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Nutritional approach to endocrine disorder

Ronald A. Codario. (ed).(2005). Type 2 diabetes, pre-diabetes, and the metabolic syndrome : the primary care guide to diagnosis and management. Vivian Fonseca. (ed).(2008). Therapeutic Strategies in Metabolic syndrome. First ed. Clinical publishing Oxford.Christos S. Mantzoros (ed).(2006). Obesity and diabetes. First ed. Humana Press Inc. Jack Challem and Ron Hunninghake (Ed).(2007). Stop prediabetes now: the ultimate plan to lose weight and prevent diabetes. John Wiley & Sons, Inc.Arisman (2011). Obesitas, Diabetes Mellitus dan Dislipidemia: . Egc.

Obesity can be defined as a set of complex interactions among genetic, environmental, and behavioral factors, all acting on energy balance, and approaches for prevention of childhood obesity can be just as complex

Periode kritis perkembangan obesitasPeriodeAlasan peningkatan risikoPrenatalGizi semasa dalam kandungan berpengaruh langsung pada ukuran, bentuk dan komposisi tubuh, serta kompetensi metabolik dalam menangani zat gizi makro. Pola tumbuh dalam kandungan terbukti bertalian dengan kegendutan perut, obesitas, serta faktor komorbiditas pada usia selanjutnya.Usia 5-7 tahunBMI mulai meningkat cepat setelah masa pengurangan jaringan lemak pada usia pra sekolah. RemajaPeriode otonomi ini bertalian erat dengan dengan ketidakteraturan bersanap, perubahan kebiasaan makan, tidak aktif pada waktu senggang, dan perubahan fisiologis; yang kesemuanya bermuara sebagai peningkatan deposit lemak, terutama pada wanita.Dewasa mudaPada usia ini kegiatan fisik berkurang secara nyata. Pada wanita berlangsung pada usia 15-19 tahun (sebagian bisa berlanjut hingga menjelang umur 30).KehamilanBerbagai penelitian membuktikan keterkaitan antara pertambahan usia dan jumlah kehamilan (paritas) dengan penigkatan berat badan.MenopauseMati haid berpengaruh pada asupan pangan serta penyusutan BMR, meskipun patofisiologisnya belum jelas benar.Sumber: Obesity: preventing and managing the global epidemic. WHO, 2000.

RACKUS

Factors Determining Childhood Weight.

School PoliciesSchools should provide an opportunity for preventing overweight and obesity by promoting physical activity and healthy eating habits.

Watching television is a sedentary activity, but the potential influence of television on weight is not simply a matter of decreased physical activity. Television also communicates powerful messages about diets, food products, and social norms.

Per week children spend about 19 hours watching television, 2 hours playing video games, and 2.5 hours on the computer.This translates to almost 3.5 hours daily watching a screen.

Eating BehaviorsGenetic and demographic factors, parent factors, feeding practices (breast-feeding, food restriction, parent control, and modeling), social and physical environment factors, and TV viewing all affect eating behaviors.

The strong preferences for sweet, fatty, and salty foods helps explain why intake of such foods is so high and why reducing their consumption is so hard

Two linear relationships interact to create a closed loop

Parent education and ethnicity and child age and gender are related to dietary patterns. Boys tend to eat more fast food and girls prefer and consume more fruits and vegetables. Low socioeconomic status is associated with greater intake of sugar and fat and lower intake of fruits and vegetables among children.

Overweight parents who consume a higher fat diet are also making this diet more available to their children and developing their preference for these types of food.Overweight parents who have problems controlling their own food intake and are concerned about their child's weight status may adopt ineffective, overcontrolling feeding strategies.

Modeling by other children, especially older children, can be powerful and suggests that child care environments may be an important location for modeling of healthy eating if such foods are made readily available

Obesity prevention means prevention of excess weight gain, where excess means weight gain beyond that considered favorable to short and long term health and where the excess weight is characterized by excess fat. The weight ranges considered harmful to health are termed overweight and obese.

A conceptual framework of the lifecourse approach to obesityepidemiology and prevention.

Health conditions associated with obesity

Physical, social, and emotional health consequences of obesity in children and youth

Primary, secondary, and tertiary prevention on disease continuum.

Framework for Addressing the Prevention of Chronic Diseases through Environmental and Policy Change.

Components of an integrated comprehensive model for school-based obesity prevention

School food environmentEstablish specifications for healthy foods based on nutrient content and portion sizeProhibit use of foods of minimal nutritional value in schools including fundraising (candy, soda).Encourage healthy snacks from home as well, such as fresh fruits and vegetables onlyInternalize vending contracts to increase control no external companies; let the school food service control vending with healthy choices and receive the revenue.

School food environmentLimit all vending beverages to waterRequest vendors to price healthier options appropriately and replace food advertisements with picture of physical activity on vending machines.Include water, milk, yogurtFresh fruits and vegetablesVegetables with low fat dip or salsaSalads (both fruit and vegetable)Whole grain foods

School food environmentUse non food rewards, substitute pizza party with a walk with the PrincipalSell fruit baskets or gift wrapped fruit for fundraisersSell breakfast cart items instead of candy for fundraisersUse placemats or table covers to decorate the cafeteria and make the dining experience rewardingInvite guests, celebrities or the Principal to dine with the students focusing on the company rather than the foodAllow music in the cafeteria as a reward

School food environmentTaste test new productsInformation and promotional messages at point of purchaseInclude students in the food selection processDevelop school wide promotions for healthier food choicesPrice healthier foods at a lower price than unhealthy foodsLimit snacks available to all studentsReduce portion size to a prescribed calorie amount (i.e. 200 calories)Eliminate vending machines in elementary and middle schools

Preventing Obesity and Promoting Healthful Behaviors in Young Children: Guidelines for Parents and Health Care Practitioners Recommendations for Physical Activity Children should obtain 1 hour of moderate to vigorous physical activity daily Encourage play and participation in activities at home, in school, child-care settings, and throughout the community as opportunities for physical activity Parents can set good examples for children by being physically active.

Preventing Obesity and Promoting Healthful Behaviors in Young Children: Guidelines for Parents and Health Care Practitioners Recommendations for Television Viewing Limit television to 2 hours of high-quality programming each day. Keep children under age 2 from watching any television. Refrain from placing television sets in children's bedrooms.

Preventing Obesity and Promoting Healthful Behaviors in Young Children: Guidelines for Parents and Health Care Practitioners Recommendations for Dietary Behaviors Breast-feed exclusively for the first 4 to 6 months of life . Provide healthful foods and beverages in the home. Consider nutrient quality and energy density of those foods. Have a variety of nutritious, low-energy-dense foods available, such as fruits and vegetables. Limit access to high-calorie and low-nutrient-density foods at home.

Preventing Obesity and Promoting Healthful Behaviors in Young Children: Guidelines for Parents and Health Care Practitioners Recommendations for Dietary Behaviors Promote healthful eating behaviors in the home, including having family meals, limiting snacking, and serving controlled portions . Parents can be good role models for children by eating healthfully. Expose children to initially disliked foods up to 10 times to break down resistance and encourage healthy food preferences. Avoid using food as a reward.

A systematic approach to management based on BMI and other risk factors

Guidelines for screening of overweight in children and adolescents.