dec

4
Obesity papers

PART I
PRELIMINARY
A. Background
The influence of globalization in all fields, developments in technology and
industry has brought many changes in the behavior and lifestyle of the
community and environment situation. The changes are unwittingly contributing
to the occurrence of epidemiologic transition with the increasing cases of noncommunicable diseases. Health Research Association in 2007 also showed an
increase in cases of non-communicable diseases are quite significant, making
Indonesia has a double burden. Community health status can be viewed from a
variety of indicators, one of which the nutritional status of the community.
Nutritional problems are the problems that exist in each country, whether poor
countries, developing countries and developed countries. Poor countries and
developing countries tend to the problem of malnutrition (infections) and
developed countries tend to more nutritional problems (degenerative diseases).
Developing countries such as Indonesia have multiple nutritional problems that
any combination of malnutrition and over nutrition problems.
Before the 20th century, obesity is rare, but in 1997 the WHO officially declared
obesity as a global epidemic. WHO stated that obesity has become a world
problem. Data collected from around the world show that an increase in the
prevalence of overweight and obesity in the last 10-15 years, is currently
estimated at over 100 million people worldwide suffer from obesity. By 2005,
WHO estimates that globally there are approximately 1.6 billion adults were
overweight or overweight and 400 million (9.8%) of which are categorized as
obese. In 2015 predicted cases of obesity will be doubled from that figure.
Obesity rates also rose with increasing age at least until the age of 50 to 60
years and severe obesity in the United States, Australia, and Canada are
increasing faster than overall obesity rates.
Across the world, the prevalence of obesity has increased more than doubled
between 1980 and 2008. In 2008, 10% of men and 14% women in the world are
obese. An estimated 205 million men and 297 million women over the age of 20
years are obese. The highest prevalence was on American soil that is 62% to
26% for overweight and obesity and the lowest prevalence in the region is 14%
overweight and 3% obese. In all regions women tend to be more obese than
men. In areas of Africa, the Eastern Mediterranean and Southeast Asia, women
have twice the prevalence of obesity than men.
In Europe, the UK the number one country in the case of obesity in children, with
a prevalence rate of 36%. Followed by Spain, with a prevalence of 27% as
reported by the International Obesity Team (CyberMed, 2003). Obesity problem
extends to developing countries, for example, in Thailand the prevalence of
obesity in children 5-12 years has increased from 12.2% to 15.6% in just two
years (WHO, 2003).

The prevalence of obese children ages 6 to 11 years has more than doubled
since the 1960s (WHO, 2003).
Source Euromonitor International said the Asia-Pacific, obesity is increasing
rapidly and the number of countries predicted to have the fastest growth rate of
obesity from 2010 to 2020 namely, Vietnam 225 percent, 178 percent Hong
Kong, India 100 per cent, South Korea 80.7 percent, Zealand The new 52 per
cent, and Indonesia 50 percent.
Based on data from the Health Research (Riskesdas) in 2007, the national
prevalence of obesity in the general Indonesian population aged 15 years were
10.3% consists of (male 13.9%, female 23.8%). While the prevalence of
overweight children aged 6-14 years in males 9.5% and 6.4% in women. This
figure is almost the same as the WHO estimates by 10% in children aged 5-17
years.
Based on data from the WHO in 2008, the prevalence of obesity in adulthood in
Indonesia by 9.4% with the division reached 2.5% in men and in women 6.9%.
Previous survey in 2000, the percentage of obese population of Indonesia is only
4.7% ( 9.8 million). It turns out in just 8 years the prevalence of obesity in
Indonesia has increased twice as much. Indonesia entered the top 10 in the
world with obesity overweight people were 40 million people. Obesity, whether in
a group of children and adults, increased by almost one percent annually.
In 2010, the national prevalence in Indonesia was 14.0%, an increase that is
significantly less than the prevalence of obesity in 2007, ie 12.2% (Balitbangkes,
2010).
Riskesdas data in 2013 showed that, nationally problems obese children aged 512 years are still high, ie, 18.8 percent, 10.8 percent consists of fat and very fat
(obese) 8.8 percent, while the prevalence of fat on adolescents aged 13-15 years
in Indonesia by 10.8%, consisting of 8.3% fat and 2.5% are very overweight or
obese.
The prevalence of overweight in adolescents 16-18 years experienced a
significant increase over 2007 of 1.4% to 7.3% in 2013 (Ministry of Health, 2013).
According to data Susenas 1995 and 1998 in South Sulawesi, the obesity rate is
high, ie from 4.7% to 6.22% by the indicators BB / U median standard WHONCHS. While the prevalence of obesity in the age group of 6-14 years by
Riskesdar 2007 in South Sulawesi are 7.4% of men and 4.8% women. In the
province of South Sulawesi, to the prevalence of central obesity, Jeneponto the
first order the district (22.5%) after the town of Pare-Pare (23.9%) and Makassar
(23.8%) higher than the national average (18.8 %) (Riskesdas, 2007).
It was concluded that obesity has become a problem in many countries one of
them in Indonesia. It shows if the problem is not addressed, then the burden of
government, especially the Ministry of Health will be growing (Regional Office of
the Department of Health, 1998).
B. Problem Formulation
Based on the back of the above, the issues to be discussed in this paper are:
a. What does the term obesity?
b. What are the types of obesity?
c. How onset etiology of obesity?
d. What are the symptoms - symptoms of the onset of obesity?

