anda ingin memiliki berat badan...
TRANSCRIPT
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ANDA INGIN MEMILIKI
BERAT BADAN
UNGGUL????
DR. LILIWATI BT ISMAIL
PAKAR PERUBATAN KELUARGA
KK. HUTAN MELINTANG
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BERAT BADAN UNGGUL
• berat badan yang sesuai mengikut ketinggian tubuh.
• Ia boleh diukur dengan menggunakan • Ia boleh diukur dengan menggunakan indeks jisim tubuh (BMI)
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OBESITI DIUKUR MELALUI BODY MASS INDEX (BMI)
BMI = Weight (kg)
Height (m2)
Classification BMI (kg/m2) Risk of co-morbidities
Normal range 18.5−−−−24.9 17- 23 Average
World Health Organization, 1998
WHO/WPR Asian Guidelines, 2001
Normal range 18.5−−−−24.9 17- 23 Average
Overweight ≥ ≥ ≥ ≥ 25 >23Pre-obese 25−−−−30303030 23 - 25 IncreasedObese class I 30−−−−35 25 - 27 ModerateObese class II 35−−−−40 40 40 40 27 27 27 27 −−−− 35353535 SevereObese class III ≥≥≥≥40.0 >35 Very severe
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UKURAN PINGGANG
Faktor risiko
kardiovascular
WANITAWANITA
>88 cm = Increased risk1
Asian: 80 cm
LELAKILELAKI
>102 cm = Increased risk1
Asian: 90 cm
1Lean MEJ, et al. Lancet;1998:351:853–6
cm
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DEFINISI & PENILAIANMENGIKUT BMI DAN UKURLILIT PINGGANG
CLASSIFICATION BMI KG/M2
DISEASE RISK*
WAIST CIRCUMFERENCE< 90 cm (men) > 90 cm (men)
< 80 cm (women) > 80 cm (women)
Underweight <18.5Underweight <18.5
Normal range 18.5 – 22.9
Overweight 23.0 – 27.4 Increased High
Obesity (Class I) 27.5 – 34.9 High Very high
Obesity (Class II) 35.0 – 39.9 Very high Very high
Extreme Obesity (Class III)
>40.0 Extremely high Extremely high
* Relative to normal weight and waist circumference, disease risk for type 2 diabetes, hypertension and CVD.Clinical Practice Guidelines on Management of Obesity 2004Clinical Practice Guidelines on Management of Obesity 2004
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OBESITI DAN KESIHATAN
• Biasanya lebih dianggap sebagai masalah sosial
PENAMPILANPENAMPILANKECANTIKAN
KARIER
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DISKRIMINASI
KURANG KEYAKINAN DIRI
MASALAH PERHUBUNGAN
KURANG KEYAKINAN DIRI
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• Secara global – 1.1 juta mengalami masalah lebih berat badan & obesiti
NATIONAL HEALTH & MORBIDITY SURVEY
NHMS OVERWEIGHT (%)
BMI 25-29.9
OBESE (%)
BMI > 30BMI 25-29.9 BMI > 30
Female Male Female Male
2 (1996) 17.9 15.1 5.7 2.9
3 (2006) 32.4 30.9 18.8 13.9
NHMS 2011 27.8 30.9 17.6 12.7
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Kenapa obesiti semakin meningkat
• Perubahan cara hidup• Pengambilan kalori yg bertambah• Peningkatan taraf Sosio ekonomi
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MAKANAN
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CARA HIDUP
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BAGAIMANA BERAT BADAN BERTAMBAH
• Ketidakseimbangan tenaga– Kalori yang diambil tidak sama dgn kalori yg
digunakan
• Berlaku dalam jangkamasa yang lama• Berlaku dalam jangkamasa yang lama• Dgn kombinasi beberapa faktor
– Tabiat dan tingkah laku individu– Interaksi sosial– Persekitaran – genetik
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LEPTIN
• Hormon yang dirembeskan oleh tisu adipos
• Bergantung kepada jumlah lemak dlm badanbadan
• Bertindak ke atas hipothalamus untuk merencatkan rasa lapar dan meningkatkan penggunaan tenaga
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GHRELIN
• Hormon yang dirembeskan dlm perut• Bertindak di hipothalamus utk merangsang
selera • Dirembeskan sejurus sebelum makan dan • Dirembeskan sejurus sebelum makan dan
berkurang selepas makan
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Bagi mereka yang mengawal pemakanan sahaja
• Kandungan Leptin berkurang – meningkatkan selera makan dan mengurangkan kadar metabolisma
• Paras Ghrelin bertambah selepas berat badan berkurang disebabkan kawalan dietberkurang disebabkan kawalan diet
• Badan akan bertindak balas meningkatkan paras ghrelin dirangsang oleh pengurangan berat badan.
