REFERAT

Obesity in Children
Preceptor:
dr. Pulung M Silalahi, Sp.A
Presenter:
Fitria Nurulfath
(1102010105)
Pediatric Department
Raden Said Soekanto Hospital
Yarsi Medical University
Periode August 3rd October 11th 2015

Definition
Definition of obesity varies depending on the source of the
information obtained.
In Dorland Medical Dictionary states that obesity is an increase
in body weight exceeds the limits of the physical needs of order
and, as a result of excessive fat accumulation in the body.

The most common obesity criteria determined based on

anthropometric data. Anthropometric measurements following
three methods can be used in the determination of obesity.
Weight / height above the 90th percentile or 120% above
ideal body weight. Weight greater than 140% is defined as
super obese.
Body mass index (BMI) is calculated by weight in kilograms
divided by height in meters squared, if the value of the child's
BMI is greater equal to the 95th percentile then included
into obesity.

 Measurement of subcutaneous fat by measuring the

thickness of skin folds (TLK) above the 85th percentile is
an indicator of obesity. Thick folds of skin can be measured on
the biceps, triceps, subscapular, and suprailiaca.

Epidemiology
Adult obesity in children is a global problem which is found not
only in developed countries but many are also found in
developing countries. According to epidemiological studies, the
prevalence of obesity in children increases every year.
According to data from the year 2010 RISKESDAS mentioned
the prevalence of overweight and obesity in children 6-12
years of age is of 9.2%. Other studies mentioned an increase in
the prevalence of overweight and obesity has doubled every
year, especially at the age of school children.

In 2010 the prevalence of obesity nationally in Indonesia was

14.0 percent. There is an increased prevalence of obesity, namely
from 12.2 percent in 2007 to 14.0 percent in 2010. Twelve
provinces have obesity problems above the national average. The
order to 12 provinces of the prevalence highest to lowest are: (1)
Jakarta, (2) North Sumatra, (3) Southeast Sulawesi, (4) Bali, (5)
East Java, 6) South Sumatra, (7) Lampung, (8) Aceh, (9) Riau (10)
Bengkulu, (11) West Papua and (12) of West Java.

Etiology and Risk Factor

90% of obesity cases are
caused by idiopathic
factors
or
primary
obesity or nutritional,
while 10% of cases are
caused by endogenous
factors or secondary
obesity
or
non
nutritional, which is
caused by the hormonal
abnormalities, or genetic
syndromes.

genetic factors
Idiopathic obesity
caused by the interaction
of multifactorial. In
general divided by two:
environmental factors

Genetic factors are known to play a major role is

parental fatness, obese children usually come from
families with obesity. If one parent is obese, the
prevalence was 40%. And if both parents are not obese,
the prevalence dropped to 14%.

Environmental Factors

Nutritional

Physical
activity

Medications
(steroids)

Trauma
(neurological or
psychological)

Socio-economic

Penyebab endogen obesitas pada anak (ganggguan

hormonal)
Penyebab hormonal

Bukti diagnostik

Hipotiroidism

Kadar TSH , kadar thyroxine

Hiperkortisolism

Uji supresi deksametason abnormal;

Kadar kortisol bebas urin 24 jam

Hiperinsullinisme primer

Kadar insulin plasma , kadar C-peptide

Pseudohipoparatiroidism

Hipokalsemia, hiperfosfatemia, kadar PTH

Lesi hipotalamus didapat

Adanya tumor, infeksi, sindrom, trauma,

lesi vaskualar hipotalamus.

Penyebab endogen obesitas pada anak (sindrom genetik)

Sindrom genetik

Karakteristik klinis

Prader-Willi

Obesitas, hiperfagia, retardasi mental,

hipogonadism, strabismus

Laurence Moon/Bardet-Bield

Obestias, retardasi mental, retinopati

pigmentosa, hipogonadism, paraplegia
spastik

Alstrom

Obesitas, retinitis pigmentosa, tuli, diabetes

melitus

Borjeson-Forssman-Lehmann

Obesitas, retardasi mental, hipogonadism,

hipermetabolisme, epilepsi

Cohen

Obesitas trunkal, retardasi mental,

hipotonia, hipogonadism

Turner

Perawakan pendek, ambiguous genitalia,

kelainan jantung bawaan, webbed neck,
obesitas, genotipe 45,XO

Pathophysiology
1. Obesity and energy
balance
2. Obesity and
adipocytes
disorders

Clinical Manifestation
Obesity physical shape distinguished according to fat distribution
in the apple shaped body or android when more fat in the upper
body and a pear-shaped body or gynoid if more fat is distributed
in the lower part of the body (hips and thighs). The middle is an
intermediate form. Apple body shape tend to be more likely to
develop cardiovascular disease, hypertension and diabetes.

Obesity is clinically apparent at any age, but most often

at the age of 1 year, 5-6 years and adolescence.
Signs and symptoms typical of obesity are :

face that is
rounded

the cheeks are

chubby

double chin

the neck is
relatively short

chest out

enlarged breasts
due to fat
tissue

belly bulge with

abdominal wall
many times

striae are white

or purple

Great limb in both

the thigh or upper
arm

the fingers are

relatively small

generally X-shaped
legs

both attached to the inner

thigh and rub together,
causing lacerations and
ulcerations that cause bad
odors

buried penis

Diagnosis
When a child is present with obesity, it is necessary to
ascertain whether the criteria are met clinically obese
and anthropometric.
Further worth exploring risk factors for obesity and
the impact that might occur.
Diet and physical activity is important to explore.

Treatment
In general, treatment of obesity is divided into lifestyle
modification and intensive therapy.
Lifestyle modification should be sustained before choosing the
intensive therapy. Lifestyle modifications include diet, increasing
physical activity, behavior modification and the most important is
the support and involvement of the family.

Dietary
A balanced diet with a composition of 50-60%
carbohydrate, 30% fat, and 15-20% protein
sufficient for normal growth and development. Highfiber diet can help weight control through the effects of
fiber can reduce hunger, filling and decrease fat storage.

Broadly speaking, the principles of the diet are:

1. Avoiding obesity and maintaining normal growth.
2. Put a low-carbohydrate diet (48% of total energy).
3. Reduce fat intake (<30% of total energy), saturated fat (10% of
total energy), as well as cholesterol <300 mg / day.
4. Increase high-fiber foods.
5. Foods with enough salt content (5 grams / day).
6. Increase the input of iron, calcium and fluorine.

Physical activity
Physical exercise is needed to aid
in weight loss and redistribution
of body fat into muscle mass.
Training provided must be small
and then gradually increased, to
avoid fear and rejection of the
child. The best achievement is 2030 minutes of moderate activity
per day, regardless of physical
activity in school children.

Behavior modification
1. Control intake, body weight, physical activity
and development.
2. Control stimulus, such as avoiding all foods
when children watch television.
3. Changing eating behavior, such as eating fast
becoming eat more slowly, portion control, control
the intake of snacks.
4. The award, praise and encouragement when
children succeed.
5. Self-control

Complications
Obstructive
sleep
apneu (OSA)
Non alcoholic fatty
liver
diseasae
(NAFLD)
Orthopedic disorders;
Torsi tibial, flat foot,
tibia
vara
(blount
disease),
scoliosis,
osteoartritis

Preventions