Obesity: definition
Chronic disease characterized by
accumulation of fat. Obesity is defined as a
condition when ideal body weight is
exceeded by 20%
Medical condition responsible for serious
co-morbidity and mortality.
Obesity id defined as a condition in which there is an
excess of body fat. The operational definitions of
obesity and overweight however are based on BMI
which is closely correlated with body fatness
Apple-shaped
Visceral fat
Peer-shaped
Obesity : Definition
APPLE TYPE
:Central or
abdominal
adiposity
(ANDROID)
increased WHR
& associated
with higher
morbidity risk.
>
Android obesity
or
Obesity : Definition
PEAR TYPE :
GYNOID or
typical
female
distribution
of fat : less
health risks
Gynoid obesity
or
In many countries in the world, the prevalence
of obesity are rapidly rising, reflecting an overall
increase in general fatness
There is a global epidemic of obesity.
WHO report launched in 1998 signifying the
seriousness of this problem
Sorensen TIA. Diabetes Care 2000;23 (Suppl. 2):B1-B4
The Obesity Pandemic
What causes Obesity?
Genetic predisposition
Disruption in energy balance
Environmental and social factors
Aetiology of obesity
LIFESTYLE
PSYCHOLOGICAL
MEDICAL
GENETIC
OBESITY
IA6
The physiology of weight
gain
Energy input
Energy output
Control factors
Genetic make-up
Diet
Exercise
Basal metabolism
Thermogenesis
Keseimbangan Energi
Pemasukan
Rasa lapar
Rasa kenyang
Penyerapan
makanan
Pengeluara
n
Metabolic Rate
Termogenesis
Aktivitas
Kenapa Gemuk
1. Jumlah kalori yg dimakan lebih banyak dari
kebutuhan
2. Gaya Hidup dan pola makan.
Banyak mengkonsumsi lemak tinggi.
Kalori 1 gram lemak ( 9 kal ) = 2,5 x lebih
besar dari karbohidrat ( 4 kalori )
Sumber lemak : ngemil, Gorengan,
santan, fast food, cokelat, keju, kacangkacangan.
Lemak rasanya enak, mudah dikunyah
namun kurang mengenyangkan.
Aktifitas fisik kurang
3. Genetik
Fat as the Macronutrient
Culprit
Protein
Carbohydra
te
Fat
Energy content per g
Ability to end eating
High
Moderate
Low
Ability to suppress
hunger
High
High
Low
Storage capacity
Low
Low
High
Pathway to transfer
excess
to alternative
Ability
to stimulate own
compartment
oxidation
Yes
Yes
No
Excellent
Excellent
Poor
Adapted from WHO Consultation 1998
Eat to
Live!
Live to
Eat!
EAT TO LIVE
Intake = Expenditure
Weight Stable
LIVE TO EAT
Intake > Expenditure
Obese
Health Consequences of
Obesity
Endometrial Cancer
Infertility
Diabetes
CAD
Hyperlipidemia
Hypertension
Osteoarthritis
Increased surgical
risks
VTEs
Stroke
CHF
Gout
Gallstones
Sleep apnea
GERD
Consequences of obesity
Stroke
Respiratory disease
Heart disease
Gallbladder disease
Hormonal abnormalities
Hyperuricaemia
and gout
Cardiovascular risk
factors
Diabetes
Osteoarthritis
Cancer
Blindness in a child...
because of fat infiltration
in eyelids...
Type 2 diabetes
Hypertension
Coronary heart disease
Gallbladder disease
Osteoarthritis
Breast cancer
Ulterine cancer
Colon cancer
57%
17%
17%
30%
14%
11%
11%
11%
1. Body Mass Index
BMI
Weight in kg
=
(Height in meters)2
2. Body Fat Distribution
Android type (central obesity = visceral obesity)
Ginecoid type
1. DEXA, CT-SCAN, or MRI
2. Waist to hip ratio (WHR)
3. Waist circumference
Classification of Obesity
NIH Guidelines
BMI
Category
<18.5
Underweight
18.5 24.9
Normal Weight
25.0 29.9
Overweight
30.0 34.9
Obesity I
35.0 39.9
Obesity II
>39.9
Obesity III
Abdominal Obesity and
Waist Circumference
Thresholds
of NCEP and IDF
Men
White/Black/
Hispanic
(ATPIII)*
Women
>102 cm (>40 in)
in)
White
(IDF)
South
Asian*
Chinese*
>94 cm (37.0 in)
Japanese
>85 cm (33.5 in)
>90 cm (35.4 in)
>90 cm (35.4 in)
>88 cm (>
>80 cm (31.5
in)
>80 cm (31.5
in)
>80 cm (31.5
in)
>90 cm (35.4
in)
*Update of ATP III Metabolic Syndrome (AHA/NHLBI) 2005
International Diabetes Federation. 2005.
Obesity, hypertension, and hypercholesterolemia
are similar, a disease or not ?
