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"Latar belakang dan tujuan: Kemampuan kogntiif anak merupakan salah satu indikator penting perkembangan manusia. Kegagalan pertumbuhan linear (KPL) diketahui berdampak pada kemampuan kognitif anak. Selain itu, faktor gizi juga diketahui memiliki kontribusi penting terhadap kognitif anak. Pendekatan Faktor Risiko Kumulatif (FRK) telah dilakukan pada beberapa studi sebelumnya, namun belum ada yang melakukan pendekatan risiko kumulatif terkait nutrisi di awal kehidupan. Studi ini bertujuan untuk mengetahui hubungan antara kegagalan pertumbuhan linear pada awal kehidupan dan risiko kumulatif terkait gizi di awal kehidupan dengan kemampuan kognitif anak usia 4-6 tahun.Metode: Disain studi merupakan studi longitudinal, yang dilakukan di kota Bogor, Indonesia pada tahun 2012, yang mengikuti anak-anak sejak lahir. Untuk analisis ini yang menjadi responden penelitian yaitu 139 anak berusia 4-6 tahun. Variabel terikat yaitu perkembangan kognitif yang diukur dengan Wechsler Prescool and Primary Scale of Intelligence (WPPSI) Indonesia dengan indikator Full-scale IQ (FSIQ), Verbal IQ (VIQ) dan Performance IQ (PIQ). Variabel bebas utama yaitu kegagalan pertumbuhan linear dan indeks kumulatif terkait gizi pada awal kehidupan. Analisis multivariat dengan menggunakan uji regresi cox proportional hazard regression digunakan untuk menganalisis pengaruh faktor independen terhadap kemampuan kognitif anak.Hasil: Sepertiga dari anak memiliki kegagalan pertumbuhan linear di awal kehidupan. Studi ini tidak menemukan hubungan yang bermakna antara kegagalan pertumbuhan linear di awal kehidupan dengan skor kognitif yang rendah, namun terdapat kecenderungan terjadinya perawakan pendek di awal kehidupan berhubungan dengan rendahnya kemampuan kognitif, juga terdapat hubungan yang bermakna dengan subtes dari VIQ yaitu aritmetika sedangkan hubungan ini tidak ditemukan bermakna pada subtes dari PIQ. Indeks risiko kumulatif terkait gizi di awal kehidupan yang dikembangkan merupakan kombinasi dari 15 faktor risiko yang terkait dengan gizi. Indeks tersebut tingkat konsistensi nya baik dengan nilai Cronbach alpha 0.863. Uji multivariat menemukan indeks tersebut merupakan faktor risiko terhadap rendahnya kognitif anak walaupun secara statistik tidak bermakna.Kesimpulan: Kegagalan pertumbuhan linear pada awal kehidupan belum ditemukan memiliki hubungan yang bermakna dengan rendahnya kognitif anak. Terjadi nya perawakan pendek serta indeks kumulatif terkait gizi pada awal kehidupan di awal kehidupan ditemukan sebagai salah satu faktor risiko terhadap kemampuan kognitif yang rendah walaupun secara statistik tidak bermakna.

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Background and objective: Children's cognitive abilities are one of the important indicators of human development. Linear growth failure is known to have an impact on child cognitive abilities. In addition, nutritional factors are also known to have an important contribution to children cognitive. A cumulative risk approach has been carried out in several previous studies, but no one has yet approached a cumulative risk related to early life nutrition. Thus, this study aims to investigate the association between linear growth failure (LGF) and Nutrition-related Cumulative risk Factors (NCRF) in early life with children cognitive development in 4-6 years.

Methods: A sampled longitudinal study started in Bogor City, Indonesia, in 2012, and children were followed from birth. For this analysis, we considered 139 children aged 4-6 years. The dependent variable in this analysis is cognitive development as measured by the Indonesian Wechsler Preschool and Primary Scale of Intelligence (WPPSI) with the indicators of Full-Scale IQ, Verbal IQ and Performance IQ. The main independent variables are LGF and NCRF in early life. Multivariate analysis used Cox regression test.

