OBESITY IN CHILDREN

Muhammad Faisal Alim

(1102012171)

Departement of Pediatrics
RS Bhayangkara Tk. I Raden Said Sukanto Jakarta
 Introduction
Obesity is the most prevalent nutritional disorder among children
1 and adolescents

It relates with technological developments  fast food products,

2 the use of motor vehicles, various electronic media (television,
video game)

Riskesdas 2013  the incidence of obesity 8,8% in children aged

3 5-12 years.

Increased comorbidities that have the potential to become

4 degenerative diseases in the future  Hypertension, DMT2,
Coronary heart disease
Physiology of Energy Balance

Neutral Energy Balance

When the calories you
take in is equal to the
calories expended

Positive Energy Balance Negative Energy Balance

When the calories you When the calories you
take in is greater than take in is less than the
the calories expended calories expended
 Energy input

Intake of food

Controlled by
hypothalamus

Long-term Short-term
control of control of
dietary intake dietary intake
 Definition
Obesity
• A disorder or disease characterized by
excessive accumulation of body fat tissue
Overweight
• Being overweight compared to the ideal
weight that can be caused by
accumulation of fat tissue or non-fat
tissue. Eg: Weightlifting athletes 
muscular hyperthropy
 Obesity
Criteria

Measurement of
Weight/ Body Mass
subcutaneous
Height Index (BMI)
fat

Above percentile Age 0-5 years  Above percentile

90 or 120% from WHO 2006 85
ideal weight Age 5-18 years 
CDC 2000
 Epidemiology

• The incidence of overweight and

child obesity globally increased from
4.2% in 1990 to 6.7% in 2010. This
trend is expected to reach 9.1% or
60 million by 2020 8.8%
• Indonesia  based on the Riset
Kesehatan Dasar (Riskesdas) 2013,
nationally indicates that overweight
and obesity problems in children
aged 5 to 12 consecutive years of
10.8% and 8.8%, are approaching
the world's estimates by 2020.
 Etiology of Obesity

Energy expenditure

Idiopathic
(primary obesity/ nutritional) Endogenous factors

Genetic Environmental Hormonal

abnormalities

Parental Eating behavior Syndroms/

fatness
genetics
Physical activity
defect
Neurogical/ Psychological
trauma

Sosioeconomic
 Pathophysiology
Obesity &
Obesity & energy Obesity & adipocyte
neurobehavioral
balance abnormalities
abnornalities

Excess of Gene mutations that

macronutrients belong to hunger
Energy input >
(glucose)  convert control (leptin-
energy output
to fatty acids  melanocortin
stored in adipocytes pathway)
 Clinical Manifestation

• Chubby • Enlarged • Large on both • Apple-shaped

cheeks breast thighs or body or pear-
• Double chin upper arms, shaped body
• Buldging
• Short neck abdomen relatively • Burried penis
small fingers
with fat • White or • Precocious
accumulation violet striae • X-shape limbs puberty
Diagnosis Obesity criteria Antropometrically
Child comes with
obesity complaints
Clinically

Calculate BMI

Family History
• Parental obesity, the presence of cardiovascular or diabetes type 2 in the
family
Diet
• Indentify the person who is feeding the child, high calories consumtion

Activities
• Physical activity, playing time, time that used to watch television or playing
video games
 Treatment
Principles of obesity management 
Based on the pathophysiology of reducing intake and increasing energy expenditure.
Komponen Keterangan
Menetapkan target Mula-mula 2,5 sampai 5 kg, atau dengan kecepatan 0,5-2 kg per
penurunan berat badan bulan

Pengaturan diet Nasihat diet yang mencantumkan jumlah kalori per hari dan anjuran
komposisi lemak, protein, dan karbohidrat.

Aktivitas fisik Awalnya disesuaikan tingkat kebugaran anak dengan tujuan akhir 20-
30 menit per hari diluar aktivitas fisik di sekolah

Modifikasi perilaku Pemantauan mandiri, pendidikan gizi, mengendalikan rangsangan,

memodifikasi kebiasaan makanm aktivitas fisik, perubahan perilaku,
reward and pusihment

Keterlibatan keluarga Analisis ulang aktivitas keluarga, pola menonton televisi; melibatkan
orang tua dalam konsultasi gizi
 Treatment
Physical Activity Behaviour Parental/Family Intensive
Diet Control
Control Modification Involvement Therapy

• Composition of • Physical • Control intake, • Family • Pharmaco-

50-60% exercise 20-30 body weight, members therhpy 
carbohydrate, minutes a day physical activity participate in sibutramin,
30% fat, and 15- excluded and diet programs, orlistat
20% protein physical activity development. change eating • Bariatric surgery
• High fiber diet at school • Stimulus control behaviors and  Laparoscopic
 reduce  avoiding activities that Adjustable
hunger snacks while support the Gastric Banding
watching TV success of the (LAGB)
• Changing of program
eating behavior
 eat slowly,
portion control,
snacking control
• Reward and
punishment