High blood pressure and hypercholesterolemia
per se are not a risk, but rather its damage
to vessels which effects several organs
Obesity, it is not the increase of fat per se
but its consequences on other organs
Bray GA, et al. Handbook of obesity, 1998
Like
hypertension,
hypercholesterolemia, and
osteoporosis,
obesity
is preventable and treatable
Diet, exercise, and behavior
modification
Pharmacological treatment
Surgical treatment
Spectrum of obesity
management
Medical Care /
Perawatan Medik
1. Obat Obatan
2. Pembedahan .
Konsultasi Dokter
Sebelum
mengkonsumsi
Obat
Buat kontrak yang mengikat
dalam hal sasaran
penurunan berat badan
Obat Yang dapat digunakan
1. Sibutramin
( Reductil )
- Bekerja sentral di otak
- Menimbulkan perasaan kenyang
1. Orlistat
( Xenecal )
- Menghambat absorbsi lemak di
usus
The Metabolic Syndrome
Why the Metabolic Syndrome?
A means to explain the markedly increased
risk of heart disease in certain populations
To stimulate identification of vascular
disease risk factors and preventive
interventions
An attempt to seek a unified cause for
macrovascular disease based on
commonalities amongst risk factors
Similar factors seem to predispose to both
heart disease and diabetes
Grundy SM et al. Circulation. 2005;112:27352752.
Obesity at the Core of Metabolic Ris
Obesity
(esp. Abdominal
Obesity)
Other
Factors
Insulin
Resistance
Metabolic Risk Factor
Clustering
ASCVD
T2DM
Clustering of the Metabolic
Risk Factors: Nomenclature
Metabolic syndrome
Syndrome X
Insulin resistance syndrome
Dysmetabolic syndrome
Deadly quartet
Cardiometabolic syndrome
Prediabetes and type 2 diabetes
OBESITY - METABOLIC SYNDROME
DM / IGT
Hypertension
Dislipidemia
Hypertriglycemia and/or Low
HDL-Cholesterol
Central Obesity
The black goat
Obesity Syndrome
(Syndrome X, Metabolic
Syndrome, Insulin
Resistance Syndrome)
Insulin
Resistance/
Hyperinsuline
mia
Dyslipidemia
Glucose
Intolerance
Obesity/
Overweight
Hypertension
Kidney
Disease
Atheroscle
rosis
Obesity
Insulin Resistance
Metabolic Syndrome
Type 2DM
Hypertension
NASH
PCOS
Dyslipidemia
Metabolic Syndrome : Definitions
Factors
NCEP-ATP III
IDF Criteria
Visceral Obesity
Waist circumference
(Asian Modifications)
Male
: > 90 cm
Female : > 80 cm
Europids :
M: > 94 F: > 80
South Asians:
M: > 90 F: > 80
Chinese :
M: > 94 F: > 80
Japanese:
M: > 85 F: > 90
Hypertension
BP > 130/85 mmHg
Or treated
BP > 130/85 mmHg
Or treated
Dyslipidaemia
TG > 150 mg/dl or
HDL < 40
TG > 150 mg/dl or
HDL M: < 40
F: < 50
Impaired glucose
Metabolism
FBG > 110 mg/dl
FBG > 100 mg/dl or preexisting DM
Criteria for Diagnosis
Any 3 of the above
Waist circumference + any
2 of the above
DYSLIPIDEMIA
INSULIN
RESISTANCE
OBESITY
HIGH
BLOOD
PRESSURE
DROP
Dislipidemia
Dislipidemia
Kelainan metabolisme lipid :
kenaikan kadar kolesterol total
kenaikan kolesterol LDL
kenaikan kadar TG (Trigliserida)
penurunan kadar kolesterol HDL
Lipid fractions
Total cholesterol
LDL-cholesterol
HDL-cholesterol
Triglycerides
Total C = HDL-C + LDL-C+ TG/5
KADAR LIPID PLASMA
NORMAL
KLASIFIKASI TOTAL, LDL, HDL-KOLESTEROL, DAN TRIGLISERID
MENURUT NCEP ATP III
LDL kolesterol
< 100
mg/dl
100 129 mg/dl
130 159 mg/dl
160 189 mg/dl
> 190
mg/dl
Total kolesterol
< 200
mg/dl
200 239 mg/dl
> 240
mg/dl
HDL kolesterol
< 40
mg/dl
> 60
mg/dl
Optimal
Mendekati optimal
Sedikit tinggi (Borderline)
Tinggi
Sangat tinggi
Diinginkan
Sedikit tinggi (Borderline)
Tinggi
Rendah
Tinggi
JAMA 2001;285:24862-497
TRIGLISERIDA (NCEP-ATP III)
Optimal
< 150 mg/dl
Sedikit tinggi(borderline)
150 - 199 mg/dl
Tinggi
200 - 499 mg/dl
Sangat tinggi
> 500 mg/dl
PENATALAKSANAAN
Perubahan gaya hidup
(therapeutic lifestyle changes )
Perencanaan makan (diet)
Olahraga
Berhenti merokok
Batasi alkohol
Obat penurun lipid
Lipid Management Pharmacotherapy
TC
LDL
HDL
TG
Patient
tolerability
19-37%
25-50%
4-12%
14-29%
Good
13%
18%
1%
9%
Good
Bile acid
sequestrants
7-10%
10-18%
3%
Neutral or
Poor
Nicotinic acid
10-20%
10-20%
14-35%
30-70%
Reasonable
to Poor
19%
4-21%
11-13%
30%
Good
Therapy
Statins*
Ezetimibe
Fibrates
HDL-C=High-density lipoprotein cholesterol, LDL-C=Low-density lipoprotein cholesterol, TC=Total
cholesterol, TG=Triglycerides
*Daily dose of 40mg of each drug, excluding rosuvastatin.
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