• Paras ghrelin akan semakin meningkat dgn pengurangan berat badan.
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RISIKO OBESITI TERHADAP
KESIHATAN
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RISIKO OBESITI TERHADAP KESIHATAN
Greatly increased
(RR>3)
Moderately increased
(RR 2-3)
Mildly increased
(RR 1-2)
Type 2 DM CHD Cancer (breast, endometrial, liver, prostate, GB
Hepatobiliary disease (gallstone, fatty liver)
Cerbrovascular disease
Reproductive hormone abnormalities
Dyslipidaemia Cardiac Failure PCODyslipidaemia Cardiac Failure PCO
Metabolic syndrome LVH Impaired fertility
Breathlessness Hypertension Low back pain
Sleep apnoea OA (knees, hips) Increased anaesthetic risk
Hyperuricaemia, gout Foetal defects assd with maternal obesity
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RISIKO KARDIOVASKULAR & STROK& STROK
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OBESITI DAN PENYAKIT KARDIOVASKULAR
Framingham StudyObesiti merupakan faktor risiko yg tersendiri bagi penyakit
kardiovaskular
• Risiko jangkamasa panjang obesiti:
Sudden death 2.8
Stroke 2.0
Congestive heart failure 1.9
Coronary heart disease 1.5
Increased risk
Hubert et al. Circulation 1983; 67:968-977
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Incidence for Coronary Heart Disease RiskAccording to BMI and Waist Circumference
Rexrode KM, et al.,Rexrode KM, et al., JAMA,JAMA, 1998;280:1843 1848.1998;280:1843 1848.
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MASALAH KOLESTEROL
• High Total Cholesterol ( 5.2 mmol/L)High TG ( 1.7 mmol/L )High LDL (2.6 mmol/L)Low HDL (1.0M/1.2F)Low HDL (1.0M/1.2F)
• Risiko serangan jantung (MI) & Stroke.• Atherosclerosis
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OBESITI DAN DIABETES• Masalah kesihatan global - Pandemik• Semakin meningkat disebabkan:
– Peningkatan populasi– Peningkatan umur– Peningkatan umur– Perbandaran – Masalah obesiti & lebih berat badan semakin
meningkat– Kurang aktiviti fizikal
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PENYAKIT DIABETES DI MALAYSIA
• 1960’s & 1970’s - prevalence of 1-2% • National Health and Morbidity Survey1986 NHMS 1 - 6.3% 1996 NHMS 2 - 8.2% 1996 NHMS 2 - 8.2% 2006 NHMS 3 - 14.9%
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Excess weight is a risk factor for type 2 diabetes (Nurses Health Study)
60
100
Relative risk of type 2 diabetes
80
93.2
Colditz et al. Ann Intern Med 1995; 122: 481-6
0
20
40
60
<22 22.0–22.9
23.0–23.9
24.0–24.9
25.0–26.9
27.0–28.9
≥3529.0–30.9
31.0–32.9
33.0–34.9
1.0 2.9 4.3 5.0 8.115.8
27.6
40.3
54.0
BMI (kg/m2)
Marked increase above BMI 25
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Relative risk of type 2 diabetes according to waist circumference (women)
Relative risk
24
20
16
Risk of Diabetes increased markedly above 81cm
71–75.9
16
12
8
4
0<71 76–81 81.1–86 86.1–91 91.1–96.3 ≥≥≥≥96.4
Adapted from Carey et al. Am J Epidemiol 1997; 145: 614–9, with permission
Waist circumference (cm)
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OBESITI DAN PENYAKIT DARAH TINGGI
• Tekanan darah dikawal oleh hormon • Hormon yang dikeluarkan oleh tisu adipos
– mengaktifkan renin angiotensin.• Insulin resistance – hormon insulin yang • Insulin resistance – hormon insulin yang
tinggi dalam badan.• Kesan kepada ginjal – hyperfiltration –
focal glomerular sclerosis.
