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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