Obesity is a disease that can cause emotional and social problems. A person is said to be obese if his body weight reaches more than 20% of his normal weight. Obesity is a serious problem in many developing countries with a negative impact on economic growth. Along with population growth, obesity has increased for approximately 20 years along with habits, ways of consuming, and lifestyle.
According to the World Health Organization (WHO), obesity is a global epidemiological problem that poses a serious threat to world public health, with 2.8 million people dying from diabetes and heart disease as a result of obesity .
Obesity arises because the number of calories that enter through food is more than the calories burned, this situation if it lasts for years will result in the accumulation of excessive fat tissue in the body, resulting in obesity. In addition, a person's environmental conditions and heredity factors will also affect the incidence of obesity.
Poor diet will lead to the risk of obesity. The increasing availability of food has an impact on the cheaper price of food on the market so that a person's tendency to eat will increase. People can choose their own food so that it is easier to experience excess food intake and being overweight is difficult to avoid .
Light physical activity causes energy output to be low, resulting in an imbalance between energy input which is more than energy output. As a result of the lack of energy that comes out of the body, the rest of the energy will be stored as fat and then become overweight until it continues to be obese.
Productive age is more prone to obesity, which is caused by poor eating habits, frequent consumption of fast food (junk food), and lack of physical activity. High obesity at productive age will increase the risk of degenerative diseases that can result in a person's productivity decreasing, the economy declining and the morbidity rate rising. Thus, it is necessary to prevent and control the causes of degenerative diseases.
To overcome the problem of obesity can be done in various ways, which include setting goals and lifestyle changes, such as eating low-calorie foods, increasing consumption of high-protein foods, processed wheat, fruits and vegetables. Avoid foods that contain saturated fat, trans fat, cholesterol, high salt, and high sugar and increase physical activity.
Diet is a variety of information that provides an overview of the types and even amounts of food eaten by one person every day and is a characteristic of a particular community group (Sulistyoningsih, 2012). Diet is a way or effort in regulating the amount and type of food with a specific purpose such as to maintain health, nutritional status, prevent or help cure disease. A healthy diet always refers to a balanced nutrition, namely the fulfillment of all nutrients according to needs.
The diet has 3 (three) components, namely the type, frequency, and amount of food.
1. Type of Eating
Type of food is a type of staple food eaten every day consisting of staple food, animal side dishes, vegetable side dishes, vegetables and fruit consumed every day. Staple food is the main food source in Indonesia that is consumed by every person or group of people consisting of rice, corn , sago, tubers, and flour.
2. Eating Frequency
Frequency of eating is the number of times you eat in a day including breakfast, lunch, dinner and snacks. Frequency of eating is the daily amount of food both qualitatively and quantitatively, naturally food is processed in the body through the digestive organs from the mouth to the small intestine. The duration of food in the stomach depends on the nature and type of food eaten. If the average stomach is empty between 3-4 hours, then the eating schedule also adjusts to the empty stomach.
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A good and correct diet contains carbohydrates, fats, proteins, vitamins, and minerals. The pattern of eating 3 times a day is breakfast, lunch, lunch, afternoon interlude, dinner and before bed. Snacks are very necessary, especially if the portion of the main food consumed at breakfast, lunch, and dinner is not sufficient. Interludes should not be excessive because it can cause appetite when eating the main meal is reduced because it is already full by the interlude.
3. Amount of Food
The number of meals is the amount of food eaten by each person or each individual in the group. The amount and type of daily food is a way of eating an individual or group of people by consuming foods containing carbohydrates, protein, vegetables and fruit. The frequency of 3 times a day by eating interludes in the morning and afternoon to achieve adequate body nutrition, excessive eating patterns can lead to overweight or obesity in the body.
A balanced diet is a way of regulating the amount and type of food in the form of a daily diet that contains nutrients, consisting of six substances, namely carbohydrates, proteins, fats, vitamins, minerals, water and food diversity. A balanced diet is the composition of the amount of food consumed that contains balanced nutrition in the body and contains two substances, namely building blocks and regulatory substances. and fruit.
A balanced menu is a variety of foods that meet the nutritional needs in the General Guidelines for Balanced Nutrition (PUGS). Food sources of building blocks come from plant foods such as nuts, tempeh, tofu, while from animals such as eggs, fish, chicken, meat, milk and processed products such as cheese. Building substances play a role in the development of the quality of a person's level of intelligence. Food sources of regulatory substances are all vegetables and fruits that contain lots of vitamins and minerals that play a role in smoothing the function of the body's organs.
