Manajemen Pada Obesitas

Manajemen pada obesitas
AHMAD MUHYI
10 steps to treating overweight and obesity
1. Measure height and weight.
2. Measure waist circumference.
3. Assess comorbidities.
4. Should your patient be treated?
5. Is the patient ready and motivated to lose weight?
6. Which diet should you recommend?
7. Discuss a physical activity goal. Discuss a physical activity program.
8. Review the Weekly Food and Activity Diary.
9. Give the patient copies of dietary information and exercise prescription.
10. Enter the patient’s information and the goals you have agreed on in the weight
and goal record.
Weight Management in Adults
• In general, among Asians, weight loss management is recommended for patients with
a BMI of ≥25 kg/m2 , and
• For patients with BMI between 23 to 24.9 kg/m2 or a high-risk waist circumference
plus two or more risk factors (comorbidities).
• The most important comorbidity is the metabolic syndrome (central obesity,
hypertension, dyslipidemia, and diabetes mellitus )
• Other co-morbidities include family history of early cardiovascular disease,
cholecystitis/cholelithiasis, obstructive sleep apnea and osteoarthritis.
• The goal of management is to decrease insulin resistance and improve the patient’s
metabolic profile.
• Weight management programs should include lifestyle modification and behavioral
management.
European Guidelines for Obesity
Management in Adults
BMI≥ 23 kg/m2
WC ≥ 90 cm (M)
WC ≥ 80 cm (W)
BMI ≥ 27,5 kg/m2 or ≥ 25
kg/m2 with comorbidites
BMI ≥ 27,5 kg/m2 with

DM2
Lifestyle Modification
• Lifestyle modification consists of dietary intervention and increased
physical activity.
• Dietary interventions for weight loss should be calculated to reduce
500 to 1000 kcal from the total daily caloric intake.
• The initial goal of weight loss is to reduce baseline weight by 10%
within 6 months, at a rate of approximately 0.5 to 1.0 kg (1 to 2
pounds) per week.
• After the initial goal is achieved, a weight maintenance program
should then be included.
Physical activity
• Initially, moderate levels of physical activity for 30 to 45 minutes per day, with a
frequency of 3 to 5 times per week.
• The physical activity program should be tailored according to the individual’s health or
physical condition.
• Moderate-intensity cardiovascular exercise for 20 to 60 minutes (or longer) at least 3
to 5 days per week is recommended initially.
• Low-impact activities, such as walking, swimming, water exercise, cycling, and step
aerobics are preferred.
• A strength-training program with 1 to 3 sets of exercises for the major muscle groups,
for 10 to 15 repetitions, is recommended at least two days per week.
• The patient should be advised to start slowly, then gradually increase the frequency,
duration and intensity of the exercise.
• It is important to emphasize adequate fluid intake before, during, and after exercise.
Behavioral modification
• Behavioral modification includes goal setting, self monitoring,
stimulus control, cognitive restructuring and prevention of relapse or
weight regain.
Pharmacological treatment
• Pharmacologic therapy should be considered on an individual case
basis in patients with a BMI ≥25 kg/m2 with co-morbidities, or a BMI
≥27,5 kg/m2 , following careful assessment of risks and benefits.
• Medications should never be used without concomitant lifestyle
modification
Surgery
• Metabolic surgery should be performed in high-volume centers with
multidisciplinary teams knowledgeable about and experienced in the
management of diabetes and gastrointestinal surgery.
• Long-term lifestyle support and routine monitoring of micronutrient and
nutritional status must be provided to patients after surgery, according to
guidelines for postoperative management of metabolic surgery by
national and international professional societies.
• People being considered for metabolic surgery should be evaluated for
comorbid psychological conditions and social and situational
circumstances that have the potential to interfere with surgery outcomes.

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BMI ≥ 27,5 kg/m2 with

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