Results: One third of children have LGF in early life. Most of them are having early stunted. This study did not find significant association between LGF in early life with low cognitive scores. However, there is a trend of the children that experience stunted in early life have lower score on all cognitive domain, with the significant association found with arithmetic subtest. NCRF index in early life course developed is a combination of 15 risk factors which are indicators of nutrition related problems. The index is reliable (Cronbach alpha 0.863) and most of its components are valid (p value < 0.05 Chi square test). The index is found to be a risk factors of low cognitive among children 4-6 years old eventhough not statistically significant.

Conclusions: LGF in early life not found to be a significant factor for children low cognitive development in 4 to 6 years, while experience of stunted found to be a risk factors of low cognitive outcomes. NCRF index in early life course found to be a risk factor for child low cognitive development after adjusting other factors eventhough not statistically significant."

"Latar Belakang dan Tujuan: Prevalensi pendek pada anak usia di bawah dua tahun (baduta) di Indonesia pada tahun 2018 sebesar 29,9%, sedangkan di Jakarta sebesar 27,2%. Kondisi pendek pada awal kehidupan berhubungan dengan peningkatan morbiditas dan mortalitas, serta dapat mengurangi kapasitas fisik dan peningkatan risiko penyakit metabolik pada usia dewasa. Tujuan penelitian adalah memahami peran inflamasi usus pada baduta terhadap kejadian pendek.Metode dan bahan: Studi dengan desain kasus kontrol yang dilakukan pada anak usia 6–23 bulan di Kelurahan Kampung Melayu, Jakarta. Penentuan subjek penelitian secara acak sederhana. Pendek ditetapkan berdasarkan nilai z-score panjang badan menurut­­­­­­ umur (PB/U). Pengukuran panjang dan tinggi badan menggunakan infantometer dan microtoise. Penilaian hormon pertumbuhan berdasarkan kadar TSH, sedangkan penilaian inflamasi usus berdasarkan pengukuran kadar Reg 1B. Fungsi absorbsi usus ditetapkan dengan pengukuran kadar xilosa darah. Infeksi parasit dideteksi dengan pemeriksaan feses secara makroskopis dan kultur Blastocystis. Penilaian asupan energi dan zat gizi makro dilakukan dengan metode recall 24 jam. Frekuensi pengukuran panjang dan tinggi badan, inflamasi usus dan penilaian asupan dilakukan 2 kali dengan selang waktu 6 bulan.Hasil: Pada penapisan 269 anak didapatkan 20,4% pendek dengan 55,8% laki-laki, 55,0% kelompok umur 12-23 bulan dan 47,3% memiliki kedua orang tua normal. Profil subjek penelitian adalah 61,1% laki-laki, 88,9% pada kelompok umur 12-23 bulan dan memiliki kadar TSH normal. Persentase rata-rata asupan energi dan zat gizi makro anak pendek lebih rendah daripada anak normal, tetapi tidak berbeda secara statistik. Pada subjek penelitian tidak ditemukan Soil Transmitted Helminths dan hanya 1 anak normal yang positif Blastocystis hominis. Untuk pemeriksaan Reg 1B tidak ditemukan perbedaan antara anak pendek dan normal, tetapi subjek penelitian yang mengalami peningkatan kadar Reg 1B sebagian besar terjadi penurunan nilai Z-score PB/U dan berbeda bermakna secara statistik. Pada pemeriksaan kadar xilosa darah tidak ditemukan perbedaan antara anak pendek dan normal. Dalam analisis korelasi, tidak diperoleh korelasi antara infeksi parasit usus dengan inflamasi usus dan malabsorbsi tetapi ada korelasi bermakna antara inflamasi usus dengan malabsorbsi.Kesimpulan: Inflamasi usus terjadi pada anak pendek dan normal serta secara signifikan menurunkan nilai Z-score PB/U dari kedua anak tersebut dan berkorelasi secara bermakna dengan malabsorbsi.

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Background and Objective: The prevalence of stunting in children under two years in Indonesia in 2018 is 29.9%, while in Jakarta it is 27.2%. Stunted early in life is associated with increased morbidity and mortality, and can reduce physical capacity and increase the risk of metabolic diseases in adulthood. The aim of the study was to understand the role of intestinal inflammation in children under 2-yrs of age in stunted incidents.

