Pi Sunyer, 2009

Principle of
Obesity Management
WHO guideline
• Diet, exercise, and behavioral
modification should be included in all
obesity management approaches for
body mass index (BMI) of 25 kg/m2 or
higher.

• Pharmacotherapy for BMI of 27 kg/m2

or higher with comorbidity or BMI
over 30 kg/m2.

• Bariatric surgery for BMI of 35 kg/m2

with comorbidity or BMI over 40
kg/m2, should be used as adjuncts to
behavioral modification to reduce
food intake and increase physical
activity when this is possible.
BODY MASS INDEKS
Height Measurement
 The purpose of weight loss program
• Aesthetic
• Personal demand
• Comfort
• Disease risk control
• Disease therapy
 Dietary Intake Analysis
• Quantitative:
– 24 h recall.
– Repeated 24 h recall.
• Qualitative:
– Food frequency Questionnaire (FFQ)
• Mix:
– Semiquantitative FFQ
– Dietary History
 Dietary Intake Analysis

Foods and Serving How

Time beverages size prepared Where Comments
 Analyse Food composition content
Next Steps ... and weight:
– Ukuran rumah tangga.
– Berat/volume makanan.
Analyze:
Software/Nutrisurvey Program
Manual Analysis:
– Analyse based on Indonesian food
compositionn table, or
– Resep dasar makanan Indonesia,
or
– Analyze food processing (convert
to another software food analysis
based on food processing)
– Observation to local cafe/food
street, or
– Analyze nutrition fact from
labelled food
 Simple Steps
– Dietary recall.
• Quantity.
• Frequency
• Main course/between meal
• Energy density
– Weekday & weekend habit.

– Monitoring and Evaluation: Food diary.

 Reduce step by step

Another Diagnosis Tool:
Body Composition Analysis
Laboratory and Clinical Assessment
• Laboratory assessment: • Clinical asessment: • Another:
– Based on underlying – Underlying – Physical
disease. disease. activity
– Renal function – Disease risk – Food
– Liver function – Disease alergy/intolera
– Blood glucose complication nce
– Lipid profile – Nutrient – Religion.
– Hematology
deficient – Culture
– Drug interaction – Another
environment
limitation
 Nutritional
Intervention
• Dietary intervention:
– Regular dietary intake:
• Breakfast/Lunch/Dinner
• Low calorie Between
meal snack
– Adequate protein intake
– Low fat food sources
– Adequate micronutrient
food sources
– Increase fiber intake
– Adequate non-caloric
drink.
 Go slow
 Specific Nutrient
• Antiinflamation effect:
– Balance energy and protein.
– Minimize saturated fatty acid.
– Functional food:
• Vitamin A,C,E.
• Polyphenol: green tea, fruit, vegetable.
– Minimize food processing
– Low Glycemic index
– Synbiotic
– Micronutrient supplementation.
Physical Activity for Weight Management:
More than this WHO recommendation:
• Increase physical activity:
– Frequency : more than 3x/week
– Intensity : low to moderate
– Duration : 30 – 60 minutes
 Medication:
Site of Action of Pharmacotherapy
Caution of Antiobesity Drugs
Contraindications:
• Pregnancy, breast-feeding
• Unstable cardiac disease
• Uncontrollled hypertension (SBP > 180 Hg, DBP>110 mmHg)
• Unstable severe systemic illness
• History of anorexia nervosa
• Active severe psychiatric disorder
• Other drug therapy, if incompatible
(e.g. monoamine oxidase inhibitors, antimigraine, drug, adrenergic
agents, drugs with arrhythmia potential)

Cautions :
• Presence of any severe systemic illness
• History of severe psychiatric disorder
• Other drug therapy
• Close angel glaucoma
• Age < 18 years or > 65 years
Medication
Orlistat promotes weight loss by decreasing the absorption of fat from
the gastrointestinal tract.
On average, 120 mg of orlistat taken three times per day will decrease
fat absorption by 30% .
 Effect on insulin sensitivity and blood glucose

Phentermine and diethylpropion is a sympathomimetic anorexogenic

agent.
Phentermine’s main side effects are related to its sympathomimetic
properties, including elevation in blood pressure and pulse, insomnia,
constipation and dry mouth

Metformin as peripherally acting anti diabetes drug that enhances

insulin sensitivity and has been associated with weight losses of 5-10%
of initial body weight.
Medication

Alpha cyclodextrin: Binds with dietary fat and inhibits its absorption, helps
manage weight /prevent weight gain when combined with a healthy diet
and exercise

Lorcaserin: a selective serotonin receptor agonist  treatment for obesity

for adults with a BMI ≥ 30 kg/m2 or with a BMI ≥ 27 kg/m2.
Reduces appetite by binding to the 5-HT2C receptors on anorexigenic pro-
opiomalocortin (POMC) neurons in the hypothalamus

Liraglutide: GLP-1 receptor agonist that has been used for type 2 diabetes
in doses up to 1.8 mg. In a short-term study (5 weeks) involving obese
individuals without diabetes demonstrated that liraglutide 3.0 mg/day
suppressed acute food intake, subjective hunger, and delayed gastric
emptying
As general popular diets could be based on:
 Calorie content (low calorie diet, very low calorie diet).
 Nutrient content (various composition of protein, lipid
and carbohydrate)
 Any unclassified methods that required scientific
analysis.

People are interested in popular diets because:

Easy to use, comfort, without medical supervision and
many succesfull testimonial from public figure.
 CASE STUDY
• 52 year old man:
– Obese grade 2
– WC: 110 cm.
– Vital sign: in normal limit.
– Laboratory result: in normal limit
– Sedentary activity.
 Case Study
• 40 year old woman
– Obese grade 1
– WC: 100 cm
– Vital sign: in normal limit
– Laboratory result: in normal limit
– As housewife