Patologi Manusia Dasar

GANGGUAN AKIBAT KELEBIHAN

ASUPAN ENERGI
Ifiq Budiyan Nazar, dr.

Energy Balance
State in which energy intake, in the form of food and /or
alcohol, matches the energy expended, primarily through
basal metabolism and physical activity
Positive energy balance
Energy intake > energy expended
Results in weight gain
Negative energy balance
Energy intake < energy expended
Results in weight loss

Energy Balance

Fat Storage
FAT
Most fat is stored directly into adipose tissue
Body has unlimited ability to store fat (as fat)
CARBOHYDRATES
Limited CHO can be stored as glycogen
Most CHO is used as a energy source
Excessive CHO will be synthesized into fat (for storage)

Protein and Fat Storage

Protein is primarily used for tissue synthesis
Adults generally consume more protein than needed for tissue
synthesis
Excess protein is used as a energy source
Some protein will be synthesized into fat (for storage)

Macronutrients and Fat Storage

Body prefers to use CHO as energy source
Only excess intake of CHO and protein will be turned into fat
Fat will remain as fat for storage
Physical activity encourages the burning of dietary fat
Beta-oxidation
Most endurance athletes burn fatty acids for energy
glycogen is used also

Body Mass Index (BMI)

The preferred weight-for-height standard
Calculation:

Body wt (in kg)

[Ht (in m)]2

OR

Body wt (in lbs) x 703.1

[Ht (in inches)]2

Health risks increase when BMI is > 25

Obesity
Excessive amount of body fat
Women with > 30-35% body fat
Men with > 25% body fat
Increased risk for health problems
Are usually overweight
Measurements using calipers

Body Fat Distribution

Upper-body (android) obesity--Apple shape
Associated with more heart disease, HTN, Type II
Diabetes
Abdominal fat is released right into the liver
Fat affects livers ability to clear insulin and lipoprotein
Encouraged by testosterone and excessive alcohol intake
Defined as waist to hip ratio of >1.0 in men and >0.8 in
women

Body Fat Distribution

Body Fat Distribution

Lower-body (gynecoid) obesity--Pear shape
Encouraged by estrogen and progesterone
Less health risk than upper-body obesity
After menopause
upper-body obesity appears

Overweight and Obesity

Underweight = BMI < 18.5

Healthy weight = BMI 18.5-24.9
Overweight = BMI 25-29.9
Obese = BMI 30-39.9
Severely obese = BMI >40

Juvenile-Onset Obesity
Develops in infancy or childhood
Increase in the number of adipose cells
Adipose cells have long life span and need to store fat
Makes it difficult to loose the fat (weight loss)
Causes
poor dietary patterns
lack of physical activity
43% of adolescents watch 2 hours or more of TV/day

Adult-Onset Obesity
Develops in adulthood
Fewer (number of) adipose cells
These adipose cells are larger (stores excess amount of fat)
If weight gain continues, the number of adipose cells can
increase

Causes of Obesity
Set Point Theory
Genetics
If both parents are obese, then 80% risk that
children are obese.
If neither parent is obese, then risk is less than
10%
Twin studies Identical twins are more likely to
weigh the same as fraternal twins even when
reared apart.
Food intake, tastes, BMR, number of fat cells,
enzymes all may be influenced by genetics.
Anthropologists have hypothesized are bodies are
adapted to storing fat due to times of famine.

Causes of Obesity (Continued)

Lipoprotein Lipase Enzyme which promotes fat storage in
fat cells and muscle cells.
Leptin Hormone which influences appetite and energy
balance. It increases satiety and energy. Ob gene has been
found to code for leptin.
Peptide PYY
Environmental Stimuli
Learned Behavior
Physical Inactivity

Environment
Overeating

Toxic food environment

Increased dietary variety. Studies have shown that
more than one flavor encourages people to eat.
Soft drink consumption. Drinking calories does
not reduce hunger.
Growing portion sizes. Adults (and children) eat
more when served larger portions.

Environment (Continued)
Too delicious. Some research suggests that
delicious foods may cause the body to feel
hungry sooner.
Snacking. People now eat about 1.5 snacks a
day compared to 1, in the 70s and 80s.
Snacks have more calories too (80 calories
from an apple to a 250 calorie candy bar).
Eating out. People who eat at least 13 times a
month, consume an average of 32% more
calories than those who eat out 5 or fewer

Environment
Physical Inactivity

Activity can actually curb appetite and help people

stay motivated to continue exercise.
Life requires less exertion.
Television.

Environmental factors

Food options
Increased cost of
healthy foods
Junk foods cheap and
easily available
Bigger portion size

Physical activity
School transport
Increased TV
time

Aggressive Treatments of Obesity

Drugs
Diuretics
Appetite Suppressor (Uptake serotonin inhibitor,
pancreatic lipase inhibitor)
herbal supplements
Very Low Kilocalorie Diets
Surgery
Stomach stapling
Gastric Bypass

Why Diets Dont Work

Obesity is a chronic disease
Treatment requires long-term lifestyle changes
Dieters are misdirected
More concerned about weight loss than healthy lifestyle
Unrealistic weight expectations

Why Diets Dont Work

Body defends itself against weight loss
Thyroid hormone concentrations (BMR) drop during weight
loss and make it more difficult to lose weight
Activity of lipoprotein lipase increases making it more
efficient at taking up fat for storage

Lifestyle Vs. Weight Loss

Prevention of obesity is easier than curing
Balance energy in(take) with energy out(put)
Focus on improving food habits
Focus on increase physical activities

Regular Physical Activity

Fat use is enhanced with regular physical activity
Increases energy expenditure
Duration and regularity are important
Make it a part of a daily routine