Program Intervensi Sidartawan

Director, Indonesia Diabetes Institute
(INDINA)

Executive Committee Member,
Western Pacific Region
International Diabetes Federation (IDF)
Temporary Technical Advisor,
World Health Organisation (WHO)
Sidartawan Soegondo
MD PhD F.A.C.E.
Professor of Medicine
University of Indonesia
Thursday, February 24, 2011
Diabesity
Tackling the Global Epidemic
3
Everyone has to die of something
UNDERLYING
SOCIOECONOMIC,
CULTURAL, POLITICAL
AND ENVIRONMENTAL
Unhealthy diet
5
Globalization
Urbanization
Population ageing
Physical Inactivity
Tobacco use
NON-MODIFIABLE RISK
FACTORS
Age
Heredity
Raised blood pressure
Raised blood glucose
INTERMEDIATE RISK
FACTORS
Abnormal blood lipids
Overweight/obesity
Causes of Chronic Diseases
COMMON MODIFIABLE
RISK FACTORS
Heart disease
Stroke
MAIN CHRONIC
DISEASES
Cancer
Chronic Respiratory
diseases
Diabetes
You are what you eat
Penuuuuk Inuonesia INT > 2S kgm2 :
2S.1%.
Kelompok usia S8-47 tahun :
SS.4%
The Thrifty Gene
Hypothesis
Diabetes
+
Obesity
=
Diabesity

Prevalence
People who know they have diabetes
People who dont know they
have diabetes
Indonesian Basic Health Research (RISKESDAS 2007)
Diagnosed DM = 1,5%
Undiagnosed DM = 4,2%
Total DM = 5,7 %
IGT = 10,2 %
The Diabesity Epidemic

Almost two-thirds of adults in the United States are either overweight
(BMI of 25-30) or obese (BMI >30), and nearly one-third of children
ages 6-18 fit these same descriptions. Moreover, the incidence of
type 2 diabetes in children has increased ten-fold in the last 15 years.
The Diabesity Epidemic
Normal
Glucose tolerance
Impaired
Glucose tolerance
IFG
Diabetes
Actual Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
Fatty acids
Visceral obesity
Dysglycemia Continuum
Type 2 DM is Progressive
Relative
function
(units)
0

100

200

300

-10

-5

0

5

10

15

20

25

30

Years of Diabetes
Insulin resistance
Normal insulin level
Beta cell failure
At risk for
diabetes
Adopted from D. Kendall, R. Bergenstal International Diabetes Center
Glucose
(mg/DL)
50

150

250

350

Fasting glucose
Post-meal glucose
-10

-5

0

5

10

15

20

25

30

16
People with normal
glycemic levels
People with
prediabetes
People with
uncomplicated
diabetes
People with
complicated
diabetes
Obesity
prevalence
Prediabetes
detection &
management
Diabetes
detection &
management
Death
Complications onset Diabetes onset Prediabetes onset
Recovery
Dysglicaemia Continuum
Normal
Glucose tolerance
Impaired
Glucose tolerance
IFG
Diabetes
Actual Diabetes
Insulin
Blood glucose
Proinsulin
Fatty acids
Visceral obesity
18
People with normal
glycemic levels
People with
prediabetes
People with
uncomplicated
diabetes
People with
complicated
diabetes
Obesity
prevalence
Prediabetes
detection &
management
Diabetes
detection &
management
Elderly fraction
Death
Complications onset
Diabetes onset Prediabetes onset
Recovery
Diabetes
prevalence
Unhealthy days
& costs per
person with
diabetes
Unhealthy days
& costs from
diabetes
Changes in the
physical and social
environment
Weight loss/
Maintenance services
for individuals
Caloric
Balance
Trends and
planned
Interventions
Flow-rate
between BMI
categories
Death
Overweight and
obesity prevalence
Birth Immigration
Population by Age (0-99) and sex
yearly aging
Dynamic Population weight framework
Not
Overweight
Moderately
overweight
Moderately
Obese
Severely
Obese
Normal
Glucose Tolerance
Impaired
Glucose Tolerance
IFG
Diabetes
Insulin
Blood glucose
Proinsulin
FA
DM detected
Visceral obesity
Actual Diabetes
Insulin Resistance
Islet !-cell
Impaired Insulin Secretion
Normal
Glucose tolerance
Impaired
Glucose tolerance
IFG
Waist
Insulin
Proinsulin
Glucose
Insulin
Blood glucose
Proinsulin
FA
Dysglicemia Continuum
Visceral obesity
Pro insulin : Insulin
BETA CELL DYSFUNCTION
Normal
Glucose tolerance
Impaired
Glucose tolerance
IFG
Diabetes
Actual Diabetes
Insulin
Blood glucose
Proinsulin
FA
Visceral obesity
Intermediate Hyperglicaemia (WHO)
Different names for the same condition
Prediabetes (IDF)
Increased Risk for Diabetes (ADA)
Impaired Glucose Regulation (IGR)
Non Diabetic Hyperglycaemia (NDH) (UK)
Normal
Glucose toleranc
Impaired
Glucose tolerance
IFG Diabetes
Diabetes
Waist
Insulin
Proinsulin
Glucose
Insulin
Blood glucose
Proinsulin
FA
Diagnosis
Visceral obesity
Normal
Glucose tolerance
Impaired
Glucose tolerance
IFG Diabetes
Waist
Insulin
Proinsulin
Glucose
Insulin
Blood glucose
Proinsulin
FA
Visceral obesity
New
Diabetes
New
Diabetes
Islet !-cell
Only 50 %
Function 30 %
E
B
A
I
D
E
T
S
Progresive
Normal
Glucose Tolerance
Impaired
Glucose Tolerance
IFG
Diabetes
Insulin
Blood glucose
Proinsulin
FA
DM detected
Visceral obesity
Actual Diabetes
Diabetes
Diabetes
Insulin
Proinsulin
Fatty Acid
Early Diagnosis
Non Insulin Requiring
Insulin Requiring
Insulin Dependent
Late Diagnosis
Blood glucose
Visceral obesity
Weight
Management
Exercise is Beneficial Even
Without Weight Loss
Turn off the television
Children walk (run, bike, hike,

