Prevalence of obesity and factors

contributes obese
• Indonesia is one of the developing countries in
the world with its own health problems.
Mostly developing countries face poverty,
infection and nutritional problems.
• As the country develops and growing old,
there is emendation in certain aspect, mostly
important in economic aspect
• People start to afford to buy better food or any
food with greater value.
• Advance technology with the use of motor
vehicle and electronics take a big role in
decreasing physical activity and finally reduced
energy expenditures.
• On the other hand, fast food with its outstanding
commercials changes food consumption
composition. This changes, with low physical
activity and lead to obesogenic lifestyle.
• Obesity is a medical condition on which excess
body fat has accumulated to the extent that it
may have a negative effect on health.
• BMI is a simple measure of overall adiposity
• Other approaches to quantifying obesity include
 waist circumference,
waist hip ratio,
anthropometry (skin fold thickness),
densitometry (underwater weighing),
 electrical impedance
• Leptin is a 16-kDa circulating protein with
hormone released by white adipose tissues,
mainly subcutaneous fat.
• Act as a hormone in hypothalamus.
• Regulator of energy balance, as it act in the brain
to decrease food intake and increase energy
expenditure.
• In obesity there are an insensitivity or resistance
to leptin due to excessive leptin signal to the
brain, thus the brain won’t react anymore.
• Ghrelin a protein that is produced from the
stomach cell.
• Ghrelin play an important role by
 enhances appetite by its activation of
neuropeptide Y neurons.
 inhibition of pro-opiomelanocortin neurons.
• Act primarily in hypothalamus and promotes
a positive energy balance.
 FACTORS OF OBESITY
Stess
• Induced excess energy intake
• Activates the hypothalamic pituitary axis
thereby releasing glucocorticoids, including
cortisol.
• High concentration of the glucocorticoids
increase the expression of corticotropin
releasing factor mRNA in the central nucleus
amygdala.
Diet
• Glycemic index has become one of triggering
factors of obesity in adolescents.
• High-GI meals produced lower fatty acids
concentration throughout the day and lower
the rates of fat oxidation.
• High GI foods increase insulin secretion
leading to postprandial hyperinsulinemia, .
Physical activity
• More adolescent are choosing to sit in front
of a television or a computer instead of
participating in some form of physical activity.
Sleep
• Sleep deprivation can lead to increased
hunger for high energy –dense food.
• Shortened sleep patterns have also led to an
increase in ghrelin and decrease in leptin
 Management of Obesity
Behavioural Therapy
• Exercise moderately with aerobics, gradually
increasing the intensity as fat is lost.
• Physical activity improving glucose control,
endothelial fuction, high density lipoprotein
and quality of the life.
Low Glycemic Index foods
• Prolonging absorption time, spreading the nutrient load,
modifying the endocrine and metabolic response to food.
• Slowly absorbed, posses some of features of dietary fiber in
providing a substrate for colonic bacteria fermentation.
• Examples of food with low GI are:
1. Brown rice
2. Oats
3. Brococoli
4. Almonds
 Pharmacotherapies (weight –loss
drugs)
Sibutramine
• Sibutramine is a serotonin and noradrenaline
reuptake inhibitor.
• By inhibiting reuptake more serotonin and
noradrenalin are available to act on receptors,
thereby increasing satiety and increasing
energy expenditure.
Bariatric Surgery
• More effective than non-surgical intervention
in achieving weigh loss among obese people
• For example, a Roux-en –Y gastric bypass
involves changes to the person’s stomach and
small bowel.
• A bypass of the small bowel is also created to
reduce the absorption of food.