Materials and Methods: A case-control study involving children aged 6-23 months in Kampung Melayu Village, Jakarta was done in 2018. Study sampling was determined by simple randomization. Stunting is determined based on the z-score of the body length by age (LZA). Length was measured using infantometer while height was measured by microtoise. Growth hormone was determined by TSH levels, while intestinal inflammation was determined with faecal Reg 1B levels. The function of intestinal absorption is determined by blood xylose levels. Parasitic infections are determined by macroscopic fecal examination and Blastocystis culture. Assessment of intake of energy and macro nutrients was analyzed by 24-hour recall method. The frequency of length and height measurements, intestinal inflammation and intake assessment were carried out twice with an interval of 6 months.

Results: Screening of 269 children found 20.4% of stunting with 55.8% of men, 55.0% of age group 12-23 months and 47.3% had both normal parents. The percentage of the average intake of energy and macro nutrients from stunting was lower than normal, but not statistically different. Soil Transmitted Helminths were not found and only one child for positive Blastocystis hominis. For the examination of Reg 1B there was no difference between stunted and normal children, but the study subjects who experienced an increase in Reg 1B levels were mostly accompanied by decreased Z-score values of LZA and were significantly different. On examination of blood D-xylose levels no differences were found between stunted and normal children. In correlation analysis, there was no correlation between intestinal parasitic infection and intestinal inflammation and malabsorption but there was a significant correlation between intestinal inflammation and malabsorption.

Conclusion: Intestinal inflammation occurs in stunted and normal children and significantly decreases the Z-score of LZA from these two children and correlates significantly with malabsorption.

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"Latar belakang: Indonesia dihadapkan pada masalah stunting yang cukup tinggi. Anak yang menderita stunting memiliki konsentrasi asam amino esensial yang lebih rendah. Mechanistic Target of Rapamycin Complex 1 (mTORC1) sebagai jalur utama regulasi pertumbuhan yang sensitif terhadap asam amino, mempromosikan sintesis protein melalui S6K1 dan 4EBP1. Penelitian ini bertujuan menganalisis keterlibatan asam amino esensial pada kadar mTORC1, S6K1, dan 4EBP1 dan korelasinya dengan kejadian stunting. Metode: Desain penelitian adalah kasus-kontrol. Anak berusia 6-24 bulan di Provinsi Sumatera Selatan diambil secara cluster random sampling berjumlah 137 orang. Pengumpulan data menggunakan kuesioner dan pengukuran antropometri. Pemeriksaan feses secara makroskopis dan mikroskopis, pemeriksaan darah dengan teknik LC-MS dan ELISA. Hasil: Terdapat perbedaan bermakna dalam hal usia anak, panjang badan lahir, BB/U, dan LK/U. Tidak ditemukan perbedaan makroskopis dan mikroskopis feses di antara kedua kelompok. Asam amino triptofan berbeda bermakna (p=0,004) dan berhubungan dengan kejadian stunting (p=0,045). Kadar mTORC1 dengan S6K1 dan 4EBP1 tidak berbeda pada kedua kelompok. Kadar mTORC1 tidak berhubungan dengan kejadian stunting. Kadar asam amino lisin berhubungan bermakna dengan kadar mTORC1 (p=0,003). Kadar mTORC1 berhubungan bermakna dengan kadar S6K1 dan 4EBP1 (masing-masing p<0,001). Simpulan: Asam amino esensial berimplikasi pada kejadian stunting dan kadar mTORC1, mTORC1 memengaruhi kadar S6K1 dan 4EBP1 anak.

