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BAB I

PENDAHULUAN

A. Latar Belakang
B. Rumusan Masalah
1. Apa pengertian dari obesitas?
2. Apa saja patofisiologi obesitas?
3. Apa saja klasifikasi obesitas?
4. Apa saja gejala dan tanda dari obesitas?
5. Apa saja diagnosis dari obesitas?
6. Bagaimana pengobatan obesitas?
C. Tujuan
1. Untuk mengetahui pengertian dari obesitas
2. Untuk mengetahui patofisiologi obesitas
3. Untuk mengetahui klasifikasi obesitas
4. Untuk mengetahui gejala dan tanda dari obesitas
5. Untuk mengetahui diagnosis dari obesitas
6. Untuk mengetahui pengobatan obesitas

BAB II

TINJAUAN PUSTAKA

A. Pengertian Obesitas
Obesity occurs when there is an imbalance between energy intake and
energy expenditure over time, resulting in increased energy storage
(Wells, 2012). Obesity is the state of excess body fat stores, which
should be distinguished from overweight (i.e., excess body weight
relative to a person’s height) (Wells, 2009).
B. Patofisiologi Obesitas
 Genetic factors appear to be the primary determinants of obesity
in some individuals, whereas environmental factors are more
important in others. The specific gene that codes for obesity is
unknown; there is probably more than one gene.
 Environmental factors include reduced physical activity or work;
abundant and readily available food supply; increased fat intake;
increased consumption of refined simple sugars; and decreased
ingestion of vegetables and fruits.
 Excess caloric intake is a prerequisite to weight gain and
obesity, but whether the primary consideration is total calorie
intake or macronutrient composition is debatable.
 Many neurotransmitters and neuropeptides stimulate or depress
the brain’s appetite network, impacting total caloric intake.
 Activity is thought to play a role in obesity, but studies designed
to test the benefit of increased physical activity yield inconsistent
results.
 Weight gain can be caused by medical conditions (e.g.,
hypothyroidism, Cushing’s syndrome, hypothalamic lesion) or
genetic syndromes (e.g., Prader-Willi’s syndrome), but these are
unusual to rare causes of obesity.
 Medications associated with weight gain include insulin,
sulfonylureas, and thiazolidinediones for diabetes, some
antidepressants, antipsychotics, and several anticonvulsants
(Wells, 2009).

C. Klasifikasi Obesitas
D. Gejala dan Tanda
 Obesity increase weight, reduces physical movements and also
brings in slowness in emotional and mental activities
 Food intake increases
 Obesity can result in frustation
 Laziness increases
 Sometimes obesity can create obstruction to breathing process
 Obesity may result in heart problems, diabetes or blood
pressure.
E. Diagnosa
 Skinfold thickness
 Body density using underwater body weight
 Bioelectrical impedance and conductivity
 Dual-energy x-ray absorptiometry
 Computed axial tomography scan
 Magnetic resonance imaging.
 Body mass index (bmi) and waist circumference (wc) are
recognized, acceptable markers of excess body fat, which
independently predict disease risk.
 Wc, the most practical method of characterizing central
adiposity, is the narrowest circumference between the last rib
and top of the iliac crest.
F. Pengobatan

(Wells, 2012).
1. Non Farmakologi
a. Dietary
A low-calorie diet is essential for weight-loss management in
overweight and obese patients. The Step 1 Diet (Table 99–4) is
a low-calorie diet (LCD) recommended as part of an obesity
education initiative from the National Heart, Lung, and Blood
Institute. 6 In general, the Step 1 Diet restricts daily calories to a
range of 1000 to 1200 kcal (4184 to 5021 kJ)/day for women
weighing less than 165 lb (75 kg) and 1400 to 1600 kcal (5858
to 6694 kJ)/day for all others. However, this daily limit should be
considered after assessing a patient’s normal daily caloric intake
and ensuring that the initial caloric restriction does not exceed
500 to 1000 kcal (2092–4184 kJ)/day. For example, a male
patient who consumes 3000 kcal (12.552 kJ)/day should not
reduce his daily caloric intake to less than 2000 kcal (8368
kJ)/day when initially implementing a dietary program. Further
reduction to the target of 1600 kcal (6694 kJ)/day can be
attempted once the patient has reduced calories successfully as
initially recommended for a period agreeable by the provider and
the patient.