Carbohydrate intake is the amount of carbohydrate intake into the body that comes from daily food and drink by the subject as measured using a Semiquantitative food frequency questionnaire. The basic thing in the Guideline for Balanced Nutrition (PGS) is the daily consumption of food containing nutrients in types and amounts (portions) according to the needs of each person or age group.
Food consumption is the arrangement of food which is a habit that is eaten by a person in the type and amount of food that each person in a day is consumed or eaten for a certain period of time. Food consumption survey measurement is a method that can be used to determine the nutritional status of individuals or groups. The purpose of the consumption survey food is to measure the amount of food consumed at the group, household, and individual levels so that eating habits are known and the adequacy of food consumed by a person can be assessed.
Physical activity is any body movement that can increase energy or energy expenditure. Physical activity is also a basic function of human life. Since ancient times, physical activity was needed to gather food by walking around forests and rivers, running from enemies or wild animals that were about to pounce. In subsequent developments, after humans recognized the cultivation system, humans used a lot of physical activity to farm, plant rice, and garden to grow vegetables to meet food needs. In order to survive, ancient humans needed a place that provided food, moving from one place to another where there were still many sources of food. Along with the development of human civilization began to recognize the means of transportation or transportation in the form of animals such as horses that are used as a means of transportation. At the time when the means of transportation were known, the physical activity of humans to walk to a place had begun to decrease.
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According to WHO, physical activity is a body movement produced by skeletal muscles that requires energy expenditure. Physical activity that is planned, structured, repetitive and aims to maintain physical fitness. The amount of energy required to complete an activity can be measured in kilojoules (KJ) or kilocalories (KKal). Physical activity is useful for maintaining blood flow and increasing brain power by facilitating metabolism and neurotransmitters so that it can also trigger changes in brain plasticity. Physical activity is closely related to molecular cellular and neurochemical changes, but in fact there are still many people who feel lazy to do the sport.
Physical activity is any bodily movement that increases energy expenditure. To get the health benefits of physical activity should be done for 30 minutes per day (150 minutes per week) of moderate intensity.
Types of Physical Activity
Physical activity is divided into three kinds. The following is a division of the types of physical activity, namely:
1. Daily Physical Activity
Daily physical activity is a daily activity that can help burn calories obtained from the food consumed. Such as washing clothes, mopping, walking, cleaning windows, gardening, ironing, playing with children, and so on. Calories burned can be 50-200 kcal per activity.
2. Physical Exercise
Physical exercise is all forms of activity carried out in a structured and planned manner with the aim of improving physical fitness. Included in physical exercise such as walking, jogging, push ups, stretching, aerobics, cycling, and so on. Judging from the activities, physical exercise is often categorized as sports.
Sport is defined as a structured, planned, and continuous physical activity by following certain rules by following certain rules and aiming to improve physical and mental fitness to make the body fitter. Which includes sports such as football, badminton, basketball, swimming, and so on.
Benefits of Physical Activity
regular physical activity has a beneficial effect on health, namely avoiding heart disease, stroke, osteoporosis, cancer, high blood pressure, diabetes, etc., controlling body weight, more flexible muscles and stronger bones, ideal body shape. and proportionate, more confident, more energetic and fit, the overall state of health becomes better.
In addition to having good benefits for the body, physical activity is not in accordance with the impact of low levels of physical activity, according to WHO (2010) the impact of physical activity is:
1. Increase the risk of chronic disease, coronary heart disease, diabetes, hypertension, and cancer.
2. Increase the risk of metabolic disorders such as obesity and diabetes.
3. Increase the risk of mental health decline such as easy anxiety, depression, dementia in old age.
4. Affects physical performance before adolescence and adulthood. Increases the risk of impaired bone and muscle strength in the elderly.
Physical Activity Measurement
Activity measurement is divided into 4 dimensions, namely as follows:
- Mode or type It is a physical activity. (example: walking, gardening, cycling).
- Frequency Represents the number of sessions of physical activity (per day or per week) in a given context.
- Duration or time Is the length of time doing physical activity (minutes or hours) for a certain period of time.