e. Any classification of obesity?

f. How factors that affect obesity?
g. What are the risks posed obesity?
h. How does obesity prevention?
C. Objectives
a. To know the definition of obesity.
b. To find out what type - the type of obesity.
c. To determine the etiology of obesity.
d. To know the symptoms - symptoms of the onset of obesity.
e. To determine the classification of obesity.
f. To determine the factors that affect obesity.
g. To determine the risk posed obesity.
h. Pinpoint ways obesias prevention.
CHAPTER II
DISCUSSION
A. Understanding Obesity
The word obesity comes from the Latin ob means the result of, and ESUM
interpreted as eating, so that obesity means overeating. Obesity is a condition of
excess body fat so the weight far in excess of normal weight.
Obesity is the accumulation of abnormal or excessive fat that can harm health
(WHO).
Obesity is a complex metabolic disorder caused by many factors including
genetic and environmental factors, where the incidence of obesity is a
combination of both factors (James, et al., 2011: in Oetomo, 2011; 5).
In the pathophysiology of obesity is the excessive accumulation of triacylglycerol
in adipose tissue because imbance (imbalance between energy intake by the
user), (Bays et al, 2008; in Oetomo 2011; 3).
Obesity is defined by too much eating, too little physical activity or exercise, or
both (Misnadierly, 2007).
Overweight (obesity) is not actually synonymous with being overweight, but
rather related to the composition of the body where there is excess fat. Obesity
and overweight have a different understanding. Obesity is a condition of being
overweight as a result of the accumulation of fat, for men and women
respectively exceeded 20% and 25% of the weight of the body and can be
harmful to health. While overweight (overweight, obesity) is a condition where a
person's weight exceeds the normal weight. Excess body fat is associated with
the incidence of metabolic syndrome, which is a risk to the health problems of
obesity. It is known that obesity is associated with metabolic syndrome, which is
the onset of degenerative illnesses such as hypertension, diabetes mellitus,
dyslipidemia, coronary heart disease, stroke, cancer, and others.
Based on the above explanation, the obesity is an imbalance of food intake
compared with expenditure of energy by the body as a result of food
consumption that far exceeds its needs.
B. Type - Type of Obesity