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Background: Indonesia is faced with a fairly high stunting problem. Children who suffer from stunting have lower concentrations of essential amino acids. The Mechanistic Target of Rapamycin Complex 1 (mTORC1) as the main pathway of growth regulation that is sensitive to amino acids, promotes protein synthesis through S6K1 and 4EBP1. This study aims to analyze the involvement of essential amino acids in mTORC1, S6K1, and 4EBP1 levels and their correlation with stunting. Methods: The study design was a case-control study. Children aged 6-24 months in South Sumatra Province were taken using cluster random sampling totaling 137 people. Data collection used questionnaires and anthropometric measurements. Macroscopic and microscopic examination of feces, and blood examination using LC-MS and ELISA techniques. Results: Significant differences were in child age, birth length, BB/A, and LK/A. There were no macroscopic and microscopic differences in feces between the two groups. Tryptophan amino acids were significantly different (p=0.004) and associated with stunting (p=0.045). mTORC1 levels with S6K1 and 4EBP1 were not different in both groups. mTORC1 levels were not associated with stunting. Lysine amino acid levels were significantly associated with mTORC1 levels (p=0.003). mTORC1 levels were significantly associated with S6K1 and 4EBP1 levels (each p<0.001). Conclusion: Essential amino acids are implicated in stunting and mTORC1 levels, and mTORC1 affects children's S6K1 and 4EBP1 levels."

"Remaja dengan kelebihan berat badan harus diintervensi agar tidak menjadi orang dewasa dengan obesitas. Berkembangnya patient-centered care sebagai upaya pemberdayaan diri dapat menjadi pendekatan terpilih. Dibutuhkan motivasi besar dalam menjalani proses perubahan perilaku. Coaching dilakukan untuk mendampingi klien (coachee) agar mampu mengoptimalkan potensi sehingga memiliki sikap positif, mental yang kuat, dan gaya hidup yang lebih baik. Belum ada penelitian yang mengidentifikasi keberhasilan patient-centered care berbasis pemberdayaan diri dengan metode coaching pada mahasiswa obesitas.Penelitian dilakukan dengan mixed method dalam tiga tahap. Tahap 1 merupakan studi potong lintang untuk mengidentifikasi persepsi mahasiswa terhadap dampak obesitas bagi kesehatan. Kuesioner daring terdiri dari identitas, data antropometri, S-Weight, dan P-Weight. Tahap 2 dilakukan pengembangan model pelayanan dengan cara melaksanakan focus group discussion. Peserta diskusi adalah pakar di tingkat mikro, meso dan makro sistem layanan kesehatan. Tahap 3 menilai kemamputerapan dan efektivitas model layanan yang dikembangkan. Studi dilakukan pada dua kelompok mahasiswa obesitas (usia 18-24 tahun) yang dibagi dalam kelompok intervensi dan kontrol. Pada kedua kelompok diberlakukan model layanan yang sama yaitu pengukuran status antropometrik dan komposisi tubuh, pengisian kuesioner pada awal program, edukasi, dan kembali dilakukan pengukuran status antropometrik dan komposisi tubuh serta pengisian kuesioner pada akhir program. Pada kelompok intervensi ditambahkan uji coba coaching sebanyak 6 sesi setiap dua minggu. Pengukuran awal dan akhir berjarak 3 bulan.Tahap 1 diperoleh 134 mahasiswa obesitas (respons rate 14.1%). Teridentifikasi responden berada pada tahap kontemplasi (35,8%) dan aksi (35,1%) terhadap perubahan perilaku dalam proses menurunkan berat badan. Kesiapan responden bersifat