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OBESITI & KANSER
Breast (post-menopausal) Colon Endometrial Esophageal Kidney Prostate. Prostate.
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CANCER – BREAST, ENDOMETRIUM & OVARY
WANITA DGN BMI > 34kg/m2 MEMPUNYAI 6X
GANDA RISIKO GANDA RISIKO MENDAPAT KANSER
ENDOMETRIUM
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OBESITI DAN SLEEP APNEA
• Pernafasan yang terhenti seketika semasa tidur.
• Risiko meningkat 12 – 30 x ganda.• Kelebihan lemak di bahagian dada • Kelebihan lemak di bahagian dada
mengganggu otot pernafasan, lemak di bahagian leher menyekat saluran pernafasan.
• Gangguan tidur menyebabkan keletihan, sakit kepala,mengantuk, mudah marah, murung.
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OBESITI DAN LEMAH JANTUNG (Heart failure)
• Kandungan interleukin 6, C reactive protein dan fibrinogen yang tinggi dalam darah.
• Menyebabkan keradangan pada tisu • Menyebabkan keradangan pada tisu jantung dan salur darah
• Tisu jantung membesar (LV hypertrophy), cardiac output meningkat.
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OBESITI DAN OSTEOARTHRITIS
• Lebihan berat badan terpaksa ditanggung oleh sendi dan tulang (weight bearing joints) menyebabkan sendi mudah rosak dan haus.
• Semasa berjalan sendi terpaksa menahan daya berat 3-6 kali berat badan.
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OBESITI DAN KEMATIAN AWAL (Premature death)
• Kajian epidemiologi– Peningkatan kadar kematian awal 50-100% (BMI >
30kg/m2) berbanding BMI < 25kg/m2
• Jangka hayat seseorang yang sederhana obes boleh berkurang 2 – 5 tahun.boleh berkurang 2 – 5 tahun.
• Kematian berhubung rapat dengan morbiditi disebabkan oleh obesiti.
• Kajian di sweden 1969 (1.7 million) – 2897 mati semasa f/up 18 – 38 tahun. Kadar kematian lebih tinggi di kalangan obes.
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RISIKO KEMATIAN AWAL, BMI & MEROKOK
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Metabolic SyndromeMETABOLIC SYNDROME
Central obesity [WC 90cm for men and 80cm for women].
Plus any two of the following four factors:
• Raised TG level: > 1.7 mmol/L, or specific treatment for this lipid abnormality
• Reduced HDL cholesterol: < 1.0 mmol/L) in males and < 1.3 mmol/L in females, or specific males and < 1.3 mmol/L in females, or specific treatment for this lipid abnormality
• Raised blood pressure: systolic BP > 130 mmHg or diastolic BP > 85 mmHg, or on treatment of previously diagnosed hypertension
• Raised FPG > 5.6 mmol/L, or previously diagnosed T2DM. OGTT is strongly recommended but is not necessary to define presence of the syndrome.
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MASALAH LAIN
• Semput / Lelah• Skin problems – acanthosis nigricans,
Fungal infection.• Varicose veins• Varicose veins• Badan berbau – peluh berlebihan• Kesukaran bergerak• Masalah sosial
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OBESITI = MEMBUNUH DIRI??
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BAGAIMANA CARA UNTUK MENDAPATKAN BERAT
BADAN UNGGUL/ MENGURANGKAN & MENGURANGKAN &
MENGEKALKAN BERAT BADAN?