Is the level of energy expenditure which is an indicator of the metabolic needs of an activity (physical activity results in an increase in energy expenditure above the resting level, and the level of energy expenditure is directly related to the intensity of physical activity).
Physical activity is generally quantified by determining energy expenditure in kilocalories or by using the Metabolic Equivalent (MET) of an activity. One MET represents resting energy expenditure during quiet sitting and is generally interpreted as 3.5 mL O2/kg/min or = 250 mL/min oxygen consumption. Which represents the average value for a standard person weighing 70 kg. MET can be converted into kilocalories, ie 1 MET = 1 kcal/kg/hour. Oxygen consumption increases with the intensity of physical activity. Therefore, a simple quantification of the intensity of physical activity using the method of multiplying resting energy expenditure. For example, a person doing physical activity that requires oxygen consumption of 10.5 mL O2/kg/min is equivalent to 3 MET i.e., 3 times the resting level
Global Physical Activity Quesioner (QPAG)
The Global Physical Activity Questionnaire (QPAG) is an instrument for measuring physical activity developed by WHO. The QPAG questionnaire consists of 16 simple questions related to daily activities carried out during the past week using a physical activity index which includes four dominants, namely physical activity at work, travel activities from one place to another, recreational activities and sedentary activities. (sedentary activities). GPAQ measures physical activity by measuring it using Metabolic Equivalent Turnover (MET).
Metabolic Equivalent Turnover (MET) is a measurement of the intensity of physiological physical activity carried out by a person. MET is used as a measurement ratio for a specific type of physical activity. Each physical activity has different results, such as walking 2.7 km/hour has 2.9 MET, watching television 1 MET, jumping rope 10 MET, and sleeping 0.9 MET.
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Physical activity levels were assessed based on the following criteria:
1. High, in 7 days or more of physical activity walking, moderate or vigorous intensity activity of at least 3000 MET minutes per week.
2. Moderate, within 5 days or more of physical activity walking, moderate or high intensity activity of at least 600 MET minutes per week.
3. Low, someone who does not meet the criteria for high, or moderate.
Causes of Obesity
The basic cause of overweight and obesity is an energy imbalance between energy intake and energy output. Incoming energy is the amount of energy in the form of calories obtained from food and drinks. While the energy out is the amount of energy or calories used by the body in things such as breathing, digestion and also doing physical activities.
Energy intake and energy expenditure are influenced by various factors that can be grouped more specifically, such as individual factors such as genetics and body metabolic processes, factors from lifestyle behaviors such as lack of physical activity and external factors including environmental factors such as the low price of a food.
In general, obesity occurs due to increased intake of foods that are high in fat and lack of daily physical activity both at work and in transportation. Other causes of obesity include an inactive lifestyle, environment, genetics and family history, health conditions, medications, emotional factors, smoking, age, pregnancy and lack of sleep can be risk factors for obesity.
The risk factors that can cause obesity include:
1) Sedentary lifestyle
Today most people spend time in front of the television (TV) and computer at work, at school and at home. In addition, many people have private vehicles to travel even if it is only a short distance. People who are inactive are more likely to gain weight because they don't burn the calories they take in from food and drink. An inactive lifestyle also poses a risk for coronary heart disease, high blood pressure, diabetes, colon cancer and other health problems.
2) Genetic Factors
Individuals from obese families are 2-8 times more likely to be obese than non-obese families. It is very likely that the cause of obesity is not only in a single gene but a mutation in several genes.
Several hormone problems can lead to being overweight and obese, such as hypothyroidism, Cushing's syndrome, and polycystic ovarian syndrome.
Certain drugs can increase the risk of obesity, such as corticosteroids and antidepressants.
5) Emotional factor
Some people eat more than usual when they are bored, angry or stressed. Over time, overeating will lead to weight gain and can lead to being overweight or obese.
Determination of Obesity
Obesity is measured based on a person's body mass index (BMI). BMI is a simple index of height and weight that is commonly used to classify overweight and obesity in adults. BMI is expressed as body weight in kilograms divided by the square of height in meters (kg/m2). A person is categorized as overweight if the BMI is >25 kg/m2 and obese if the BMI is >30 kg/m2.
Risks of Obesity Patients
There are so many risks of health problems that can occur in adolescents or productive age who are obese. Obesity can have problems with the heart and blood vessel system (cardiovascular), namely hypertension and dyslipidemia (abnormalities in cholesterol).