Type in obesity can be divided into two classifications, ie the type of obesity is
based on the condition of the cell and the type of obesity based on body fat
distribution. Under the conditions of his cell, obesity can be classified in several
types (Purwati, 2001), namely:
a. Hyperplastic mode, is obesity that occurs because of the number of cells more
than normal, but the size of the cells in accordance with the size of normal cells
occurs in childhood. Efforts to lose weight to normal conditions in childhood will
be more difficult.
b. Hypertrophic mode, overweight occurs because the cell size larger than the
size of a normal cell. This type of obesity occurs in adulthood and attempts to
lose weight will be easier when compared with hyperplastic type.
c. Type Hyperplastic and hypertrophic obesity this type occurs because of the
number and size of cells than normal. This type of obesity begins in childhood children and continue until as an adult. Attempts to lose weight on this type is
the most difficult, because it can be at risk of disease complications, such as
degenerative diseases.
Based on the fat distribution in the body, there are three types of obesity,
namely:
a. Types of apples (Adroid), this type of growth characterized by excess fat upper
body section which is around the chest, shoulders, neck, and face. This type is
generally experienced by men and women who are menopausal. Fat accumulates
is saturated fat.
b. Type pear (genoid), this type have fat deposits on the bottom, which is around
the abdomen, hips, thighs, and buttocks. This type suffered by women. Type
hoard fat is unsaturated fat.
c. Type ovid (a box of fruit), the type is large in all parts of the body. Ovid types
commonly found in people who are genetically obese.
C. Etiology Obesity
a. Genetic: Children of obese parents tend to be 3-8 times become obese than
parents of normal weight, even though they were not raised by biological
parents.
b. Environment: Influence the family, for example, the use of food as a reward,
not allowed to eat dessert before the plate all the food runs out. Helping
developing eating habits that can lead to obesity.
c. Psychology: Overeating may occur in response to loneliness, grief or
depression, may be a response to external stimuli.
d. Physiology: Energy issued decreases with age, and this often leads to weight
gain in middle age.
The primary etiologic factor underlying cause of obesity is an excessive calorie
consumption of the energy required (Coutney Mary Moore, 1994).
Several studies have been conducted to determine the cause of obesity.
Scientifically obesity occurs due to excess intake of food or energy in the body.
The cause of an imbalance between caloric intake and burning are still unclear,
but this situation is accompanied by a variety of factors that can be avoided to
avoid obesity. Various studies have shown that obesity is influenced by the
environment 70% and 30% are influenced by genetics.

D. Symptoms of Obesity
Common symptoms experienced by someone who is obese, among others:
a. The habit of sleeping with snoring, the accumulation of fat in the neck also
lead a person to snore.
b. Shortness of breath, the average body fat of people who will feel his breath
heavier. Excessive accumulation of fat below the diaphragm and in the chest wall
can suppress the lungs, causing breathing problems and shortness of breath.
c. Sleep apnea, respiratory problems may occur during sleep and cause a
temporary cessation of breathing (sleep apnea), so that during the day people
often feel sleepy.
d. Often feel sleepy and tired
e. Pain in the knee joints, overweight due to factors that may increase the
burden or pressure on the knees and ankles.
f. Lower back pain (low back pain) and usually aggravate osteoarthritis, a lot of
obese people will complain of backache. This is due to the addition of spinal load
by fat accumulation. Risk of fatal if the weight does not go down, the spine may
increase the risk of fractures from within.
g. Easy depression, more easily depressed mind because of her physical
condition.
h. Rashes or infections of the skin folds, people with obesity are more likely to
have dark skin and skin folds occurs. Susceptible to fungal and bacterial
infections in the skin with signs of a rash.
i. Sweating excessively, a person who is obese has a body surface that is
relatively narrow compared to the weight, so that body heat can not be removed
efficiently and sweat more.
E. Classification of Obesity
International classification for the degree of obesity is determined by the Body
Mass Index (BMI) as shown in Table 2.1. Body Mass Index (BMI) is a mathematical
formula related to body fat adults, and is expressed as weight in kilograms
divided by height squared in size meter (Arisman, 2007).
The formula determines the BMI: BMI = BB
TB
The degree of overweight and obesity definition allows comparison of prevalence
internationally. Other anthropometric sizes based on the circumference of the
body are also used in this field. One such measure is the ratio of waist
circumference to the circumference of the pelvis (waist hip ratio). WHR is more
an indicator of fat distribution than the total amount of body fat as in table 2.1
Table 2.1 Definition of categories of body mass index (BMI) and a circumference
perutb
Classification
BMI (kg / m2)
Less weight (underweight)
<18.5

