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OBESITY

Nutrition department
Medical school
University of Sumatera Utara

Globesity: a worldwide problem
0
5
10
15
20
25
Global Least developed Developing Transition Developed
BMI < 17
BMI > 30
In 1995 WHO
estimated there were
200 million obese
people
In 2000 more than
300 million people
were estimated to be
obese
132 million in
developed countries
170 million in other
countries
What is Obesity?
Obesity: Definition
Excess body fat
Fat cells function to store and release
energy

Normal body fat is 10 to 20 kg
Obese body fat is 40 to100 kg
Levels of Body Fatness
Men Women
Essential fat 5% 10%
Borderline 5-9% 10-16%
High performance 5-15% 10-23%
Good fitness health 10-20% 17-28%
Marginal fitness 21-25% 29-35%
Overfatness > 25% > 35%
Etiology
1. Genetics factor
- contribute to ones predisposition to or
protection from obesity
- include determinations of RMR, where fat is
stored, physiologic response to overfeeding,
eating behavior
- Ob gene produce leptin
- -3adrenoreceptor gene regulate
RMR & fat oxidation
2. Neuroendocrine syndrome (<1%)
Rarely causes severe degrees of obesity
- hypothiroidism & hypopituitarism
- Cushings syndrome
- castration & ovarian failure
- PCOS (Stein-Leventhal syndrome)
- hypothalamic lesion
3. Environmental factor primary causes
Dietary excess
- active
- passive

Physical inactivity

4. Epidemiological studies
Age
Gender >
Ethnicity
Educational level & income
Marital status ( after marriage)
Parity
Smoking
Alcohol consumption
Decreases with Education
0
5
10
15
20
25
30
1991 2000
< HS
HS
Some College
College +
Body Composition
Assessment
Body Composition Assessment
Techniques
Underwater weighing
Technological assessments
Skinfold technique
Anthropometric measurements
Underwater Weighing Technique

The
"Gold
Standard"
Underwater Weighing
Measurement issues
Based on body density calculations
Density of lean tissue = 1.1 g/cc
Density of fat tissue = .9 g/cc
General conclusions
Gold standard measure (1-2% error)
Impractical for most applications
Technological Assessments
of Body Composition
Bioelectric impedance
Infra-red spectroscopy
Ultrasound
Imaging techniques (DEXA, MRI)
Bioelectric Impedence
(Measurement Issues)
Based on resistance to current flow
Lean tissue has more water - less resistance
Fat tissue has less water - more resistance
General conclusions
Overestimates lean / underestimates obese
Practical, but expensive measure for general
population
Infrared Spectroscopy
(Measurement Issues)
Based on differential absorbance rates
Lean tissue has a different energy absorption and
reflectance pattern than fat tissue
Sources of error
Validity of absorbance readings is questionable!
General findings
NOT a valid measure!
Ultrasound
(Measurement Issues)
Based on reflection of sound
Fat content increases the time is required for
sound to reflect off of bone and muscle.
General conclusions
Highly accurate measure of body fat - especially for
obese
Expensive and not practical for most applications
Imaging Techniques
(Measurement Issues)
Based on imaging of body tissues
Based on cross sectional area measures
calculated at different levels of the body
General conclusions
Very precise measure of body composition
Expensive and not practical measure for most
uses
Anthropometric Measurements
Body Mass Index (BMI)
Waist to Hip Ratio (WHR)
Circumference measures
Body Mass Index (kg/m
2
)
Dose - Response Risk Relationship
Underweight < 18.5
Normal 18.5 - 25
Overweight 25 - 30
Obese > 30
Class I 30 - 34.9
Class II 35 - 39.9
Class III >40
Body Mass Index (kg/m
2
) in adult Asians
Dose - Response Risk Relationship
Underweight < 18.5
Normal 18.5 22.9
Overweight 23
- At risk 23 24.9
- Obese I 25 29.9
- Obese II 30
Body mass index and total mortality in
the Nurses Health Study
0
0.5
1
1.5
2
2.5
<23 23-
<25
25-
<26
26-
<27
27-
<28
28-
<29
29-
<30
30-35 >35
All
Source: JAMA 1999;282:1530

Regional Fat Deposition
Abdominal body fat poses greater health risks
than fat stored in other areas

Males store more fat
centrally and have
increased health
risks associated
with body fatness
Higher health risk
Lower health risk

Male (apple)




Female (pear)

Regional Fat Deposition
Visceral Fat
Visceral body fat poses greater health risks because this
fat is more labile and has greater access to the
circulation.

The accumulation of visceral body fat is typical of the
android (male) fat pattern
males: visceral accounts for 10-35% of total fat
females: visceral accounts for 8-13%of total fat







































WOMEN
MEN
High Risk
Moderate Risk
Low Risk
> 1.0 > .85
.90 -1.0 .80-.85
HEALTH RISK
< .90 < .80
Waist to Hip Ratio (WHR)
Waist to Hip Ratio is an effective way to
examine regional fat distribution.
Tipe buah Pear
(Obesitas Ginecoid)
Tipe buah Apel
(Obesitas Android)

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