Modifikasi Diet Pada Obesitas-print

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MODIFIKASI DIETPADA OBESITAS

Dr. Ekky M. Rahardja, MS, SpGK

Oleh:

Fakultas Kedokteran Universitas Tarumanagara



Obesitas

AkumulasiLemak

Berlebihan

Hereditas

Metabolik

HormonalObat-obatan

Aktifitas Fisik

KebiasaanPsikologik



Human Body Composition

BodyWeight

Lean BodyMass

Total Adipose

Tissue

Lean BodyMass

Subcutaneousadipose tissue

Visceraladipose tissue



Lemak Tubuh Orang Dewasa

Pria Wanita

Fat mass 15-18% 20-25%

Ess. fat 4-7% 12%

Obese 25% 30%

Pada wanita Sex specific body fat (5-9%)

payudara, pinggul, paha



Penentuan Lemak Tubuh

• Metoda hidrostatik (under water weighing)

• Bahan radioaktif (potassium count)

• Bio-electrical Impedance Analysis (BIA)• Computed Tomography (CT)

• Magnetic Resonance Imaging (MRI)

• Dual Energy X-ray Absorptiometry (DEXA)



Secara Klinis Praktis

BB (Kg)IMT (Kg/m2) =

TB2 (m)

Berat Badan IMT

Kurang < 18.5

Normal 18.5-22.9

Lebih > 23

Pra obese 23-24.9

Obese I 25-29.9

Obese II >30

WHO –

Regional Office for the Western Pacific, 2000



Classification of weight by BMI:

WHO vs Asia Pacific

Underweight Underweight

Normal

Pre Obese

Obese I

Obese II

Obese III

Normal

At-Risk

Obese I

Obese II

18.5-24.9

25.0-29.9

30.0-34.9

35.0-39.9

>40.0

<18.511

18.5-22.9

23.0-24.9

25.0-29.9

>30

<18.5

WHO Asia Pacific



Secara Klinis Praktis

BB (Kg)BBR = X 100%

TB – 100 (cm)

Tebal lemak lipatan bawah kulit :• Pria > 15 mm

• Wanita > 25 mm

Normal 90 – 100% Overweight 110 – 120% Obese 120%



Risiko Obesitas

• Selain masalah estetik

• Akumulasi lemak viseral faktorrisiko terjadinya:

–Diabetes melitus –Hipertensi –PJK; stroke –

Dislipidemia –Sleep apneu syndrome –Batu empedu –Osteoartritis (OA)



Risiko Obesitas

• Obstetri ginekologi

–

Kelainan haid – Infertilitas

–Fluor albus

–Gangguan kehamilan & persalinan –Masalah hubungan seksual

–Keganasan



Risiko Obesitas

• Dermatologi

–

Dermatomikosis

•

Psikologi

–Depresi, kurang percaya diri



Terapi / Solusi

• Berbeda untuk tiap individu –Diet –Olahraga –Modifikasi perilaku –Obat-obatan –Operasi

Usahakan defisit kalori

Modifikasi diet

Aktifitas fisik





Modifikasi Diet

• Puasa (total fast; protein sparing fast)

• Rendah kalori seimbang (Balanced low calorie)

• Rendah kalori tidak seimbang(unbalanced low calorie)



Diet Puasa

• BB turun cepat

• Efek samping: –

Sakit kepala –Rasa lemah –Konstipasi –Ketogenesis –Hipotensi ortostatik –Gangguan keseimbangan cairan dan

elektrolit –Mudah tersinggung; depresi –Aritmia kordis (total fast)



Diet Rendah Kalori TidakSeimbang

• Produk komersial

• Tidak melatih kebiasaan

• Tinggi karbohidrat, rendah lemak(Zen Macrobiotic; Cambridge Diet)

• Rendah karbohidrat, tinggi lemak

(Atkins Diet, Stillman Diet)• Diet kalori sangat terbatas

(Scarsdale, Last Chance Diet)



Diet Rendah Kalori Seimbang

• Kebutuhan internal

• KH & lemak dibatasi

• Protein, vitamin dan mineral cukup

• Seimbang(KH 60-70%; protein 15-20%; lemak 10-

15%)

• Tinggi serat

• AmanBatasi Lemak & KH



National fat consumption and % standard body weight: less developed

countries

70

80

90

100

110

120

130

5 10 15 20 25 30 35

Energy % fat

%

o f s t a n d a r d w e i g h t

Pakistan

Malaysia

GuatemalaSalvador

Honduras

Costa Rica

Uruguay

Venezuela

Nicaragua

Panama



National fat consumption and % relative weight: Seven Countries Studies

80

85

90

95

100

105

5 10 15 20 25 30 35 40 45 50

Energy % fat

% r

e l a t i v e w e i g h t

Japan

Italy

Yugoslavia

Netherlands

Finland

Greece

USA



Cross Sectional Studies

In 13 epidemiological studies, 11

studies demonstrated associations between dietary fat (energy adjusted)and obesity

Lissner & Heitmann, 1995



Dietary Fat and Hyperphagia

• Palatability

• Chewing requirement

• Volume/weight effect

• Less satiating effect

•Glucogenostatic regulation of food intake



Satiety Score of Different Food Holt, 1995



Kandungan Kalori Lemak

• Trigliserida

• Jaringan adiposa

• Lemak makanan

9.3 kkal/g

7.7 kkal/g

9.0 kkal/g



Keseimbangan Energi

• Energy input = output : BB stabil

• Energy input > output : BB naik

• Energy input < output : BB turun



Artinya

• Bila energi input > output : 100

kkal/hari

• Kelebihan energi pertahun: 36500 kkal

•Kenaikan lemak tubuh sebesar: 4.7 Kg

(0.45 Kg lemak tubuh = 3.500 kkal)



Recommendation for Dietary Therapy (NHLBI, 1999)

• LCD are recommended for weight loss

in overweight and obese persons (Evidence category A)

• Reducing fat as part of an LCD is a

practical way to reduce energy intake

(Evidence category A)



Recommendation for Dietary

Therapy (NHLBI, 1999)

• Reducing dietary fat alone without reducing energy is not sufficient for weight loss. However,reducing dietary fat, along with reducing dietary

carbohydrates can facilitate energy reduction (Evidence Category A)

• A diet that is individually planned to create a deficit of 500-1.000 kcal/day should be an integral part of any program aimed at achieving a weight loss of 0.5 – 1 kg/week.

(Evidence Category A)



Komponen Penggunaan Energi

Aktifitas

Thermogenesis

Basal Metabolik

10%

20%

70%

Diet Induced Thermogenesis

Cold

Stress Drug

Digestion Oxidation

Storage



Aktivitas fisik

Diet saja RMR dan TEF

Kompensasi dilakukan denganmeningkatkan:

• Aktivitas fisik

– Defisit kalori >

– RMR >

• Manfaat – Aktifitas fisik (olah raga) bermanfaat untuk mencegah

osteoporosis, mengendalikan gula darah, kolesterol,

trigliserida, meningkatkan konsentrasi, menghilangkan



Calorie prescription

• Calorie prescription needs regular

adjustment • Remember!

Reduction in body weight is followed

by reduction in BMR



Kesimpulan

Lifestyle harus diubah

– Membatasi masukan kalori

– Meningkatkan aktifitas fisik

• Diet rendah kalori seimbang

– Kalori rendah defisit

– Tidak berbahaya

– Mampu mengurangi lemak tubuh

– Tidak menimbulkan gangguan metabolisme

• Olah raga intensitas ringan-sedang



The more youconsume

The less you live

Thank you

Documents

Modifikasi Diet Pada Obesitas-print