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OBJEKTIF
• Mengurangkan berat badan
• Mengekalkan berat badan pada tahap yg lebih rendah
• Mengelakkan pertambahan berat badan
• Merawat penyakit dan penyebab kepada obesiti
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PENINGKATAN BERAT BADAN DISEBABKAN OLEH FAKTOR UMUR TIDAK DAPAT DIELAKKAN
Bo
dy w
eig
ht
(kg
)B
od
y w
eig
ht
(kg
)
YearsYears
Bo
dy w
eig
ht
(kg
)B
od
y w
eig
ht
(kg
)
MonthsMonths
Small weight gain with time Small weight gain with time represents natural history not represents natural history not loss of efficacy since full loss of efficacy since full theoretical weight suppression theoretical weight suppression remains fully maintainedremains fully maintained
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Body weight
Successes
1. Sustained weight, no increase
KEJAYAAN DALAM PENGURUSAN BERAT BADAN
Years of management or intermittent monitoring
Normal
Overweight
Obese2. Minor weight loss with dietary
change to reduce risk of complications
3. Modest weight loss with clear risk factor reduction e.g. B.P,
diabetes.
4. Weight normalisation- rare, unrealistic.
Adapted from Rössner, 1997
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PENURUNAN BERAT BADAN
• Sasaran – Penurunan 10% drpd berat badan asal– Realistik dan dapat dicapai
• Kadar penurunan berat badan– Penurunan 10% berat badan dlm tempoh 6 bulan– Penurunan berat badan yang mendadak boleh
menyebabkan:• Ketidakseimbangan elektrolit• Meningkatkan risiko batu dalam pundi hempedu• Pertambahan berat badan
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SASARAN TAK REALISTIK
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OBJEKTIF 1
• MENURUNKAN BERAT BADAN– Sasaran mestilah realistik dan boleh dicapai
– Mensasarkan penurunan sebanyak 2kg – Mensasarkan penurunan sebanyak 2kg sebulan• Mungkin tidak akan dicapai pada setiap bulan
– Penurunan 10% drpd berat asal dlm tempoh 6-12 bulan
– Menilai semula sasaran yang telah ditetapkan
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OBJEKTIF 2
• Mengekalkan berat badan pada tahap yang lebih rendah– Kadar penurunan berat badan akan berkurang
selepas 6 bulanselepas 6 bulan– Keutamaan – untuk mengekalkan berat badan• Pertambahan berat badan < 3 kg dlm tempoh 2
thn• Mengekalkan pengurangan ukurlilit pinggang
sekurang-kurangnya 4cm
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OBJEKTIF 3
• Mengelakkan pertambahan berat badan
– Sekiranya penurunan berat badan yang disasarkan tidak dapat dicapai
– Dianggap sebagai separa berjaya
– Tiada pertambahan risiko sekiranya berat badan tidak bertambah
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PILIHAN RAWATAN
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MODIFIKASI CARAHIDUP
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DIET
• Low Calorie Diet– Pengurangan kalori sehingga 500-1000 cal/sehari drpd
keperluan harian
– Keperluan secara umum• 1000-1200 cal/sehari - wanita• 1000-1200 cal/sehari - wanita
• 1200-1500 cal/sehari - lelaki
– Penurunan berat badan - 8-10%, purata 11 kg dlm tempoh 6-12 bulan
– Ukur lilit pinggang berkurang 1.5-9.5 cm
– Memastikan semua keperluan pemakanan yang disarankan adalah mencukupi.
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LIFESTYLE MODIFICATION: DIET
• Very Low Calorie Diet
– 200-800 cal/sehari, biasanya dalam bentuk cecair nutrisi
–Hanya sesuai sekiranya seseorang menghadapi risiko penyakit yang serius.risiko penyakit yang serius.
–Penurunan berat badan dijangkakan 20kg dalam tempoh 12-16 minggu, mengekalkan ½ - 2/3 drpd penurunan berat badan selama 1 tahun berikutnya.
Jarang disarankan – boleh menyebabkan kekurangan nutrisi, tidak dapat dikekalkan dlm jangkamasa panjang, menyebabkan kehilangan protein dan otot.
