1. Mnt for Obesity1

8/12/2019 1. Mnt for Obesity1

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Marketing to Children

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MANIPULATING CHILDRENS BEHAVIOUR

Food promotion

Can confuse nutritional knowledge e.g whether fruit is in product

Changes food prefences

Changes purchasing behaviour

Influences choice and consumption by brand

Alter balance of catagories of food eaten

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UK Food Standards Agency, 25th September 2003

CHANGING DIETARY HABITS

Increased intake of caloric sweeteners & edible oil

Increased intake of processed foods, refined carbohydrates & salty

high fat snacks

Reduced intake of fruits and vegetables

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From Traditional food to Modern Meals

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PORTION SIZE

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From Traditional to Modern Snacking

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From Traditional Food Marketing to ModernFood Supermarkets

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DECREASED PHYSICAL ACTIVITY

Excess TV; computer, & play station time

Children are home alone (dual income parents)

Decreased physical activity at school & at home

Transportation by car or school bus

Neighborhood safety

Few public parks, sidewalks, swimming pools ..etc

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From Traditional to Modern Leisure

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Klasifikasi dan risiko PenyakitPenyerta berdasar WHO:

Klasifikasi dan risiko PenyakitPenyerta untuk orang ASIA:

(Lestiani, 2011)

KLASIFIKASI

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TEBAL LIPATAN KULIT TRISEP

Obesitas umumnya menyebabkan akumulasi lemak pada daerah subkutan dan

jaringan lainnya. Cara yang digunakan untuk mengukur lemak subkutan di

lengan atas, salah satunya dengan mengukur Tebal Lipatan Kulit Trisep

Kategori Interpretasi

> 85 percentil obesitas

> 95 percentil superobesitas

(Rahmawati, 2009) 15

Waist Circumference untuk mendeteksi obesitas melalui akumulasi lemak

visceral tubuh

Cutt off ASIA:

Laki-laki : >90 cm

Perempuan : >80 cm

(Gibson, 2005)

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BEHNKES THEORITICAL BODY COMPOSITION MODEL FOR A MANAND WOMAN WIT H HEALTHY PERCENTAGE BODY-FAT RANGES

Males

Total fat 8%-24% Storage fat 5%-21%

Essential fat 3%

Muscle 44.8%

Bone 14.9%

Remainder 16.3-32.3%

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Females

Total fat 21%-35%

Storage fat 9% - 23%

Essential fat 12%

Muscle 38%

Bone 12%

Remainder 15-29%

BODY FATNESS(DEURENBERG AND DEURENBERG-YAP, 2003)

% body fat = (1,2 x BMI) + (0,23 x age in yrs)- (10,8x G)-5,4

G =1 for male, G=0 for female

For example if BMI=28, age 21and G=female

%body fat = (1,2x28)+(0,23x21)-(10,8x0)-5,4

= 33,6+4,83-0-5,4

= 33%

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NOTE:

A body fat percentage of 20% to 25% or more in a male and 25%to 32% or more in female is ussualy considered to be excessive andassociated with the metabolic and health risks of obesity

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PATHOPHYSIOLOGY

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FAT CELL DEVELOPMENT

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FAT CELL METABOLISM

Enzim LPL

Promotefat storage

adiposaMusclecells

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Gender specific hormones (estrogen dan testosteron)

r gu l t s

LPL Activity

Women :

Fat Cells in the breast

Fat cells in the hips

Fat cells in the thighs

Men :

Fat cells in the abdomen

Produce abundant LPL Produce abundant LPL

Tipe Obesity :

Men = Central Obesity

Women = Lower body fat around hip and thigh

OBESITY PROMOTE HEALTHPROBLEM

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-cell pankreas

Insulin Release

Fosforilasi IRS 1 & IRS 2

Signal Insulin

Glut-4 ke

membran sel

Glukosa

masuk sel

Diet Lemak

Fat cell

Sitokain

Serin

Obesitas

Adiponektin

Glukosa serum

Resistensi insulin

Tyr fosforilasi

DIET TINGGI LEMAK MENYEBABKAN RESISTENSI INSULIN

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MEKANISME OBESITAS MENYEBABKAN DISLIPIDEMIA (BARBARA,ET AL. 2003)Obesitas

Kolesterol

Insulin Resisten

Aktivitas LPL

Plasma TG (TG yangada dalam VLDL dan

Kilomikron )

clearence VLDL

Glukosa Hepatic

PengambilanGlukosa otot

FFA Gangguanaksi LDL-R

FFA dan Glukosa Hepar

ProduksiVLDL

VLDL Plasma

Fasting dan PPTRL

small dense LDL HDL

clearence VLDL

3

4

*LPL : Lipoprotein Lipase

LDL-R : LDL ReceptorTRL : Triglyseride Rich Lipoprotein

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MEKANISME INSULIN RESISTEN MENYEBABKAN DIABETESMELLITUS TIPE 2

(Mechanisms linking obesity to insulin resistance and type 2 Diabetes.