Diets too restrictive in calorie reduction are successful initially


but fail long term because compliance is difficult to sustain.
Therefore, this less aggressive approach promotes gradual
weight loss and weight maintenance. Dietary consumption
should be balanced in carbohydrates, protein, and fat. Several
diet plans exist that promote weight loss through strict limitation
or overabundance of only one macronutrient (e.g., low-fat, low-
carbohydrate, or high-protein diets); however, overall energy
consumption and expenditure will determine the amount of
weight alteration. Consultation with a dietician is recommended
when implementing a healthy meal plan tailored to the
individual’s nutritional needs.
b. Exercise
While diet and exercise contribute to weight loss, combining a
low-calorie diet with physical activity results in greater weight
loss compared with either therapy alone. Additionally, physical
activity can help to prevent weight regain and reduce related
cardiovascular risks.6 Slow titration of both the amount and
intensity of physical activity is recommended for most
overweight and obese patients. A program that incorporates
daily walking is a viable option for most patients (Table 99–5).
Consider 10 minutes per day 3 days per week with a target of 30
to 45 minutes most days, if not every day.6,27 This type and
amount of activity equate to a 100 to 200 kcal (418–836 kJ)/day
caloric expenditure.
c. Behavioral
Non-adherence with recommended lifestyle changes may result
in unsuccessful weight loss.6,25 Therefore, eliminating these
barriers through behavior modification is necessary to gain
maximal benefit from both dietary modification and exercise.
Components to successful behavioral modification include, but
are not limited to, the following steps:
 Determine the patient’s readiness to lose weight and
willingness to implement a weight-loss plan.
 Build and nurture the patient-provider partnership.
 Restructure cognitive abilities.
 Set achievable goals.
 Contact the patient frequently.
 Instruct the patient on the importance and technique of
selfmonitoring.
 Control stimuli that negatively affect weight loss or weight
maintenance.
 Reward the patient for any amount of weight loss or
avoidance of weight regain (Burns, 2008).
2. Farmakologi

 Orlistat (180 or 360 mg in 3 divided doses/day) is a lipase inhibitor


that induces weight loss by lowering dietary fat absorption; it also
improves lipid profiles, glucose control, and other metabolic
markers. Soft stools, abdominal pain or colic, flatulence, fecal
urgency, and/or incontinence occur in 80% of individuals using
prescription strength, are mild to moderate in severity, and improve
after 1 to 2 months of therapy. Orlistat is approved for long-term
use. It interferes with the absorption of fat-soluble vitamins,
cyclosporine, levothyroxine, and oral contraceptives. A
nonprescription formulation is also available.
 Lorcaserin is a selective serotonin receptor agonist (5-HT2c)
approved for chronic weight management. Activation of central 5-
HT2c receptors results in appetite suppression leading to modest
weight loss as compared with placebo. Discontinue lorcaserin if 5%
weight loss is not achieved by week 12. Common adverse effects
include headache, dizziness, constipation, fatigue, and dry mouth.
 Phentermine in combination with topiramate extended release is
indicated for chronic weight management. Doses are gradually
titrated from phentermine 3.75 to 15 mg and topiramate 23 to 92 mg
over 4 months but the drug should be stopped after 12 weeks if 5%
weight loss is not achieved. Common adverse effects include
constipation, dry mouth, paraesthesia, dysgeusia, and insomnia.
 Phentermine and diethylpropion are each more effective than
placebo in achieving short-term weight loss. Neither should be used
in patients with severe hypertension or significant cardiovascular
disease. Short-term therapy is not consistent with current national
guidelines for chronic management of obesity (Wells, 2012).
1. Childhood/Adolescent Patients with Obesity Although the
prevalence of overweight and obesity is increasing among children
and adolescents, current guidelines do not incorporate treatment
recommendations because long-term outcome data are limited. As
such, prevention of childhood obesity is a national priority for the
National Academies’ Institute of Medicine (IOM) and cannot
succeed without the engagement of those entities (e.g., family,
school, and community) that affect the environment and behavior of
American youths. The IOM report establishes steps to confront this
epidemic and includes the involvement of the federal, state, and
local governments; industry and media; health care professionals;
community organizations; state and local schools; and parents and
families. The BMI should be calculated for all children and
adolescents yearly to identify excessive weight gain relative to
linear growth. Education and encouragement should be provided to
parents or caregivers to promote healthy eating patterns and self-
regulation of food intake. Examples include support for healthy
snack selections and parent (caregiver) modeling of nutritious food
consumption. Routine physical activity should be advocated, as well
as limiting television viewing and video time to 2 hours daily. If
children or adolescent patients are overweight or obese,
assessment of obesity-related risk factors also should occur.
2. Elderly Patients with Obesity The prevalence of obesity in older
adults is increasing; therefore, it should not be surprising that more
cardiovascular risk factors are present in this group of individuals.
Additionally, obesity is a major predictor of functional limitation and
mobility problems in older persons. Age alone should not prejudice
the clinician from treating geriatric patients, whereas the benefits of
cardiovascular health and functionality should be considered.
Treatments should be initiated that minimize adverse effects on
bone health and nutritional status and should include dietary and
activity modifications.
BAB III
PENUTUP
A. Kesimpulan
Farmakoterapi dari obesitas yaitu orlistat, locaserin, kombinasi
fentermin-topiramat, fendimetrazin, fentermin dan dietilpropion.
B. Saran
Semoga dengan selesainya makalah ini diharapkan agar para
pembaca dapat lebih mengetahui dan memahami
tentang Farmakoterapi Obesitas.
Kami menyadari bahwa makalah yang kami buat ini masih jauh dari
kata kesempurnaan, maka dari itu kritik dan saran dari para pembaca
sangat kami harapkan demi perbaikan makalah ini.