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MODIFIKASI CARA HIDUPAKTIVITI FIZIKAL
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PELBAGAI ALASAN PENGHALANG UNTUK AFTIF SECARA PELBAGAI ALASAN PENGHALANG UNTUK AFTIF SECARA FIZIKALFIZIKAL
“SEGAN LE..”“TAK ADA MASA”
“TAK MAMPU”
“SAKIT LUTUT”
“DAH TUA”“DAH TUA”
“LETIH LE”
“TERLALU GEMUK, SUSAH NAK EXERCISE”
“TAKUT KENA KEJAR ANJING”
“BELUM ADA PENYAKIT LAGI”
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Untuk mengurangkan dan mengekalkan berat badan
• Memerlukan aktiviti fizikal (moderate intensity) – 45-60 minit sehari
• Mengekalkan berat badan bagi individu yg dulunya obes – 60-90min seharidulunya obes – 60-90min sehari
• Memilih program senaman– Frequency (kekerapan)– Intensity – Time (tempoh)– Type of exercise
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Intensity
• Senaman ringan – berjalan perlahan (4km/h), tai chi, membersih rumah, bermain golf
• Senaman sederhana – Berjalan cepat • Senaman sederhana – Berjalan cepat (6km/j), berbasikal (24km/j), badminton, berenang, aerobic dancing/exercise
• Senaman berat – Jogging (10km/j), berjalan menaiki bukit,basketball,mendaki, bermain bola sepak.
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ª Kekerapan aktiviti fizikal
- sekurang-kurangnya 3x seminggu utk fitness
- 2 x/seminggu - strength and endurance
LIFESTYLE MOD : PHYSICAL ACTIVITY
- 2 x/seminggu - strength and endurance
- 5 x/seminggu - flexibility
- setiap hari – untuk menurunkan berat badan
Kesan hilang selepas 2-3 minggu rehat
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• Intensitykadar denyutan nadi maksimumMHR = 220 - (umur dlm tahun)
e.g. 30 thn lelakiMHR = 220-30 = 190 bpm
LIFESTYLE MOD : PHYSICAL ACTIVITY
MHR = 220-30 = 190 bpm
sasaran60-85% drpd denyutan nadi max
e.g. 0.6 x 190 = 114 bpm.0.85 x 190 = 161 bpm.
Sasaran denyutan nadi : 114-161bpm
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ª intensity
Use ‘Sing-Talk-Gasp’ Principle
LIFESTYLE MOD : PHYSICAL ACTIVITY
Use ‘Sing-Talk-Gasp’ Principle
If you can sing Ô too little
If you are gasping Ô too much
If you can just talk in short sentences Ô just nice
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ª tempoh aktiviti fizikal
Bergantung kpd jenis aktivitiFor cardiovascular fitness, 20-30 min.*
LIFESTYLE MOD : PHYSICAL ACTIVITY
For cardiovascular fitness, 20-30 min.*For flexibility, 10-15 min.
* Berkesan walaupun dilakukan secara berselang 3x 10 min
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TERAPI UBAT
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SIAPA SEPATUTNYA MENDAPAT TERAPI UBATAN
• Individu yg masih tidak dapat menurunkan berat badan sebanyak 500g/minggu selepas 6 bulan dlm program penurunan berat badan.•Individu dgn BMI:•Individu dgn BMI:
– > 30kg/m2– < 27kg/m2 dgn penyakit kronik/faktor risiko
Clinical Practice Guidelines on Management of Obesity 2004
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ORLISTAT (XENICAL)
•Pancreatic lipase inhibitor•Mengurangkan penyerapan lemak drpd diet ~30%•10% penurunan berat badan dlm tempoh 1 thn•Kesan lain:–Menurunkan kandungan kolesterol darah– Kawalan gula yang lebih baik– Kawalan gula yang lebih baik–Menurunkan tekanan darah–Mengelakkan penyakit diabetes bagi individu IGT
•Kesan sampingan– Secara umum - ringan•Cramps•Flatus•Fecal incontinence/discharge
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SIBUTRAMINE (REDUCTIL)
•Inhibits serotonin and NA uptake•Dual mode of action– Enhances post-ingestive satiety– Increases resting metabolic rate
•5-8% weight loss •Other benefits•Other benefits– Improves lipid levels– Improves glycaemic control– Improves hyperuricaemia
•Side effects– Increases pulse by 4-5 bpm and blood pressure by 1-3mmHg– Dry mouth– Headache– Insomnia
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SURGICAL INTERVENTION
•Mengekalkan penurunan berat badan dalam jangkamasa lebih lama berbanding dgn cara lain.