Steven E. Kahn, Rebecca L. Hull and Kristina M. Utzschneider. Nature 444,

840-846(14 December 2006) 27 28


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OBESITY DIABETES CHD

HYPERTENSION

+

+

Dietary change

BULK,e.g. vegetables,tubers, cereals

Phytoestrogens

bioactivate molecules

Folate, B6 Homocysteinaemia

Thrombosis

Sex hormone

changes

CANCERS:breast, endometrium

Trans fattyacids

n-3 fatty acids

Saturated fats

AtherosclerosisAntioxidant

s

Total Fat

The interlinking of physical inactivity and dietary effects on obesity and the

progression of disease with industrialisation

Energydensity: fat

& refinedCHOs

+

+

-

-

-

Physical inactivity

+ + +

+

+

+ +

+

+

-

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MANAGEMENT OF OBESITY IN ADULT

Medical Management Lifestyle modification (increase exercise)

Psycological support

Drugs

Surgery

Nutritional Management Food choice changes

Nutrition education

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OBESITY TREATMENT PYRAMID

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DECIDING ON TREATMENT

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SURGARY

Weight loss surgery is an option for carefully selected patients with clinically

severe obesity (BMI 40 or 35 with comorbid conditions) when less invasive

methods of weight loss have failed and the patient is at high risk for obesity-

associated morbidity or mortality

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MEDICATION

Weight loss drugs approved by the FDA for long-term use may be useful as an

adjunct to diet and physical activity for patients with a BMI of 30 with no

concomitant obesity-related risk factors or diseases, and for patients with a BMI

of 27 with concomitant obesity-related risk factors or diseases

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PHYSICAL ACTIVITY

Initially, moderate levels of physical activity for 30 to 45minutes, 3 to 5 days per week should be encouraged.

All adults should set a long-term goal to accumulate atleast 30 minutes or more of moderate-intensity physicalactivity on most, and preferably all, days of the week

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JENIS OR YANG AMAN BAGI PASIENOBESE

1. Berjalan kaki (30 menit/hari, 5-6 x/minggu)

2. Jalan cepat (12 jam membakar 3500 kkal)

3. Berjalan diselingi jogging ringan

4. Senam aerobik low impact

5. Berenang dengan jarak agak jauh6. Berjalan kaki di kolam renang setinggi pinggang.

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TIPE OLAHRAGA UNTUK OBESITAS

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JENIS DURASI INTENSITAS

Voli 45-60 menit Intensitas Rendah,

Durasi Tinggi

Intensitas Tinggi,

Durasi Rendah

Berjalan 1 mil 35 menit

Shooting basketball 30 menit

Bersepeda 5 mil 30 menit

Berenang 20 menit

Bermain basket 15-20 menit

Lompat tali 15 menit

Berlari mil 15 menit SOME DIETS FOR OBESITY

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SOME DIETS, NOT WORKS

Low Calorie Diets: (-) 500 to 1000 Kcal daily requirements

Meal Replacements: 200-300 Kcal High satiety (Protein+ fibre)

Very Low Calorie Diets:200-800 calories daily(rich protein 0.8-1.5g/ kgIBW) 12 to 16 weeksBMI 27 to 30Rapid wt loss

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WHY DIET DOESNT WORK?

1. Regaining Wt among dieters is the norm not the exception.Lower BMReasier to put on weight (J Nutr 2005 Jun;135(6):1347-52)

2. No one can live on a Diet forever

3. We are in daily contact with food

4. Need lifestyle strategies

5. Food behaviour modification6. Personal responsibility

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EFEKTIFITAS VLCD DALAM PENGATURAN BERAT BADAN

BERDASARKAN PENELITIAN TENTANG EFEKTIFITAS VLCD DI MALAYSIA YANG DILAKUKANOLEH ISMAIL NOOR DAN KHOR POH KIM (2002) SELAMA 6 MINGGU MASA STUDI,MENYEBUTKAN BAHWA:

Pria Wanita

Total weight loss 4,5 kg 3,4 kg

Waist circumference loss 8,0 cm 8,0 cm

Hip circumference loss 5,5 cm 6,0 cm

Body fat reduction 3,6 cm 2,3 cm

BMI reduction 1,5 kg/m2 1,4 kg/m2

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EFEK NEGATIF VLCD

(Nutrition Practise:50;Krauss Food & Nutrition

Theraphy:548)

menyebabkan defisiensibeberapa zatgizi danelektrolit

Kehilangan massa otot Pembentukan gallstones

(Handbook of nutrition &food:899; Krauss Food &Nutrition Theraphy:548)

Orthostatic hypotension Gout (ketones bersaing

denganuric acid untukdiekskresi)

(krauses)

Fatigue / keletihan Light-headedness /

dizziness Dapat diatasi dengan

merubah posisitubuhsecepatnya, hindarimandi sauna, minum 1.5-2 L per hari.

