Obesity is a significant and growing public health issue that has been characterized by the World Health

Organization (WHO) as a “global epidemic”. While obesity has been a challenge in high-income countries
for some time, it is now prevalent in a growing number of lower-income countries. Approximately 1.4
billion people are overweight, of which about 500 million are obese. Rates of childhood obesity and
overweight in particular have risen dramatically in recent decades – over 32 million overweight children
are living in lower-income countries, compared to 10 million in high-income countries.

Obesity is a major risk factor for cardiovascular diseases (e.g., heart disease and stroke), diabetes,
musculoskeletal disorders and some cancers. At least 2.8 million adults are estimated to die annually due
to being overweight and obese, making these the fifth leading risk for death globally. Obesity also has
significant societal implications; in the United States alone, $190 billion in additional annual medical
spending (or 21% of total U.S. medical expenditures) is attributed to obesity. Obesity and diet-related
chronic diseases are largely preventable, but the complex systemic factors causing them present a
significant challenge to developing effective solutions.

Obesity is caused by calories consumed in excess of calories expended. Calories consumed have
increased among many people due to increased consumption of energy-dense foods, which tend to be
high in fat and sugar. At the same time, calories expended have decreased among many people due to
the increasingly sedentary lifestyle allowed by advances in technology and transportation (particularly in
the context of urban environments not conducive to active lifestyles). No longer a problem restricted to
high-income countries, similar trends are observed in lower-income countries as they undergo a
“nutrition transition” driven by an increase in consumption of animal-source foods, edible oils,
processed foods and sugar-sweetened drinks, as well as shifts in population from rural to urban settings.

Poor diets are not only a risk factor for obesity, but for other chronic diseases as well. For example, high
dietary fat intake is a risk factor for the development of high blood lipid levels and high dietary salt intake
is a risk factor for the development of high blood pressure. In turn, high blood lipid levels and high blood
pressure are significant risk factors for heart attacks, heart failure, strokes and kidney disease, which
together account for 12% of global disability-adjusted life years.

Sumber : https://www.accesstonutrition.org/obesity-and-diet-related-chronic-diseases

Etiology of Obesity:

1. Genetic factors

Heritability of BMI is about 66%. Genetic factors may affect the many signaling molecules and receptors
used by parts of the hypothalamus and GI tract to regulate food intake (see sidebar Pathways Regulating
Food Intake). Genetic factors can be inherited or result from conditions in utero (called genetic
imprinting). Rarely, obesity results from abnormal levels of peptides that regulate food intake (eg, leptin)
or abnormalities in their receptors (eg, melanocortin-4 receptor).
2. Environmental factors

Weight is gained when caloric intake exceeds energy needs. Important determinants of energy intake
include

- Portion sizes

- The energy density of the food

High-calorie foods (eg, processed foods), diets high in refined carbohydrates, and consumption of soft
drinks, fruit juices, and alcohol promote weight gain. Diets high in fresh fruit and vegetables, fiber,
complex carbohydrates, and lean proteins, with water as the main fluid consumed, minimize weight gain

3. Eating disorders

At least 2 pathologic eating patterns may be associated with obesity:

Binge eating disorder is consumption of large amounts of food quickly with a subjective sense of loss of
control during the binge and distress after it. This disorder does not include compensatory behaviors,
such as vomiting. Binge eating disorder occurs in about 3.5% of women and 2% of men during their
lifetime and in about 10 to 20% of people entering weight reduction programs. Obesity is usually severe,
large amounts of weight are frequently gained or lost, and pronounced psychologic disturbances are
present.

Night-eating syndrome consists of morning anorexia, evening hyperphagia, and insomnia, with eating in
the middle of the night. At least 25 to 50% of daily intake occurs after the evening meal. About 10% of
people seeking treatment for severe obesity may have this disorder. Rarely, a similar disorder is induced
by use of a hypnotic such as zolpidem.

Similar but less extreme patterns probably contribute to excess weight gain in more people. For example,
eating after the evening meal contributes to excess weight gain in many people who do not have night-
eating syndrome.

Sumber : https://www.msdmanuals.com/professional/nutritional-disorders/obesity-and-the-metabolic-
syndrome/obesity

Health Risks of Obesity

If you are overweight or obese, you may be at risk for a wide range of serious diseases and conditions
including:
hypertension or high blood pressure, coronary heart disease, Type 2 diabetes, stroke, gallbladder
disease, osteoarthritis, sleep apnea and other breathing problems, some cancers such as breast, colon
and endometrial cancer and mental health problems, such as low self-esteem and depression.

Obesity is one of the leading factors in heart disease and stroke, as well as in Type 2 diabetes, which
affects an estimated 1.8 million Canadians. If you are overweight, you are at high risk of becoming obese,
which can more seriously affect your health.

Basic dietary guidelines for Overweight and Obesity

1. LIMIT FAT INTAKE

An excessive intake of foods that are high in fat can lead to weight gain and the development of obesity.
Fat in food is not always easy to detect. In some foods, fat is clearly visible such as oil floating over soups,
curries and the glittering coating of fried foods. However, in other foods like nuts, pastries, cakes and
kuehs, fat is well blended into the entire food and these are usually the hidden sources of fat.

- Limit deep fried foods to 1-2 times a week.

- Use less oil for stir frying.

- Replace full cream milk with low fat or skim milk.

- Skim off the top layer of oil/fat over soup and gravy before taking.

- Select lean meat or poultry without skin.

- Replace a meat pie with a chicken sandwich but to limit the amount of dressings used.

2. REDUCE PORTION SIZES

Eating smaller portions is a simple way to cut back on fat and calorie intake.

- Take smaller portions during meal time i.e. do not upsize your meal.

- Share your foods with friends or family.

- Eat slowly, chew food well and enjoy every bite.

3. MODERATE YOUR SUGAR INTAKE

Sugar and sugary products are high in calories and can be high in fat as well. Hence, minimal amount
should be consumed.
- Cut down snacks that are high in sugar content such as jellies, icecream, chocolates and cake.

- Ask for less sugar and syrup. Artificial sweetener like aspartame or saccharine can be used as a
substitute for regular sugar.

- Choose diet soft drinks or less sugar beverages over regular soft drinks and sweetened beverages.

4. INCREASE FIBRE INTAKE

Fibre-rich foods not only contain various nutrients but also help to satisfy hunger. Adequate intake of
fluids is recommended to prevent constipation when on a fibre-rich diet.

- Choose wholegrain bread or high fibre white bread.

- Try to eat the edible skin of fruits whenever possible.

- Eat fresh fruits instead of drinking fruit juice.

- Add beans and lentils when cooking.

5. MODERATE ALCOHOL INTAKE

Alcohol is high in calories and has no nutritional value. It is recommended to avoid alcohol if you have
high blood triglycerides level, kidney disease or heart disease.

- If you choose to drink, take in moderation i.e. not more than 1 standard drink per day (e.g. 100 ml wine
= 1 standard drink).

- Use sugar-free sodas or water for mixing your drinks and cocktails.

Sumber : https://www.ttsh.com.sg/nutrition/Healthy-Eating-for-Overweight-and-Obesity/