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A BOY with
OBESITY
Dyah Mutia PS
INTRODUCTION
Obesity : abnormal accumulation of fat
tissue and
cause risk for health.
INTRODUCTION
Obesity : abnormal accumulation of fat
tissue and
cause risk for health.
Prevalence, 2007
INTRODUCTION
Obesity is caused by energy intake larger
than it
uses abnormality of metabolism
metabolic syndrome.
Metabolic syndrome risk factor of
cardiovascular disease in adulthood
Monitoring
Prevalence of obesity > comorbids >
Prevention
Obesity one of the leading cause of health problems
intervention since childhood
CASE
Identification
Add
Patien
t
Anamnesis
Chief complain: headache
Present Illness
History
One day before
admission, the
patient had a
headache, no fever,
nausea, vomit nor
seizure. No history of
head The trauma.
Patient then taken to
a pediatrician. The
blood pressure was
140/100mmHg
RSMH
Past Illness
History
No history of
hypertension
before
Family Illness
History
History of obesity
History of
hypertension
Physical Examination
General Findings
Alert
BP 140/90mmHg
Pulse 80x/min (volume &
pressure sufficient)
Temperature 36,8o C
Resp. Rate 30x/min
Obese
Physical Examination
Spesific Findings
10
Spesific Findings
Antropometric:
Weight: 68 kg
Height: 148 cm
Arm circumference: 32 cm
BMI:
31.05 kg/m2
Nutritional status: Obesity
Further investigation
Laboratory findings
Blood Examination :
Hb:15,0 gr/dl, WBC:5600/mm3, Plt:150.000/mm3 , DC:0/5/0/30/26/19.
Ureum: 12 mg/dl, creatine: 0,5 mg/dl
Total cholesterol: 107 mg/dl, Triglyseride 99 mg/dL, HDL 41 mg/dL,
LDL 128 mg/dL. SGOT: 29 U/L, SGPT: 13 U/L, BSS 98 mg/dL
Urinalysis :
protein (-), glucose (-), ketone (-), blood (-), bilirubin (-),
urobilinogen (+), nitrit (-), epithel +, wbc 0-2, eritrocyte 0-1,
cast (-), crystal (-)
11
Further investigation
DIET Analysis
Neonatal periode age 4 years old
Adequate quality
and quantity
>> quantity
NOW
3075 kkal
12
Further investigation
ACTIVITY Analysis
No routine exercise
13
SEDENTARY
LIFE
Diagnosis
14
Genetic/Heredoconstitutional
Patient is wanted child, his mother
checked her pregnant regularly
Pedigree
= Penderita
= Laki-aki
= obesitas
= obesitas,
DM,
hipertensi
16
= Perempuan
Environmental Factors
MACRO
MESO
MINI
MICRO
17
MACRO
Environmental Factor
MESO
Mini
MINI
MICRO: MOTHER
MICRO
Mikro
Religion: Islam
Ethnic: Java
Loves to cook
MACRO
MESO
MINI
MICRO
Environmental Factor
MICRO: Father Sibling - House
Father
Work: Enterpreneur
House
Permanent house
MACRO
MESO
MINI
MICRO
Environmental Factor
MACRO
MESO
Mini
MINI
MICRO
MICRO
Mikro
Environmental Factor
MACRO
MESO
MINI
Environmental Factor
MESO: NEIGHBOURHOOD
RSMH 5 hours
Puskesmas 5 min
Close contact to
neighbour
22
MACRO
MESO
MINI
MICRO
Environmental Factor
23
ASUH
Adequate
nutrition and
healthcare,
complete basic
immunization,
ASAH
ASIH
Loving & caring
family
Problem
Intervention
Problem
1.
2.
3.
Medical Problem
4.
5.
1.
Non Medical
Problem
2.
3.
4.
5.
6.
Obesity
Grade II Hypertensi on
Abdomen circumference.