Normal weight (normal weight)

18.5 to 24.9
Weight (overweight) moderate
25.0 to 29.9
Weight (overweight)
25
Preobese
25 to 29.9
obesity
30
Obese class I
30 to 34.9
Obese class II
35 to 39.9
Obese class III
40
circle Waist
Classification
Man
female
Above the action level 1
80 cm (~ 32 inches)
94 cm (~ 37 inches)
Above the action level 2
88 cm (~ 35 inches)
100 cm (~ 40 inches)
aKategori IMT didefinisikann according to WHO guidelines.
bKategori waistlines proposed by Lean et al
Overweight or overweight and obesity are different things that can be seen
through the number of IMT. According to the WHO standard categories,
overweight if the BMI is 25 to 29, while obese with a BMI of 30 and over. While
restrictions overweight and obesity in Indonesia by Riskesdas in 2010 for the
overweight with a BMI of 25 to 27, while a BMI of 27 is classified as obese.

Obesity can be determined by measuring the amount of fat around the body
using impedance instrument or measuring fat thickness in certain places using a
caliper. Besides fat around the belly can be measured using the meter.
Excess accumulation of fat above 20% of ideal body weight, will cause health
problems to malfunction of organs (Misnadierly, 2007).
Relative Weight = Weight x 100%
Height - 100
Keteragan:
90% - 110%: normal 120% - 130%: mild obesity
<90%: less than the normal 130% - 140%: moderate obesity
110% - 120%: more than normal> 140%: severe obesity
Obesity is usually defined as the excess weight is more than 120% of ideal body
weight (BBI) or desired weight. There are 4 levels of obesity by:
a. Simple obesity (mild obesity), is obesity due to excess body weight as much as
20% of ideal weight and without diabetes mellitus, hypertension, and
hyperlipidemia.
b. Mild obesity, an obesity due to excess body weight between 20-30% of the
ideal weight has not been accompanied by a specific disease, but had to watch.
c. Moderate obesity, the obesity due to excess body weight between 30-60% of
the calculated ideal weight. At this level people including high risk for certain
diseases associated with obesity.
d. Morbid obesity, an obesity due to excess body weight of ideal weight more
than 60% with a very high risk to respiratory disease, heart failure, and sudden
death.
While being overweight or obese by the age of obesity in infancy (infancy-onset
obesity), childhood (childhood-onset obesity), and adulthood (adult-onset
obesity), and the future elderly.
a. Overweight in infancy that needs to be avoided. The results showed the
number of babies who suffer from obesity in the first six months of age were
more than a third of becoming obese in adulthood. Factors causing obesity in
infants, among others; descent, maternal obesity, maternal weight gain during
pregnancy is excessive maternal obesity disease / prediabetes /. In a recent
research can be revealed that early age obesity can increase the risk of heart
disease and diabetes later in life, especially in girls. It turned out that a study
showed that babies of women who were obese (too fat) tend to have a waist
circumference larger, high insulin levels and triglycerides (a type of fat that is
normally found in the blood), as well as cholesterol levels good "HDL" very low.
Dr. Haslam, a doctor who is also member of ESCO (Experts in Severe and
Complex Obesity) said that to address the problem of obesity in infants from
pregnant women should keep eating well.
b. Obesity in childhood caused by wrong eating behavior and lack of physical
activity. Excess fat that arise between the two years until the age of adolescence
(puberty). Overweight to this period are a result of the wrong diet or unhealthy
and lack of physical movement that could sustain fat burning in the body, that
era has a sophisticated and versatile fashionable who created the whole activity
is getting easier will cause the child to lazy to do physical movement, and the
lack of guidance and support for the elderly on the health of children. In case of

obesity in children of course this is the parent's responsibility to maintain and

