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GANGGUAN AKIBAT KELEBIHAN ASUPAN ENERGIIfiq Budiyan Nazar, dr.Patologi Manusia DasarEnergy BalanceState in which energy intake, in the form of food and /or alcohol, matches the energy expended, primarily through basal metabolism and physical activityPositive energy balanceEnergy intake > energy expendedResults in weight gainNegative energy balanceEnergy intake < energy expendedResults in weight loss

Energy Balance

Fat StorageFATMost fat is stored directly into adipose tissueBody has unlimited ability to store fat (as fat)

CARBOHYDRATESLimited CHO can be stored as glycogenMost CHO is used as a energy sourceExcessive CHO will be synthesized into fat (for storage) Protein and Fat StorageProtein is primarily used for tissue synthesisAdults generally consume more protein than needed for tissue synthesisExcess protein is used as a energy sourceSome protein will be synthesized into fat (for storage)Macronutrients and Fat StorageBody prefers to use CHO as energy sourceOnly excess intake of CHO and protein will be turned into fatFat will remain as fat for storage Physical activity encourages the burning of dietary fatBeta-oxidationMost endurance athletes burn fatty acids for energyglycogen is used also

Body Mass Index (BMI)The preferred weight-for-height standard Calculation:Body wt (in kg) OR Body wt (in lbs) x 703.1 [Ht (in m)]2 [Ht (in inches)]2

Health risks increase when BMI is > 25 ObesityExcessive amount of body fatWomen with > 30-35% body fatMen with > 25% body fatIncreased risk for health problems Are usually overweightMeasurements using calipers

Body Fat DistributionUpper-body (android) obesity--Apple shapeAssociated with more heart disease, HTN, Type II DiabetesAbdominal fat is released right into the liverFat affects livers ability to clear insulin and lipoproteinEncouraged by testosterone and excessive alcohol intakeDefined as waist to hip ratio of >1.0 in men and >0.8 in womenBody Fat Distribution

Body Fat DistributionLower-body (gynecoid) obesity--Pear shapeEncouraged by estrogen and progesteroneLess health risk than upper-body obesity

After menopauseupper-body obesity appears

Overweight and ObesityUnderweight = BMI < 18.5Healthy weight = BMI 18.5-24.9Overweight = BMI 25-29.9Obese = BMI 30-39.9Severely obese = BMI >40Juvenile-Onset ObesityDevelops in infancy or childhoodIncrease in the number of adipose cellsAdipose cells have long life span and need to store fatMakes it difficult to loose the fat (weight loss)

Causespoor dietary patternslack of physical activity

43% of adolescents watch 2 hours or more of TV/dayAdult-Onset ObesityDevelops in adulthoodFewer (number of) adipose cellsThese adipose cells are larger (stores excess amount of fat)If weight gain continues, the number of adipose cells can increase

Causes of ObesitySet Point Theory Genetics If both parents are obese, then 80% risk that children are obese.If neither parent is obese, then risk is less than 10%Twin studies Identical twins are more likely to weigh the same as fraternal twins even when reared apart.Food intake, tastes, BMR, number of fat cells, enzymes all may be influenced by genetics.Anthropologists have hypothesized are bodies are adapted to storing fat due to times of famine.Causes of Obesity (Continued)Lipoprotein Lipase Enzyme which promotes fat storage in fat cells and muscle cells.Leptin Hormone which influences appetite and energy balance. It increases satiety and energy. Ob gene has been found to code for leptin.Peptide PYYEnvironmental StimuliLearned BehaviorPhysical InactivityEnvironmentOvereatingToxic food environmentIncreased dietary variety. Studies have shown that more than one flavor encourages people to eat.Soft drink consumption. Drinking calories does not reduce hunger.Growing portion sizes. Adults (and children) eat more when served larger portions.Environment (Continued)Too delicious. Some research suggests that delicious foods may cause the body to feel hungry sooner.Snacking. People now eat about 1.5 snacks a day compared to 1, in the 70s and 80s. Snacks have more calories too (80 calories from an apple to a 250 calorie candy bar).Eating out. People who eat at least 13 times a month, consume an average of 32% more calories than those who eat out 5 or fewer times per month.

EnvironmentPhysical InactivityActivity can actually curb appetite and help people stay motivated to continue exercise.Life requires less exertion.Television.

Environmental factorsFood optionsIncreased cost of healthy foodsJunk foods cheap and easily availableBigger portion size

Physical activitySchool transportIncreased TV time

Aggressive Treatments of ObesityDrugsDiureticsAppetite Suppressor (Uptake serotonin inhibitor, pancreatic lipase inhibitor) herbal supplementsVery Low Kilocalorie DietsSurgeryStomach staplingGastric Bypass

Why Diets Dont WorkObesity is a chronic diseaseTreatment requires long-term lifestyle changesDieters are misdirectedMore concerned about weight loss than healthy lifestyleUnrealistic weight expectations

Why Diets Dont WorkBody defends itself against weight lossThyroid hormone concentrations (BMR) drop during weight loss and make it more difficult to lose weightActivity of lipoprotein lipase increases making it more efficient at taking up fat for storageLifestyle Vs. Weight LossPrevention of obesity is easier than curingBalance energy in(take) with energy out(put)Focus on improving food habitsFocus on increase physical activities

Regular Physical ActivityFat use is enhanced with regular physical activityIncreases energy expenditureDuration and regularity are importantMake it a part of a daily routine