•Menurunkan kadar mortaliti bagi pesakit Diabetes.Diabetes.
• Prosedur– Vertical gastric banding–Roux-en-Y– Bilio-pancreatic bypass– Lap-Band
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SURGICAL INTERVENTION
• Criteria– Umur > 18 thn dgn BMI > 40 kg/m2– Umur 35-40 dgn penyakit berkaitan dgn obesiti– Telah menjalani program intensif di klinik obesiti– Gagal mengekalkan berat badan selepas
menjalani program lain.– Tiada kontraindikasi dari segi klinikal atau
psikologi
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KENAPA BERAT BADAN TAK TURUN2 NI??????
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SARAPAN
Nasi lemak(biasa) 320kcalTeh tarik 130 kcal
MAKAN TENGAHARI
Nasi putih(2 senduk) 200kcaIkan masin masak lemak
(1 senduk) 145kcal
jumlah= 450kcal
Sayur buncis goreng (1 senduk) 40kcal
Sirap bandung 1 gelas 160 kcal
Jumlah 545 kcal
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MAKAN PTG
Pau kaya 1 biji 130kcalpisang goreng 3 biji 130kcalnescafe ais 1 gelas 130 kcal
MAKAN MALAM
Nasi 200kcalIkan kembung masak kicap
1ekor 160kcalSayur kangkung goreng 1
senduk 50kcal
Jumlah 390kcal
senduk 50kcalTelur dadar 1 potong
100kcalKordial oren 1 gelas 70
Jumlah 580kcal
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snacking
• Kit kat 16g – 80kcal• Snickers – regular size bar (59g) 280kcal• Tapai pulut 1 bungkus 130kcal• Kacang kuda 1 senduk 160kcal• Kacang kuda 1 senduk 160kcalJumlah = 650
Jumlah keseluruhan - 2615
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BMR• JANTINA PEREMPUAN• UMUR 40• TINGGI 157CM• BERAT BADAN 52KG• SEDENTARY LIFESTYLES• SEDENTARY LIFESTYLESBMR = 655+(9.6x52kg)+(1.8x157cm)-(4.7x40)499.2 282.6 188Daily calorie requirement = 1248.8 x 1.551935.6Kcal
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SUMMARY
Jumlah kalori masuk
Sarapan 450
Makan tengahari 545
Makan petang 390
Makan malam 580Makan malam 580
snacking 650
Jumlah keseluruhan 2615
Keperluan kalori harian 1968.6 kcal sehari
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Harris-Benedict equation
• BMR♂ = 66 + (13.7 x weight in kilograms) + (5 x height in centimetres) – (6.8 x age in years)
• BMR♀ = 655 + (9.6 x weight in kilograms) + (1.8 x height in centimetres) – (4.7 x age in years)x height in centimetres) – (4.7 x age in years)
• Keperluan kalori harianBMR x factor (level of activities)
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LEVEL OF ACTIVITY
• If you are sedentary (little or no exercise) – BMR x 1.2• If your are lightly active (light exercise/sports or training
1-3 days a week) – BMR x 1.375• If you are moderately active (moderate
exercise/sports or training 3-5 days a week) – BMR x exercise/sports or training 3-5 days a week) – BMR x 1.55
• If you are very active (hard exercise/sports or training 6-7 days a week) – BMR x 1.725
• If you are extra active (very hard daily exercise/sports & physical job or training twice daily) – BMR x 1.9.
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THIS IS MY WAY
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HALF PLATE RULE
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