positif (76,9%) pada emosi, dan bersifat negatif pada konsekuensi, dukungan, dan aksi dalam menurunkan berat badan.Tahap 2 dilaksanakan dua tahap FGD terhadap 2 kelompok @ 10 orang. Teridentifikasi bahwa program penurunan berat badan harus diinisiasi dengan membangkitkan rasa kebutuhan untuk lebih sehat dengan berat badan yang ideal. Program harus bersifat personal. Diperlukan dukungan lingkungan seperti ketersediaan makanan sehat dan sarana untuk beraktivitas. Program harus merupakan program yang menimbulkan dukungan terhadap peserta, profesional, dan tersedia di layanan kesehatan. Berdasarkan hal tersebut disusun metode coaching yang sesuai dengan patient-centered care berbasis pemberdayaan diri bagi mahasiswa obesitas dalam program penurunan berat badan. Program terdiri dari 6 sesi coaching. Setiap tema dalam sesi coaching menggunakan langkah SMART dan diberi nama “From Fat to Fit with SMART Program”. Program dilaksanakan dalam waktu 3 bulan. Tema berturut-turut adalah healthy behavior habit, vision strategy, body self-image, timeline perspective/ state line exercise, happiness model, dan healthy behavior habit/ vision board. Kedua kelompok mendapatkan edukasi mengenai dampak obesitas bagi kesehatan, prinsip gizi seimbang, aktivitas fisik dan hidrasi yang sesuai bagi remaja dari para ahli yang terdiri dari spesialis penyakit dalam, spesialis gizi klinik, dan spesialis kedokteran olahraga yang dilakukan secara daring. Pengukuran antropometri, komposisi tubuh (menggunakan Bioelectric Impedance Analysis), pemantauan asupan makanan (menggunakan formulir food record), pemantauan aktivitas fisik (menggunakan bouchard activity record), pemberdayaan diri (menggunakan kuesioner subjective wellbeing dan skala kepuasan healthy behavior habit), dibandingkan antara dua kelompok menggunakan uji T berpasangan (jika distribusi data normal) dan uji Mann-Whitney (jika distribusi data tidak normal).Tahap 3 diawali dengan penerapan program terhadap dua kelompok @ 30 mahasiswa obesitas. Peserta dibagi menjadi kelompok intervensi dan kelompok kontrol. Kelompok intervensi mendapatkan coaching dari health coach yang telah mendapatkan pelatihan sebelumnya dari coach bersertifikat Internasional. Seorang health coach mendampingi 4 mahasiswa obesitas. Health coach berjumlah 8 orang yang terdiri dari dokter spesialis kedokteran keluarga layanan primer, dokter spesialis penyakit dalam, dokter spesialis kedokteran olahraga, dokter pengelola program studi fakultas, dan coach yang berpengalaman dengan pendekatan coaching di tempat kerjanya. Sesi coaching dibagi menjadi enam pertemuan setiap dua minggu secara daring melalui media zoom meeting dengan bantuan host dari tim peneliti. Namun, meningkatnya kondisi PPKM (pemberlakuan pembatasan kegiatan masyarakat) pada tahap ini, mahasiswa yang berhasil menyelesaikan program adalah 23 mahasiswa kelompok intervensi dan 18 mahasiswa kelompok kontrol.Nilai perubahan pada kelompok intervensi secara signifikan lebih besar dibandingkan kelompok kontrol pada komponen total lemak tubuh [-0.9 (-12,9, 0,70) vs 0,0 (-6,9, 3,50), p=0,02) dan healthy behavior habit [13.5 ± 11,85 vs 7,5 ± 8,08, p=0,04]. Nilai perubahan skala kepuasan healthy behavior habit secara signifikan lebih besar dibandingkan kelompok kontrol pada aspek hobby/passion [2(-4,6) vs 1(-2,2), p=0,02], movement exercise [2,3 ± 2,11 vs 1,2 ±1,93, p=0,03], sleep rest [2(-6,5) vs 1(-3,2), p=0,01], dan spiritual [1(0,6) vs 0( -1,3), p=0,00].