Non completed advance
immunisations
Early puberty
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
May 2015
VIIIX
Jan 2013
IV-VI
I - III
X-XI
FOLLOW UP
&
DISCUSSION
Weight Monitoring
100
90
80
kg
70
60
50
40
30
20
10
1
5
Trimester
28
10
Height Monitoring
29
BMI Monitoring
32.8
32.6
32.4
32.2
32.0
31.8
31.6
kg/m2
31.4
31.2
31.0
30.8
30.6
30.4
30.2
30.0
29.8
1
5
Trimester
30
10
Intake Monitoring
3600
Realizatio
n
Target
3400
3200
kkal
3000
2800
2600
2400
2200
Column
D
2000
1
Trimester
31
10
Case Analysis
Case
Father Obese
Mother Obese
Sister Obese
Uncle Obese, Hypertension,
DM
32
Literature
Gene variants :
Case Analysis
Case
33
Literature
Imbalance energy
homeostasis in > out
adipocytes >> OBESITY
Case Analysis
Case
Family lifestyle
Literature
Sedentary
Reduce duration in
watching TV
Reduce carbohydrate and
fat intake
34
Syndrome Metabolic
Monitoring
Hypertension
Abd. circumference
100cm
Acanthosis nigricans
Normal blood glucose
Normal HDL
Normal Triglyseride
Beginning of
monitoring
35
Monitoring
Education
Normotension
Abd.circumference 100cm
Acanthosis nigricans
Fasting blood glucose normal
Refuse further investigation
End of
monitoring
Case Analysis
Case
Comorbides:
2nd grade hypertension
Literature
Comorbides:
Hypertension prevalence in
Indonesia 49%, abroad 50%
Possibly 3 mechanisms:
1. altered autonom function
2. insulin resistance
3. abnormality of vasculer structure
and function
36
Case Analysis
Case
Literature
Comorbides:
Hypertension , abdomen
circurmference > P80, acanthosis
nigricans
Hypertension
Metabolic Syndrome ??
37
Case Analysis
Case
Literature
Prevalence:
Candidiasis cutis
No sign and symptom of type 2
diabetes melitus
No obstructive sleep
apneu/hypoventilation syndrome
Hypoventilation syndrome: 24%
no tonsil hypertrophy
No abdominal pain
hepatomegaly
38
no
(abroad)
Case Analysis
Case
Literature
Prevalence:
No dislipidemia
No precox puberty
No deficiency Fe anemia
Precox puberty: 0
No blount disease
39
Immunization Monitoring
Beginning of
monitoring
Complete basic
immunization
Monitoring
40
End of
monitoring
Incomplete
adolescence
immunization
Case Analysis
Case
Literature
41
Middle
puberty
Control and
independency
conflict
Denial
Defence mechanism
To protect him self from
the
unpleasure reality
42
Permissive
Child Care
Weight gain
No reduce BMI
Case Analysis
Case
PedsQL:
87,44% (self report)
83,13% (parents report)
PSC: no internalization,
externalization and attention
impaired
43
Literature
Obesity children
depression: 22% (ind), 30% (abroad)
discrimination in sosial life obesity ~
lazyness
Less satisfaction in dating status
Bullying >>
Case Analysis
Case
Quo ad funtionam:
dubia ad bonam
Literature
Case Analysis
Case
Quo ad funtionam:
dubia ad bonam
45
Literature
LITERATURE
REVIEW
46
Etiology
1
Lifestyle Sedentary
3
Food Intake >> Imbalance energy
homeostasis
Energy Balance
Energy balance regulated by factor increasing energy
expenditure and energy conserve.
Food intake
Amount & type
Energy In
Physical activity
Routine metabolism
Growth
Energy Out
48
Apetite Control
Hipotalamus
Orexican
Anorexican
Ghrelin
Leptin
CCK
-MSH - POMC
NPY
PYY
AgRP
Insulin
49
Diagnose
Antropometrik
Klinis
Laboratoris
Psikososial
Depression
50
Comorbides
Endocrine type 2 DM, insulin resistance,
metabolic syndrome
Skin Infection
Dislipidemia.
51
Metabolic Syndrome
Criteria: (IDAI)
Waist circumference > 80 percentile, with 2 or more of
these parameters:
- Hypertension
- HDL < 40 mg/dl
- Triglyseride > 110 mg/dl
- Fasting blood glucose > 100mg/dl
52
Management
1. Diet modification
2. Physical activity no sedentary lifestyle,
routine exercise
3. Behavioral Changes no sedentary lifestyle,
self monitoring
4. Environment family participation,
school participation
53
AAP Recommendation
54
AAP Recommendation
55
Prevention
Selective
Universal
For each individu in
population
Reduction of obesity
comorbides
Targets
Secunder
Comorbides of obesity
decrease
56
Thank You
57