Obesitas pada anak

Dr.Sri S.Nasar, SpA(K)

Division Pediatric Nutrition and Metabolic Diseases
Dept of Child Health
University of Indonesia School of Medicine
 Gemuk
 Overweight  Obesity
 Weight in excess of  Excessive
the average for deposition of
height adipose tissue
  lean body mass or
adipose tissue or
both
Mengapa obesitas dipermasalahkan ?

 2nd leading cause of preventable death

 Contributes to hypertension, type 2

diabetes, stroke, sleep apnea, and cancers

 Factor of social bias and discrimination

Mengapa obesitas anak dipermasalahkan ?

 15% of overweight infants…

 25% of overweight preschool children…

 80% of obese 10-14 year-old youth with

at least 1 obese parent…

…become overweight adults

Bagaimana prevalensi obesitas anak ?
 Prevalence of overweight and obese youth (6-18
years) globally:
 USSR overweight 6% and obese 8%
 China overweight 3.6% and obese 3,4%
 UK overweight 22-31% and obese 10-17%
 USA obese 12-14 %
 Indonesia
 < 5 years (1995)  4.6%
 6-12 years elementary school children
 1998 – central Jakarta 9.6%
 2002 – east Jakarta 27.5%
 11.5-20.6 years high school children
 2001 – Bogor 6.4%
Bagaimana obesitas terjadi ?
Apa penyebab obesitas anak ?

 Non-changeable  Modifiable
 Genetics  Physical Activity
 Greater risk of  Sedentary behavior
obesity in children  Eating Habits
of obese and  Environment
overweight
parents
 Syndromal
 Hormonal
Modifiable causes
 Physical Activity
 Lack of regular exercise.

 Sedentary behavior
 High frequency of television viewing, computer
usage, or similar behavior that takes up time that
can be used for physical activity.
 Eating Habits
 Over-consumption of high-calorie foods.

 eating when not hungry, eating while watching TV or

doing homework, etc.
 Environment
 over-exposure to advertising of foods that promote
high-calorie foods
 lack of recreation facilities.
Bagaimana mengenali obesitas anak ?

 Signs that may help to determine if a

child has or is at risk for childhood
obesity
 Clinical manifestations
 Anthropometric measurements
 Complications
Signs that may help to determine if a child has or is
at risk for childhood obesity

 Family history of obesity.

 Family history of obesity-related health risks such as
early cardiovascular disease, high cholesterol, high
blood pressure levels, type 2 diabetes.
 Family history of cigarette smoking and sedentary
behaviors.
 Signs in the child of obesity-related health risks
from a pediatrician's evaluation
 Patterns of sedentary behavior (such as too much
television viewing) and low physical activity levels.
 Smoking initiation. Research studies show that
youngsters use smoking as a method of weight control.
Signs in the child of obesity-related health
risks from a pediatrician's evaluation

 Cardiac Risk Factors : hypertension, dyslipidemia

 Type 2 Diabetes Risk Factors
 glucose intolerance and insulin levels higher than average.
 Orthopedic Problems
 weight stress in the joints of the lower limbs, tibial torsion
and bowed legs, and slipped capital femoral epiphysis (boys).
 Skin disorders
 heat rash, intertrigo, monilial dermatitis and acanthosis
nigricans
 Respiratory : snoring, daytime somnolent, enuresis
 Sexual development : buried penis
 Psychological / Psychiatric Issues
 Poor self-esteem, negative self-image, depression, and
withdrawal from peers
Clinical Manifestations

 Round face, double chin

 Increased truncal fat deposition
 Gynecomastia
 Pendulous abdomen and white/purple striae
 Buried penis
 Taller, often above the 50th percentile in height
 Early menarche
 Genu valgum
Anthropometric Measurements
 BMI  95th percentile
 % Ideal Body Weight (IBW)  120%
 Triceps Skinfold  85th percentile
 Fat distribution patterns (waist-hip-
ratio)
 < 0.8 gynoid type (feminine type)
 > 1.0 android type (masculine type)
 Waist circumference
Body mass index for age percentiles
{W(kg)/H(m)2}
Prinsip tatalaksana obesitas anak :

 Appropriate for the child’s age and

developmental status
 Significant weight reduction to within
20% of the IBW
 Long-term  appropriate eating and
physical activity  weight maintenance
but do not hinder growth & development
Bagaimana tatalaksana obesitas anak ?

 Dietary management
 Physical activity (exercise)
 Behaviour modification
 Family involvement
 Alternative therapy
 Dietary management
 Hypocaloric balance diet
 Reduces caloric intake 200-500 kcal/day
of usual intake
 50-60% carbohydrate, 20-30% fat, and 15-20%
protein
 The step one and step two diets for
lowering blood cholesterol level
 Average total fat 30% of total calorie
 Saturated fatty acids <10% of total calorie
(step-one) & < 7% (step two), PUFA up to 10%
of total calorie
 Cholesterol < 300 mg/day
 Principle of exercise
 Frequency 3-5x/week
 Intensity 50-60% maximal ability
 Duration 15 min initially, building to 30-40 min
 Mode : use large muscles  walking, swimming
 Interest : patient dependent  tennis, dancing,
martial arts
 Enjoyment : important factor
 Incorporation into functional activities  walking
to school, taking stairs vs elevator
 Reducing passive activities  tv watching,
videogames
Behaviour modification
 Diet and activity self monitoring
 Set weekly goal
 Stimulus control
 Eat meals and snacks at scheduled times, etc
 Cue elimination
 Store all food out of sight, leave the table
immediately after eating, etc
 Behaviour substitution
 Substitute exercise for snacking, etc
 Parental support
Family Involvement
 Parents are the most important role models
for children.
 Some ways that parents can establish a
lifetime of healthy habits for their family:
 Create a Healthy Eating Environment

 Create an Active Environment

Alternative (aggressive) therapy
(for morbid obesity)
 BMI  95th percentile
 Very Low Caloric Diet (Protein Sparing
Modified Fast Diet = PSMF)
 Pharmacotherapy
 at this time no drugs approved for use in
children
 BMI  97th percentile (rarely used)
 Bariatric surgery (reduced caloric & nutrient
absorption)
- jejunoileal bypass
- Roux-en-Y gastric bypass
Bagaimana mencegah obesitas anak ?
Respect your child's appetite: children do not need to finish
every bottle or meal.
Avoid pre-prepared and sugared foods when possible.
Limit the amount of high-calorie foods kept in the home.
Provide a healthy diet, with 30 percent or fewer calories
derived from fat.
Provide ample fiber in the child's diet.
Skim milk may safely replace whole milk at 2 years of age.
Do not provide food for comfort or as a reward.
Do not offer sweets in exchange for a finished meal.
Limit amount of television viewing.
Encourage active play.
Establish regular family activities such as walks, ball games
and other outdoor activities.
 Kesimpulan
 Anak gemuk belum tentu sehat
 Penyebab obesitas : multifaktorial
 Tatalaksana obesitas sulit serta melibatkan
berbagai disiplin ilmu
 Pencegahan lebih mudah daripada pengobatan
obesitas
 Pencegahan harus dimulai sejak dini dengan
menerapkan pola hidup sehat dalam keluarga
serta masyarakat
Recommended Childhood Obesity
Screening Procedures
In-depth
Obesity medical
assessment
BMI Overweight • Family history If any
• Blood pressure
+ positive

Not at risk • Total

of cholesterol If all
overweight - negative
• Large BMI
• Concern about • Note in chart
weight
• No therapeutic
action
Return
next year • Return next
for screen year for screen