MODIFIKASI DIET PADA OBESITAS

Oleh:

Dr. Ekky M. Rahardja, MS, SpGK Fakultas Kedokteran Universitas Tarumanagara

Obesitas
Hereditas Metabolik Hormonal Obat-obatan Aktifitas Fisik Kebiasaan Psikologik

Akumulasi Lemak Berlebihan

Human Body Composition

Body Weight

Lean Body Mass

Lean Body Mass
Subcutaneous adipose tissue Visceral adipose tissue

Total Adipose Tissue

Lemak Tubuh Orang Dewasa Pria Fat mass 15-18% Wanita 20-25% Ess. fat Obese 4-7%  25% 12%  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) .

9 > 23 23-24.5 18. 2000 .5-22.9 25-29.9 >30 WHO – Regional Office for the Western Pacific.Secara Klinis Praktis BB (Kg) IMT (Kg/m2) = TB2 (m) Berat Badan Kurang Normal Lebih Pra obese Obese I Obese II IMT < 18.

0-29.0-29.9 <18.0-24.9 25.9 30.0 35.9 <18.5 Obese II >30 18.Classification of weight by BMI: WHO vs Asia Pacific >40.5-24.511 Normal Underweight Normal Underweight WHO Asia Pacific .9 18.5-22.0-39.0-34.9 Obese III Obese II Obese I Pre Obese Obese I At-Risk 25.9 23.

Secara Klinis Praktis BB (Kg) BBR = TB – 100 (cm) X 100%  Normal 90 – 100%  Overweight 110 – 120%  Obese 120% Tebal lemak lipatan bawah kulit : • Pria > 15 mm • Wanita > 25 mm .

stroke – Dislipidemia – Sleep apneu syndrome – Batu empedu – Osteoartritis (OA) .Risiko Obesitas • Selain masalah estetik • Akumulasi lemak viseral  faktor risiko terjadinya: – Diabetes melitus – Hipertensi – PJK.

Risiko Obesitas • Obstetri ginekologi – Kelainan haid – Infertilitas – Fluor albus – Gangguan kehamilan & persalinan – Masalah hubungan seksual – Keganasan .

kurang percaya diri .Risiko Obesitas • Dermatologi – Dermatomikosis • Psikologi – Depresi.

Terapi / Solusi • Berbeda untuk tiap individu – Diet – Olahraga – Modifikasi perilaku – Obat-obatan – Operasi Usahakan defisit kalori Modifikasi diet Aktifitas fisik .

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Modifikasi Diet • Puasa (total fast. protein sparing fast) • Rendah kalori seimbang (Balanced low calorie) • Rendah kalori tidak seimbang (unbalanced low calorie) .

depresi – Aritmia kordis (total fast) .Diet Puasa • BB turun cepat • Efek samping: – Sakit kepala – Rasa lemah – Konstipasi – Ketogenesis – Hipotensi ortostatik – Gangguan keseimbangan cairan dan elektrolit – Mudah tersinggung.

Diet Rendah Kalori Tidak Seimbang • Produk komersial • Tidak melatih kebiasaan • Tinggi karbohidrat. rendah lemak (Zen Macrobiotic. tinggi lemak (Atkins Diet. Last Chance Diet) . Cambridge Diet) • Rendah karbohidrat. Stillman Diet) • Diet kalori sangat terbatas (Scarsdale.

vitamin dan mineral cukup Seimbang (KH 60-70%.Diet Rendah Kalori Seimbang • • • • Kebutuhan internal KH & lemak dibatasi Protein. lemak 1015%) • Tinggi serat Batasi Lemak & KH • Aman . protein 15-20%.

National fat consumption and % standard body weight: less developed countries 130 120 110 Uruguay % of standard weight Venezuela Nicaragua Costa Rica Honduras Panama 100 90 80 70 5 10 15 Guatemala Salvador Malaysia Pakistan 20 Energy % fat 25 30 35 .

National fat consumption and % relative weight: Seven Countries Studies 105 USA % relative weight 100 95 90 85 80 5 10 15 20 25 30 35 40 Netherlands Italy Finland Greece Yugoslavia Japan 45 50 Energy % fat .

1995 . 11 studies demonstrated associations between dietary fat (energy adjusted) and obesity Lissner & Heitmann.Cross Sectional Studies In 13 epidemiological studies.

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 9.7 kkal/g • Lemak makanan 9.0 kkal/g .3 kkal/g • Jaringan adiposa 7.

Keseimbangan Energi • Energy input = output : BB stabil • Energy input > output : BB naik • Energy input < output : BB turun .

45 Kg lemak tubuh = 3.7 Kg (0.500 kkal) .Artinya • Bila energi input > output : 100 kkal/hari • Kelebihan energi pertahun: 36500 kkal • Kenaikan lemak tubuh sebesar: 4.

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.

reducing dietary fat.5 – 1 kg/week.Recommendation for Dietary Therapy (NHLBI. However.000 kcal/day should be an integral part of any program aimed at achieving a weight loss of 0. (Evidence Category A) . 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. 1999) • Reducing dietary fat alone without reducing energy is not sufficient for weight loss.

Komponen Penggunaan Energi 10% Aktifitas Diet Induced Thermogenesis Cold Stress Drug 20% Thermogenesis Digestion Oxidation Storage 70% Basal Metabolik .

kolesterol.Aktivitas fisik Diet saja  RMR dan TEF  Kompensasi dilakukan dengan meningkatkan: • Aktivitas fisik – Defisit kalori > – RMR > • Manfaat – Aktifitas fisik (olah raga) bermanfaat untuk mencegah osteoporosis. trigliserida. menghilangkan . mengendalikan gula darah. meningkatkan konsentrasi.

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 you consume The less you live Thank you .

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