You can also experience impaired liver function where there is an increase in SGOT and SGPT and an enlarged liver. It can also be in the form of gallstones and diabetes (diabetes mellitus). In the respiratory system, pulmonary function disorders can occur, snoring during sleep and frequent blockage of the airway (obstructive sleep apnea).
Obesity can also affect skin health where striae or white stripes can occur, especially in the abdominal area (white/purple stripes). In addition, psychological disorders can also occur in obese people. A body that is too fat often makes a person often ridiculed by his friends. So it has an unfavorable impact on psychological development.
In addition to cosmetic problems, obesity is a very serious health problem. In America, 300,000 deaths per year are caused by obesity. Obesity can trigger some very serious chronic diseases such as:
1. Insulin Resistance
Insulin in the body is useful for delivering glucose as energy-forming fuel into cells. By moving glucose into cells, insulin will maintain normal blood sugar levels. In obese people there is a high accumulation of fat in the body, while fat is very resistant to insulin. Thus, to deliver glucose into fat cells and maintain normal blood sugar levels, the pancreas as an insulin factory, in the islets of Langerhans,
produce large amounts of insulin. Over time, the pancreas can no longer produce insulin in large quantities so that blood sugar levels gradually rise and there is what is called Type 2 Diabetes Mellitus.
2. High Blood Pressure
Hypertension is very common in obese people. Researchers in Norway said that an increase in blood pressure in obese women occurs more easily when compared to obese men. Increased blood pressure is also easy to occur in apple-type fat people (central obesity, fat concentration in the abdomen). when compared with those who are obese pear type (fat concentration in the hips and thighs).
3. Heart Attack
Recent studies have shown that the risk of coronary heart disease in obese people is three to four times higher when compared to normal people. For every 1 kg increase in body weight, there is a 1% increase in deaths from coronary heart disease.
Although still controversial, several studies have shown that there is an increased risk of colon, prostate, bladder and uterine cancer in obese people. In women who have menopause prone to breast cancer. In addition, obesity can also cause other health problems such as: Increased cholesterol levels (hypercholesterolemia), stroke, heart failure, gallstones, inflammation joints (gout), osteoporosis and sleep disorders. A study concluded that obese adolescents are at greater risk of developing multiple sclerosis in adulthood. The 40-year study involving 238,000 women found that those who were obese at age 18 were twice as likely to develop multiple sclerosis as those who were slimmer at that age. Studies show those who are obese or have a BMI of 30 or more by age 18 are twice as likely to develop multiple sclerosis later.
Multiple Sclerosis is a condition caused by the loss of nerve fibers and the protective tissue of myelin in the brain and spinal cord resulting in damage to the nervous system. The study, reported in the journal Neurology, used data from large-scale research on diet, lifestyle and health. At the end of the study, 593 women were diagnosed with multiplesclerosis. The researchers compared the risk of multiple sclerosis with body mass index (BMI) or the ratio between weight and height in participants when they were 18 years old.
Obesity Prevention and Treatment
The principle in an effort to lose excess weight is to create an energy deficit. This condition will force the body to use fat reserves as an energy source. Efforts to create an energy deficit is to reduce energy intake from food and increase use energy by the body. There are several ways that can be done to deal with obesity, including:
The recommended exercise is aerobic exercise, which is a sport that uses oxygen in its energy formation system. Or in other words exercise that is not too heavy but in more than 15 minutes. Examples of recommended sports include walking for 20-30 minutes every day, swimming, leisurely cycling, jogging, aerobic exercise, etc.
Because diet is related to the food consumed in the family on a daily basis, the participation of all family members to participate in changing food patterns will be very beneficial. Reduce consumption of fast food and contain lots of fat, especially unsaturated fatty acids and reduce sweet foods.
Handling obesity by surgery is done when the patient's condition is no longer possible to be given other ways such as exercise and diet. This method is also done with the reason to get the ideal body in a fast way. This operation is performed by removing excess subcutaneous fat tissue in the patient. There are several options for dealing with obesity, the following is an explanation:
- Reduce foods that contain oil and fat
- More Sports
Exercise is an important part of the body, because with
exercise the body will convert fat into carbohydrates which are used as a
source of energy for activities. The more activity, the more fat will be burned
into energy. Therefore exercise is very good for burning fat in the body so
that it makes the body healthier and fitter.
- Reduce Food Portions
- Reduce Snacking Food