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

pinggul. paha . fat Obese 4-7%  25% 12%  30% Pada wanita  Sex specific body fat (5-9%) payudara.Lemak Tubuh Orang Dewasa Pria Fat mass 15-18% Wanita 20-25% Ess.

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) .

2000 .9 25-29.9 >30 WHO – Regional Office for the Western Pacific.5-22.Secara Klinis Praktis BB (Kg) IMT (Kg/m2) = TB2 (m) Berat Badan Kurang Normal Lebih Pra obese Obese I Obese II IMT < 18.9 > 23 23-24.5 18.

9 25.9 <18.0 35.0-29.0-34.5 Obese II >30 18.9 30.9 <18.5-24.Classification of weight by BMI: WHO vs Asia Pacific >40.0-29.9 Obese III Obese II Obese I Pre Obese Obese I At-Risk 25.5-22.511 Normal Underweight Normal Underweight WHO Asia Pacific .9 23.0-39.9 18.0-24.

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 .

Risiko Obesitas • Selain masalah estetik • Akumulasi lemak viseral  faktor risiko 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 .

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) .

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) .

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

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

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 .

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

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 .

0 kkal/g .7 kkal/g • Lemak makanan 9.Kandungan Kalori Lemak • Trigliserida 9.3 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.

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) .

However.Recommendation for Dietary Therapy (NHLBI. 1999) • Reducing dietary fat alone without reducing energy is not sufficient for weight loss. 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) . reducing dietary fat.

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

menghilangkan . trigliserida. mengendalikan gula darah. 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. 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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