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Adolescents with excess weight should be intervened so as not to become adults with obesity. The development of patient-centred services as an effort to empower oneself could be the approach of choice. It takes great motivation in undergoing the process of behaviour change. Coaching is carried out to assist the client (coachee) to optimize their potential so that they had a positive attitude, strong mentality, and a healthier lifestyle. There has been no research that has identified the success of patient-centred care based on self-empowerment with coaching methods for obese students.

Mixed method research were in three stages. Phase 1 was a cross-sectional study to identify students' perceptions of the impact of obesity on health. The online questionnaire consisted of identity, anthropometric data, S-Weight, and P-Weight. Phase 2 was developing a service model by conducting focus group discussions. Discussion participants were experts at the micro, meso, and macro levels of the health care system. Phase 3 assessed the applicability and effectiveness of the developed service model. The study was conducted on two groups of obese college students (aged 18-24 years) in the intervention group and the control group. Both groups were subjected to the same service model, namely an initial physical examination, a questionnaire at the beginning of the service, and education about how to lose weight. A final physical examination and questionnaire were carried out at the end of the program. However, the intervention group was given a coaching method. Initial and final examinations were 3 months apart.

Phase 1 obtained 134 obese students (response rate of 14.1%). Respondents identified as being in the contemplation stage (35.8%) and action (35.1%) on behaviour change in the process of losing weight. Respondents' readiness was positive (76.9%) on emotions about losing weight and was negative in terms of consequences, support, and action in losing weight.

Phase 2 was carried out in 2 stages of FGD with 2 groups of 10 people. It was identified that a weight loss program should be initiated by generating a sense of the need to be healthier with ideal body weight. Programs should be personal. Environmental support was needed such as the availability of healthy food and facilities for activities. The intervention program should be a program that creates support for participants, professional, and available in health services. Based on this, a coaching method was developed following patient-centred care based on self-empowerment for students with obesity in weight loss programs. The program consisted of 6 coaching sessions. Each session used SMART steps. Each coaching session was themed sequentially and was named “From Fat to Fit with SMART Program”. The program was implemented within 3 months. The successive themes of the coaching session were healthy behaviour habits, vision strategy, body self-image, timeline perspective/ state line exercise, happiness model, and healthy behaviour habit/ vision board. Both groups received online education about obesity, balanced diet, physical activity and hydration from experts consisting of internal medicine specialists, clinical nutrition specialists, and sports medicine specialists. Anthropometric measurements, body composition (using Bioelectric Impedance Analysis), monitoring food intake (using a food record form), monitoring physical activity (using a bouchard activity record), self-empowerment (using a subjective wellbeing questionnaire and healthy behaviour habits satisfaction scale) were compared between the two groups using paired T-test (if the data distribution was normal) and the Mann-Whitney test (if the data distribution was not normal).

Phase 3 began with the application of the program to two groups of 30 obese students. Participants were divided into an intervention group and a control group. The intervention group received coaching from a health coach who had received previous training from an internationally certified coach. A health coach accompanied 4 obese students. There were 8 health coaches consisting of family medicine and primary care specialists, internal medicine specialists, sports medicine specialists, faculty study program manager doctors, and coaches who were experienced with coaching approach in the workplace. The coaching session was divided into six meetings every two weeks online via a zoom meeting with the help of a host from the research team. However, the increasing conditions of pandemic restrictions on community activities at this stage, students who completed the program were 23 students in the intervention group and 18 students in the control group. The value of change in the intervention group was significantly greater than the control group in the component of total body fat [-0.9 (-12.9, 0.70) vs 0.0 (-6.9, 3.50), p=0.02 ) and healthy behaviour habit [13.5 ± 11.85 vs. 7.5 ± 8.08, p=0.04].

The value of the change in the healthy behaviour habit satisfaction scale was significantly greater than the control group in the hobby/passion aspect [2(-4.6) vs 1(-2.2), p=0.02], move exercise [2,3 ± 2.11 vs 1.2 ±1.93, p=0.03], sleep rest [2(-6.5) vs 1(-3.2), p=0.01], and spiritual [1( 0.6) vs 0( -1.3), p=0.00]. This method has been proven to be able to be applied and is effective in reducing total body fat and significantly increasing healthy behaviour habits. This coaching method, which is following self-empowerment-based patient-centred care, has been proven to be able to be applied in the university's primary health services. However, support is needed from supportive university policies so that students participating in the program could follow it completely until all the expected output indicators are achieved properly"