regulate a child's eating properly, a lot of problems to be faced by the child if he
is overweight or obese. In general obesity in children at higher risk of developing
obesity. Childhood obesity also affect other organs such as the airway during
sleep disturbed by snoring, bones support the body weight, and can cause
feelings of inferiority. The most severe heart complications. In addition, children
at risk of diabetes as well as genetic factors.
c. Obesity in adulthood, these groups often found than obesity that occurs in
childhood. Excessive body fat starts to accumulate most often between 20-30
years old at the time someone starts a busy career. Because of busy-busy life
leads to a lack of time to carry out the sport, so if inadvertently started staking
obesity at this age (Wirakusumah, 1994). Adults who have busy schedules make
them rare and do not have time to exercise, and it caused the accumulation of
fat, and if this is consistent left so that diseases such as heart disease, stroke,
diabetes, cancer, etc. are at greater risk of severe and lead to sudden death.
d. Obesity in older age, is true if the dangers of obesity will increase with age
person. Even so, some experts say if the BMI measurement is considered less
appropriate for detecting obesity in the elderly. Recommended if diagnosing
should use the waist and hip circumference. This is due to changes in the size
and shape of the body that is significant in the elderly. The benchmark used is a
person said to be obese if the waist circumference exceeds 80 cm (for women)
and 90 cm (for men). When it occurs in those who are elderly, obesity can bring
a lot of problems that could threaten the quality of life. Some trends danger is as
follows:
a) Diabetes: Insulin Work can be interrupted by the body's fat tissues located
inside the abdominal cavity. This has resulted in elderly people with obesity may
increase the risk of type 2 diabetes mellitus.
b) Hypertension: Elderly people who have excess weight tend to be difficult to
move. Even obesity in elderly heart patients just need extra energy to work. This
is what can cause high blood pressure can occur in obese people.
c) Atherosclerosis: Narrowing of blood vessels is another name for illness caused
by obesity in the elderly this one. It occurs when cholesterol and fat in the
arteries accumulate a lot of which can cause sudden heart attack and stroke.
d) Cancer: Obesity in elderly female pairs can trigger a higher risk of breast
cancer, 37% higher than those who had normal weight. As for men, obesity can
also cause prostate cancer if the fat tissue has reached the organ reporduksi
The high obesity at age> 25 years, including the elderly, as we age due to be
some changes in the body, the body's metabolism decreases, and increased fat
in the body. The consequence may increase the risk of mortality and morbidity
resulting from degenerative diseases, and lower life expectancy.
F. Factors Affecting Obesity
The imbalance between caloric intake and consumption can be attributed to
many factors: factors that lead to obesity are directly and indirectly. Factors that
lead directly among other things:
a. genetic
The definition of genetic factors are heredity originating from their parents. The

influence of these factors actually not too clear as the cause of obesity. However,
there is some evidence to suggest that genetic factors are reinforcing factors of
obesity (Purwati, 2001). According to research, children of parents who have
normal weight turned out to have a 10% risk of obesity. When one parent
suffering from obesity, the odds increased to 40-50%. And if both parents are
obese, the chances of heredity to 70-80% (Purwati, 2001).
b. hormonal
In women who have undergone menopause, thyroid hormone function in the
body will decrease. Therefore, the ability to use energy will be reduced.
Moreover, at this age also decreased basal metabolism of the body, so it has a
tendency to gain weight (Wirakusumah, 1997).
In addition to insulin hormone thyroid hormone can also cause obesity. This is
because the hormone insulin has a role in channeling energy into the cells of the
body. People who experience an increase in the hormone insulin, the fat deposits
in the body will increase. Other hormones that influence the leptin hormone
produced by the pituitary gland, the hormone because it functions as a regulator
of metabolism and appetite and abnormal function of the hypothalamus, which
causes hiperfagia (Purwati, 2001).
c. food intake
Food intake is the amount of food consumed by a person. Excessive energy
intake is chronically will lead to weight gain, weight (overweight), and obesity.
There are three things that affect food intake, ie eating habits, knowledge and
availability of food in the family.
Recommended dietary nutritional adequacy according Allowanie (RDA) of 1989 is
the amount of nutrients that should be met from food covering virtually all
healthy people. Nutritional adequacy was influenced by age, gender, activity,
weight, height, genetic, and pregnant and breast-feeding. The recommended
dietary allowance different nutritional needs (Naidoo, 1996).
Especially macro-nutrients that cause obesity if eaten in excess, these nutrients
will be stored as body fat and will increase the overall weight. The macro nutrient
can affect weight gain if consumed in excessive amounts, among others:
a) Carbohydrates are an important role in nature because it is the main energy
source for humans and animals which is relatively cheap. All carbohydrates
derived from plants. The primary function of carbohydrates is the energy source
of food flavoring sweet, saving protein, regulate fat metabolism, aids in the
excretion of feces (altemaster, 2003). In a balanced diet, it is recommended 5060% of the calories come from carbohydrates, the primary uses for energy. Other
uses as an energy reserve, a component of cell structure, and a source of fiber
(Sayogo, 2006).
b) Proteins are macro molecules and the biggest part after water. Proteins consist
of long chains of amino acids that are bound to one another in peptide bond. This
protein has a specific function that is not replaceable by other substances,
namely to build and maintain the cells and tissues of the body. The protein needs
of adolescents ranged between 44-59 g / day. Depending on gender and age.
Protein also supplies about 12-14% of energy intake during childhood and
adolescence (Suandi, 2003).
c) Fat is one of the macro nutrient which serves as a source of energy, fat also