swim)
Water/low fat milk are the only

beverages at home
Fast food is a 1 time per week

treat
Fruits and vegetables are the only

snacks
Healthy Eating
Reading Food Labels
Plate Method
Fill ! of the plate with non-starchy vegetables
Add a serving
of a protein food
Choose a carb
serving
Dont forget
the dairy!
Finish with
a fruit
COMMUNITY
LOCALITY
Agriculture/
Gardens/
Local markets
Health
Care
Public
Safety
Public
Transport
Manufactured/
Imported
Food
Sanitation
Modied from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org
POPULATION
%
OBESE
AND
OVER--
WEIGHT
WORK/SCHOOL/
HOME
School
Food &
Activity
Infections
Labour
Worksite
Food &
Activity
Leisure
Activity/
Facilities
Family &
Home
INDIVIDUAL
Energy
Expenditure
Food
intake :
Nutrient
density
Societal policies and processes inuencing the population prevalence of obesity
NATIONAL/
REGIONAL
Education
Food &
Nutrition
Urbanization
Health
Social security
Transport
Media &
Culture
National
perspective
INTERNATIONALF
ACTORS
Development
Globalization
of
markets
Media
programs
& advertising
Components of an integrated comprehensive model for school-
based obesity prevention.
School
food
services
Nutrition
environment of
the school
School
health
services Health
instruction
(curriculum)
School counselling
and psychology
programs
Family and
community
linkages
Physical
education
classes
School-site health
promotion for faculty
and staff
Goal: enhancing healthy
eating practices and physical
activity patterns and
achieving healthy weights in
children and adolescents
1. Advertising
2. Food labelling
3. Fiscal policies
4. Research policies
5. Food standards for pre-school nurseries/
schools
6. Public sector catering
7. Health policy development
8. New role for Public Health Sector
9. Health education
Governmental responsibilities for food
Obesity: Time for Action
A joint statement from a CPG/IOTF meeting of 25 NGOs.
Recommend that the Government:
!
Appoint a cabinet minister for comprehensive cross-departmental action
!
Establish an independent government agency responsible to Parliament for
monitoring action & progress, proposing new measures and ensuring compliance
!
Ban the marketing of high fat/sugar/salt products e.g. on TV
!
Simple labelling on all foods and outlets of high/medium/low fat/sugar/salt content
!
Use public procurement and scal measures to counteract current subsidies
!
Require all urban planning, transport etc to ensure safe activity as part of normal
living
!
Increase obesity directed resources in NFS management for PCTs and guidelines
for monitoring children and progress in management and prevention
Obesity: Time for Action
A joint statement from a CPG/IOTF meeting of 25 NGOs.
The Food Industry and Retail Sector should:
!
Develop a range of reformulated staple foods with
a benefit to health
!
Support rules to prohibit promotion of high fat/
sugar/salt foods
!
Develop healthier snacks ,confectionery and soft
drinks
!
Initiate and support a long-term marketing
campaign to promote fruit and vegetables to
children

Program Intervensi Sidartawan

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Director, Indonesia Diabetes Institute

Turn off the television

Children walk (run, bike, hike,

Water/low fat milk are the only

Fast food is a 1 time per week

Fruits and vegetables are the only

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