"Remaja dengan kelebihan berat badan harus diintervensi agar tidak menjadi orang dewasa dengan obesitas. Berkembangnya patient-centered care sebagai upaya pemberdayaan diri dapat menjadi pendekatan terpilih. Dibutuhkan motivasi besar dalam menjalani proses perubahan perilaku. Coaching dilakukan untuk mendampingi klien (coachee) agar mampu mengoptimalkan potensi sehingga memiliki sikap positif, mental yang kuat, dan gaya hidup yang lebih baik. Belum ada penelitian yang mengidentifikasi keberhasilan patient-centered care berbasis pemberdayaan diri dengan metode coaching pada mahasiswa obesitas.Penelitian dilakukan dengan mixed method dalam tiga tahap. Tahap 1 merupakan studi potong lintang untuk mengidentifikasi persepsi mahasiswa terhadap dampak obesitas bagi kesehatan. Kuesioner daring terdiri dari identitas, data antropometri, S-Weight, dan P-Weight. Tahap 2 dilakukan pengembangan model pelayanan dengan cara melaksanakan focus group discussion. Peserta diskusi adalah pakar di tingkat mikro, meso dan makro sistem layanan kesehatan. Tahap 3 menilai kemamputerapan dan efektivitas model layanan yang dikembangkan. Studi dilakukan pada dua kelompok mahasiswa obesitas (usia 18-24 tahun) yang dibagi dalam kelompok intervensi dan kontrol. Pada kedua kelompok diberlakukan model layanan yang sama yaitu pengukuran status antropometrik dan komposisi tubuh, pengisian kuesioner pada awal program, edukasi, dan kembali dilakukan pengukuran status antropometrik dan komposisi tubuh serta pengisian kuesioner pada akhir program. Pada kelompok intervensi ditambahkan uji coba coaching sebanyak 6 sesi setiap dua minggu. Pengukuran awal dan akhir berjarak 3 bulan.Tahap 1 diperoleh 134 mahasiswa obesitas (respons rate 14.1%). Teridentifikasi responden berada pada tahap kontemplasi (35,8%) dan aksi (35,1%) terhadap perubahan perilaku dalam proses menurunkan berat badan. Kesiapan responden bersifat positif (76,9%) pada emosi, dan bersifat negatif pada konsekuensi, dukungan, dan aksi dalam menurunkan berat badan.Tahap 2 dilaksanakan dua tahap FGD terhadap 2 kelompok @ 10 orang. Teridentifikasi bahwa program penurunan berat badan harus diinisiasi dengan membangkitkan rasa kebutuhan untuk lebih sehat dengan berat badan yang ideal. Program harus bersifat personal. Diperlukan dukungan lingkungan seperti ketersediaan makanan sehat dan sarana untuk beraktivitas. Program harus merupakan program yang menimbulkan dukungan terhadap peserta, profesional, dan tersedia di layanan kesehatan. Berdasarkan hal tersebut disusun metode coaching yang sesuai dengan patient-centered care berbasis pemberdayaan diri bagi mahasiswa obesitas dalam program penurunan berat badan. Program terdiri dari 6 sesi coaching. Setiap tema dalam sesi coaching menggunakan langkah SMART dan diberi nama “From Fat to Fit with SMART Program”. Program dilaksanakan dalam waktu 3 bulan. Tema berturut-turut adalah healthy behavior habit, vision strategy, body self-image, timeline perspective/ state line exercise, happiness model, dan healthy behavior habit/ vision board. Kedua kelompok mendapatkan edukasi mengenai dampak obesitas bagi kesehatan, prinsip gizi seimbang, aktivitas fisik dan hidrasi yang sesuai bagi remaja dari para ahli yang terdiri dari spesialis penyakit dalam, spesialis gizi klinik, dan spesialis kedokteran olahraga yang dilakukan secara daring. Pengukuran antropometri, komposisi tubuh (menggunakan Bioelectric Impedance Analysis), pemantauan asupan makanan (menggunakan formulir food record), pemantauan aktivitas fisik (menggunakan bouchard activity record), pemberdayaan diri (menggunakan kuesioner subjective wellbeing dan skala kepuasan healthy behavior habit), dibandingkan antara dua kelompok menggunakan uji T berpasangan (jika distribusi data normal) dan uji Mann-Whitney (jika distribusi data tidak normal).Tahap 3 diawali dengan penerapan program terhadap dua kelompok @ 30 mahasiswa obesitas. Peserta dibagi menjadi kelompok intervensi dan kelompok kontrol. Kelompok intervensi mendapatkan coaching dari health coach yang telah mendapatkan pelatihan sebelumnya dari coach bersertifikat Internasional. Seorang health coach mendampingi 4 mahasiswa obesitas. Health coach berjumlah 8 orang yang terdiri dari dokter spesialis kedokteran keluarga layanan primer, dokter spesialis penyakit dalam, dokter spesialis kedokteran olahraga, dokter pengelola program studi fakultas, dan coach yang berpengalaman dengan pendekatan coaching di tempat kerjanya. Sesi coaching dibagi menjadi enam pertemuan setiap dua minggu secara daring melalui media zoom meeting dengan bantuan host dari tim peneliti. Namun, meningkatnya kondisi PPKM (pemberlakuan pembatasan kegiatan masyarakat) pada tahap ini, mahasiswa yang berhasil menyelesaikan program adalah 23 mahasiswa kelompok intervensi dan 18 mahasiswa kelompok kontrol.Nilai perubahan pada kelompok intervensi secara signifikan lebih besar dibandingkan kelompok kontrol pada komponen total lemak tubuh [-0.9 (-12,9, 0,70) vs 0,0 (-6,9, 3,50), p=0,02) dan healthy behavior habit [13.5 ± 11,85 vs 7,5 ± 8,08, p=0,04]. Nilai perubahan skala kepuasan healthy behavior habit secara signifikan lebih besar dibandingkan kelompok kontrol pada aspek hobby/passion [2(-4,6) vs 1(-2,2), p=0,02], movement exercise [2,3 ± 2,11 vs 1,2 ±1,93, p=0,03], sleep rest [2(-6,5) vs 1(-3,2), p=0,01], dan spiritual [1(0,6) vs 0( -1,3), p=0,00].

