I am

TUTORING,
not
teaching

Nutritional approach
to endocrine disorder

1. Ronald A. Codario. (ed).(2005). Type 2 diabetes, prediabetes, and the metabolic syndrome : the primary care
guide to diagnosis and management.
2. Vivian Fonseca. (ed).(2008). Therapeutic Strategies in
Metabolic syndrome. First ed. Clinical publishing
Oxford.
3. Christos S. Mantzoros (ed).(2006). Obesity and diabetes.
First ed. Humana Press Inc.
4. Jack Challem and Ron Hunninghake (Ed).(2007). Stop
prediabetes now: the ultimate plan to lose weight and
prevent diabetes. John Wiley & Sons, Inc.
5. Arisman (2011). Obesitas, Diabetes Mellitus dan
Dislipidemia: . Egc.

Obesity can be defined as a set of

complex interactions among
genetic, environmental, and
behavioral factors, all acting on
energy balance, and approaches
for prevention of childhood
obesity can be just as complex

Periode kritis perkembangan obesitas

Periode

Alasan peningkatan risiko

Prenatal

Gizi semasa dalam kandungan berpengaruh langsung pada ukuran,

bentuk dan komposisi tubuh, serta kompetensi metabolik dalam
menangani zat gizi makro. Pola tumbuh dalam kandungan terbukti
bertalian dengan kegendutan perut, obesitas, serta faktor
komorbiditas pada usia selanjutnya.

Usia 5-7 tahun

BMI mulai meningkat cepat setelah masa pengurangan jaringan

lemak pada usia pra sekolah.

Remaja

Periode otonomi ini bertalian erat dengan dengan ketidakteraturan

bersanap, perubahan kebiasaan makan, tidak aktif pada waktu
senggang, dan perubahan fisiologis; yang kesemuanya bermuara
sebagai peningkatan deposit lemak, terutama pada wanita.

Dewasa muda

Pada usia ini kegiatan fisik berkurang secara nyata. Pada wanita
berlangsung pada usia 15-19 tahun (sebagian bisa berlanjut hingga
menjelang umur 30).

Kehamilan

Berbagai penelitian membuktikan keterkaitan antara pertambahan

usia dan jumlah kehamilan (paritas) dengan penigkatan berat badan.

Menopause

Mati haid berpengaruh pada asupan pangan serta penyusutan BMR,

meskipun patofisiologisnya belum jelas benar.

Sumber: Obesity: preventing and managing the global epidemic. WHO, 2000.

RACKUS

Factors Determining
Childhood Weight.

School Policies
Schools should provide an opportunity
for preventing overweight and obesity
by promoting physical activity and
healthy eating habits.

Watching television is a sedentary

activity, but the potential influence of
television on weight is not simply a
matter of decreased physical activity.
Television also communicates powerful
messages about diets, food products, and
social norms.

Per week children spend about 19 hours

watching television, 2 hours playing
video games, and 2.5 hours on the
computer.
This translates to almost 3.5 hours daily
watching a screen.

Eating Behaviors
Genetic and demographic factors, parent
factors, feeding practices (breast-feeding,
food restriction, parent control, and
modeling), social and physical
environment factors, and TV viewing all
affect eating behaviors.

The strong preferences for sweet,

fatty, and salty foods helps
explain why intake of such foods
is so high and why reducing their
consumption is so hard

Two linear relationships

interact to create a closed loop

Parent education and ethnicity and

child age and gender are related to
dietary patterns. Boys tend to eat
more fast food and girls prefer and
consume more fruits and vegetables.
Low socioeconomic status is
associated with greater intake of
sugar and fat and lower intake of
fruits and vegetables among children.

Overweight parents who consume a

higher fat diet are also making this diet
more available to their children and
developing their preference for these
types of food.
Overweight parents who have problems
controlling their own food intake and
are concerned about their child's
weight status may adopt ineffective,
overcontrolling feeding strategies.