Kulit kering Rambut kemerah-

merahan karenakekuranganbeberapamineral seperti Zn

Menstrusi terganggu

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NUTRITION INTERVENTION Low-calorie diets are the closest to most peoplesgeneral eating patterns and present the fewest

risks for the patient

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INTERVENTION OBJECTIVES

Reducebody weight

Maintaina lower bodyweightoverthe longtime

Preventfutherweightgain

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The National Institutes of Health suggests a reduction of 10%

in body weight as an initial goal.

A weight loss of 5%10% has been shown to reduce the risk

of heart disease and stroke.

CMAJ January 3, 2006 174(1)

(Nutritionand Diagnosis RelatedCare, 2008)

NUTRITION INTERVENTION FOR OBESITY

Carbohydrate : 3550% TEE

Fat : 2535% TEE

Protein : 2535% TEE

Low glicemic load

Fiber : 2535 g/ day

Adaquate fluid

Low salt

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Nutrition and Diagnosis Related Care, 2008

NUTRITION INTERVENTION

What will work long term Wt loss 5-10%/wk

Wt loss 0.5-1.5 kg/wk

Some long term energy restrictionis inevitable 1200 to 1800 Kcal

Regular Physical Activity

Healthy eating Low fat (foods and cooking)

High carbohydrates (low refined)

High protein

High fiber

Indulge in low energy dense foods

(CMAJ. 2007 April 10; 176(8): S1S13.)

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ESTIMATING ENERGY NEEDS FOR OBESE

Using ideal body weight (IBW) when calculating energyrequirements in the obese population does not allow for increasedlean body mass (LBM) needed for structural support of the extraadipose tissue

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Cunningham developed a formula to estimate energy

requirements of the obese, often referred to as Adjusted

Body-Weight for Obesity

equations like the Harris Benedict equation


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ESTIMATING ENERGY NEEDS FOR OBESE

Adjustment Body Weight for Obesity:

[(ABW-IBW )x 0.25 + IBW]= weight to be used forcalculating REE

ABW= actual body weight

IBW=ideal body weight

0.25 represents the percentage of excess body weight that ismetabolically active

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PERHITUNGAN ENERGI

Krauses Food 12th Edition50

SOME INTERVENTIONS STRATEGIES THAT COULD BE CONSIDEREDFOR PREVENTION OF CHILDHOOD OBESITY

51Nutrition Journal 2005, 4:24

NUTRITION INTERVENTION IN CHILDHOOD OBESITY

The two most popular diets followed by adults, thelow-carbohydrate diet and the low-fat/low-caloriediet, have not yet been evaluated extensively forsafety and efficacy in children

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Source : Philippas, G. Niki & Lo, W. Clifford. Nutrition in Clinical Care, Volume 8, Number 2, 2005 77

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NUTRITION INTERVENTION IN CHILDHOOD OBESITY

Energy according age, activity, likelihood growth

Protein : 1035% TEE

Fat : 2540% TEE

Carbohydrate : 4560%TEE

Decrease the use of sweets as snack food or dessert

Control between meal-snack

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Krauses Food & Nutrition Therapy 12 editionNutrition and Diagnosis Related Care, 2008

STRATEGI MODIFIKASI GAYA HIDUP(KRAUSES FOOD 12TH EDITION)

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FOOD WEIGHT LOSS TIPS

Establish regular meals times

Read food labels when purchasing food items

Make substitution in diet to cut calories

Identify guilty pleasure such as ice cream

Pre-portion serving to control the amount

Control calories when dining out

Pre-plan meals & snacks, and make a certain to have the food onhand

Avoid places & situation that trigger eating

Try substituting other activities for eating

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THE MOST USEFUL PROGRAMCOMPONENTS :

food-label reading

cooking sessions

learning new and different physical exercises, including home-basedoptions.

Self-management techniques helpful (problem solving)

The use of a group setting and supportive 'peer' leaders werefound to be supportive.

More frequent clinical assessment was suggested for futureprograms.

(International Journal of Behavioral Nutrition and Physical Activity 2008,

5:53)

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THANK YOU

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