produces 9 cal / g her, as a lubricant that helps expenditure remains of digestion

and metabolism, maintaining body temperature and protector vital organs. MOH
recommends to consume the fat is less than 25% total energy per day (Sayogo,
2006).
d. Environmental factor
Gene is an important factor in many cases of obesity, but a person's
environment also plays a significant role. This environment includes behavior or
lifestyle patterns (eg what to eat and how many times a person eats and how
their activities). Someone certainly can not change their genetic pattern, but he
can change eating and activity patterns.
e. physical activity
Obesity can occur not only because of excessive eating, but also due to reduced
physical activity so that an excess of energy, namely lifestyle patterns without a
lot of moves. Some things that affect the reduced physical activity among these
various facilities and technological advances that provide various facilities which
led to decreased physical activity. People who are not actively require fewer
calories. Someone who tends to consume foods rich in fat and physical activity
are balanced, will be obese.
f. Factors drugs
Certain medications (such as steroids and some anti-depressants) can cause
weight gain.
g. psychological factors
What was in the mind of a person can affect eating habits. Many people reacted
to his emotions by eating. One form of emotional distress is a negative selfperception.
h. factors developments
Increasing the size or number of fat cells (or both) will increase the amount of fat
stored in the body. Obese people, especially those who became obese in
childhood, can have the fat cells to 5 times more than people of normal weight.
The number of fat cells can not be reduced, because the weight loss can only be
accomplished by reducing the amount of fat in each cell.
The factors that cause obesity indirectly among other things:
a. science of nutrition
Knowledge of nutrition plays an important role in using food properly so as to
achieve a state of adequate nutrition. Knowledge mother influenced by his
upbringing. Level of education, knowledge and skills possessed greatly affect a
person's knowledge. Armed with enough education, a person will be more
information in determining the diet for themselves and their families. Knowledge
is not only acquired through formal education, but also of other people's
information, the mass media or from the experience of others.
b. setting Spot
Nutritionally balanced dishes are foods that contain nutrients power, builder
substances, and regulatory substances consumed by a person in one day
according to the adequacy of the body (the Ministry of Health, 1996).
Factors foods that contain a lot of fat is also a factor. Some of the causes that
make a person eat more than necessities such as overeating, snacking habits

snacks, and like to eat in a hurry.

G. Risk of Obesity
Obesity can increase the risk of some diseases. Here are the risks of disease or
disorder for someone affected by obesity include:
a. Disorders of the heart and blood vessels
Coronary heart disease is a disease caused by narrowing of the coronary
arteries. The study says that of the 500 patients with obesity, about 88% got the
risk of coronary heart disease. Increased risk factors for coronary heart disease
in line with the person's weight gain. Other studies also show obesity that occurs
at age 20-40 years was influential greater occurrence of heart disease than
obesity that occurs in older age (Purwati, 2010). Obesity is a cause of heart
disease and blood vessel (cardiovascular).