Modeling by other children,

especially older children, can be
powerful and suggests that child
care environments may be an
important location for modeling
of healthy eating if such foods
are made readily available

Obesity prevention means prevention of

excess weight gain, where excess means
weight gain beyond that considered
favorable to short and long term health and
where the excess weight is characterized by
excess fat. The weight ranges considered
harmful to health are termed overweight
and obese.

A conceptual framework of
the lifecourse approach to obesity
epidemiology and prevention.

Health conditions
associated with obesity

Physical, social, and emotional health

consequences of obesity
in children and youth

Primary, secondary, and tertiary

prevention on disease continuum.

Framework for Addressing

the Prevention of Chronic Diseases
through Environmental and Policy Change.

Components of an integrated
comprehensive model for
school-based obesity prevention

School food environment

1. Establish specifications for healthy foods based
on nutrient content and portion size
2. Prohibit use of foods of minimal nutritional
value in schools including fundraising (candy,
soda).
3. Encourage healthy snacks from home as well,
such as fresh fruits and vegetables only
4. Internalize vending contracts to increase control
no external companies; let the school food
service control vending with healthy choices
and receive the revenue.

School food environment

1. Limit all vending beverages to water
2. Request vendors to price healthier options
appropriately and replace food
advertisements with picture of physical
activity on vending machines.
3. Include water, milk, yogurt
4. Fresh fruits and vegetables
5. Vegetables with low fat dip or salsa
6. Salads (both fruit and vegetable)
7. Whole grain foods

School food environment

1. Use non food rewards, substitute pizza party with a
walk with the Principal
2. Sell fruit baskets or gift wrapped fruit for fundraisers
3. Sell breakfast cart items instead of candy for
fundraisers
4. Use placemats or table covers to decorate the cafeteria
and make the dining experience rewarding
5. Invite guests, celebrities or the Principal to dine with
the students focusing on the company rather than the
food
6. Allow music in the cafeteria as a reward

School food environment

1. Taste test new products
2. Information and promotional messages at point of
purchase
3. Include students in the food selection process
4. Develop school wide promotions for healthier food
choices
5. Price healthier foods at a lower price than unhealthy
foods
6. Limit snacks available to all students
7. Reduce portion size to a prescribed calorie amount
(i.e. 200 calories)
8. Eliminate vending machines in elementary and middle
schools

Preventing Obesity and Promoting

Healthful Behaviors in Young Children:
Guidelines for Parents and Health Care Practitioners

Recommendations for Physical Activity

Children should obtain 1 hour of moderate to
vigorous physical activity daily
Encourage play and participation in activities at
home, in school, child-care
settings, and throughout the community as
opportunities for physical activity
Parents can set good examples for children by
being physically active.

Preventing Obesity and Promoting

Healthful Behaviors in Young Children:
Guidelines for Parents and Health Care Practitioners

Recommendations for Television Viewing

Limit television to 2 hours of high-quality
programming each day.
Keep children under age 2 from watching any
television.
Refrain from placing television sets in children's
bedrooms.

Preventing Obesity and Promoting

Healthful Behaviors in Young Children:
Guidelines for Parents and Health Care Practitioners
Recommendations for Dietary Behaviors
Breast-feed exclusively for the first 4 to 6 months of life
.
Provide healthful foods and beverages in the home.
Consider nutrient quality and energy density of those
foods. Have a variety of nutritious, low-energy-dense
foods available, such as fruits and vegetables. Limit
access to high-calorie and low-nutrient-density foods
at home.

Preventing Obesity and Promoting

Healthful Behaviors in Young Children:
Guidelines for Parents and Health Care Practitioners
Recommendations for Dietary Behaviors
Promote healthful eating behaviors in the home,
including having family meals, limiting snacking, and
serving controlled portions .
Parents can be good role models for children by eating
healthfully.
Expose children to initially disliked foods up to 10 times
to break down resistance and encourage healthy food
preferences.
Avoid using food as a reward.

A systematic approach
to management based
on BMI and other risk factors

Guidelines for screening of

overweight in children
and adolescents.