweight 23,0 24,9
30,0 34,9 OBESE I 25,0 29,9
35,0 39,9 OBESE II > 30,0
>40,0 OBESE III
Sumber: Anuurad, et al (2003)
KLASIFIKASI OBESITAS
(3)
SEX-SPECIFIC CUT-OFF-POINTS FOR
WAIST CIRCUMFERENCE:
Level 1 Level 2
(alerting zone) (action level)
Men > 94 cm > 102 cm
Wanita > 80 cm > 88 cm
(Sumber; Kopelman et al, 2005)
KLASIFIKASI OBESITAS (4)




Underweight <18,5 Low Average
Normal range 18,5 22,9 Average Increased
Overweight >23,0
At risk 23,0 24,9 Increased Moderate
Obese class I 25,0 29,9 Moderate Severe
Obese Class II > 30,0 Severe Very severe
BMI (Kg/m2) Risk of comorbidities
Waist circumference
< 90 cm (men) > 90 cm
< 80 cm (women) > 80 cm


(Sumber: WHO, IASO, IOTF, 2000)
SIAPA KEGEMUKAN?
FAKTOR DEMOGRAFIK (umur, gender,
etnisitas)
FAKTOR SOSIAL BUDAYA (tingkat
pendidikan, penghasilan, status perkawinan)
FAKTOR BIOLOGIS (paritas)
FAKTOR PERILAKU (asupan makanan,
merokok, konsumsi alkohol, kegiatan
jasmani)
KOMPLIKASI OBESITAS
DIABETES MELLITUS TIPE 2
PENYAKIT JANTUNG KORONER
KANKER
OSTEOARTRITIS
BATU EMPEDU
SLEEP APNOEA
GANGGUAN REPRODUKSI
GANGUAN KEHAMILAN
GANGGUAN PSIKOLOGIS
SOCIAL PENALTIES

MANFAAT PENURUNAN
BERAT BADAN (5-10%BB)
MORTALITAS UMUM: TURUN 20%
KEMATIAN AKIBAT DM: TURUN 30%
KEMATIAN AKIBAT KANKER: TURUN
40%
TEKANAN DARAH: TURUN 10 mm Hg
LIPID: CHOLESTEROL TURUN 15%
DIABETES: PENGENDALIAN KADAR
GULA DARAH LEBIH BAIK


PATOFISIOLOGI OBESITAS
(1)
ENERGY - ENERGY = ENERGY
IN OUT STORED
ENERGY STORED = FAT STORAGE
ENERGY STORES
ENERGY INTAKE ENERGY OUTPUT
Fecal energy
(2)
PATOFISIOLOGI OBESITAS (2)
MOLECULAR BEHAVIORAL
PRADER WILLI
SYNDROME
PEGULAT
SUMO
ADIPOSE TISSUE
Leptin
Lep-R
Anabolic pathway Catabolic pathway
Neurons Neurons
POMC
Hypothalamus
AGRP MC4R

Food intake
MSH
------------
- +
-
+
-
PC1
FOOD
ENERGY INTAKE
Energy lost
In faces
ENERGY IN
CIRCULATION
Energy lost
In urine
Energy
absorbed
Body
Energy
stores
Fat (77%)
Protein
(22%)
Glycogen
(<1%)
Basal metabolic rate Physical activity Thermogenesis
ENERGY EXPENDITURE
Energy metabolized
(HEAT PRODUCTION)
Principles of energy balance

Components of energy expenditure
BMR
TEF
-------------------------
Spontaneous activity
EXERCISE
Resting
Metabolic
Rate
Non resting
Metabolic
rate
_________
________
Beyond

Voluntary

control
BASAL METABOLIC RATE
% body weight % BMR
Skin,bone,gut: 33%
Adipose tissue: 21%
Skeletal muscle:
40%
Organs (brain, liver,
heart, kidney): <6%

16 %
< 5%
22%

58%
THERMOGENESIS
ISOMETRIC THERMOGENESIS
DYNAMIC THERMOGENESIS
PSYCHOLOGICAL THERMOGENESIS
COLD-INDUCED THERMOGENESIS
DIET-INDUCED THERMOGENESIS
DRUG-INDUCED THERMOGENESIS
CONTROL OF FOOD
INTAKE
HUNGER-SATIETY CONTROL
CENTRES IN THE BRAIN:
-NPY/AgRP NEURONS =
OREXIGENIC
- POMC/CART NEURONS=
ANOREXIGENIC
- LATERAL HYPOTHALAMUS =
OREXIGENIC
HUNGER-SATIETY SIGNALS
FROM THE PERIPHERY
SIGNALS FROM THE GASTROINTESTINAL
TRACT
AMINOSTATIC SIGNALS
GLUCOSTATIC AND GLYCOGENOSTATIC
SIGNALS
LIPOSTATIC AND ADIPOSITY SIGNALS
LEPTIN AND INSULIN
HEPATIC NUTRIENT METABOLISM
SIGNALS
INTEGRATED MODELS OF
FOOD INTAKE CONTROL
SHORT-TERM (HOUR TO HOUR) BLOOD
GLUCOSE HOMEOTSTASIS
MEDIUM-TERM (DAY-TO-DAY)
MAINTENANCE OF ADEQUATE HEPATIC
STORES OF GLYCOGEN
LONG-TERM (WEEKS, MONTHS OR
YEARS) MAINTENANCE OF THE BODYS
FAT AND PROTEIN COMPARTMENTS
Blood metabolites Higher centres Gut
Glucose Cognition CCK
Fatty acids Sensorial Ghrelin
Amino acids Learning GIP.GLP-1,PYY
EPISODIC SIGNALS
HYPOTHALAMUS
SNS
Energy
expenditure
ADIPOSE TISSUE
Energy
intake
TONIC SIGNAL
Leptin Insulin
Major effects
Minor effects
Additive over time
Outcome
Low SES
Gender
Environment
Economics
Nutrition
Activity
Inactivity
Smoking
Prevalence of
overweight or
obesity
+
Schematic representation of the determinants of
Overweight and obesity
ENERGY BALANCE
INTAKE EXPENDITURE
Intake>>Expenditure Obesity
Intake<<Expenditure Weight loss
DIAGNOSA OBESITAS
BMI > 25; BMI>30
TRICEPS SKINFOLD:
LAKI-LAKI > 16 MM
WANITA > 28 MM
WAIST CIRCUMFERENCE
LAKI-LAKI: > 102 CM
WANITA : > 88 CM