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Adolescents with excess weight should be intervened so as not to become adults with obesity. The development of patient-centred services as an effort to empower oneself could be the approach of choice. It takes great motivation in undergoing the process of behaviour change. Coaching is carried out to assist the client (coachee) to optimize their potential so that they had a positive attitude, strong mentality, and a healthier lifestyle. There has been no research that has identified the success of patient-centred care based on self-empowerment with coaching methods for obese students.

Mixed method research were in three stages. Phase 1 was a cross-sectional study to identify students' perceptions of the impact of obesity on health. The online questionnaire consisted of identity, anthropometric data, S-Weight, and P-Weight. Phase 2 was developing a service model by conducting focus group discussions. Discussion participants were experts at the micro, meso, and macro levels of the health care system. Phase 3 assessed the applicability and effectiveness of the developed service model. The study was conducted on two groups of obese college students (aged 18-24 years) in the intervention group and the control group. Both groups were subjected to the same service model, namely an initial physical examination, a questionnaire at the beginning of the service, and education about how to lose weight. A final physical examination and questionnaire were carried out at the end of the program. However, the intervention group was given a coaching method. Initial and final examinations were 3 months apart.

Phase 1 obtained 134 obese students (response rate of 14.1%). Respondents identified as being in the contemplation stage (35.8%) and action (35.1%) on behaviour change in the process of losing weight. Respondents' readiness was positive (76.9%) on emotions about losing weight and was negative in terms of consequences, support, and action in losing weight.

Phase 2 was carried out in 2 stages of FGD with 2 groups of 10 people. It was identified that a weight loss program should be initiated by generating a sense of the need to be healthier with ideal body weight. Programs should be personal. Environmental support was needed such as the availability of healthy food and facilities for activities. The intervention program should be a program that creates support for participants, professional, and available in health services. Based on this, a coaching method was developed following patient-centred care based on self-empowerment for students with obesity in weight loss programs. The program consisted of 6 coaching sessions. Each session used SMART steps. Each coaching session was themed sequentially and was named “From Fat to Fit with SMART Program”. The program was implemented within 3 months. The successive themes of the coaching session were healthy behaviour habits, vision strategy, body self-image, timeline perspective/ state line exercise, happiness model, and healthy behaviour habit/ vision board. Both groups received online education about obesity, balanced diet, physical activity and hydration from experts consisting of internal medicine specialists, clinical nutrition specialists, and sports medicine specialists. Anthropometric measurements, body composition (using Bioelectric Impedance Analysis), monitoring food intake (using a food record form), monitoring physical activity (using a bouchard activity record), self-empowerment (using a subjective wellbeing questionnaire and healthy behaviour habits satisfaction scale) were compared between the two groups using paired T-test (if the data distribution was normal) and the Mann-Whitney test (if the data distribution was not normal).

Phase 3 began with the application of the program to two groups of 30 obese students. Participants were divided into an intervention group and a control group. The intervention group received coaching from a health coach who had received previous training from an internationally certified coach. A health coach accompanied 4 obese students. There were 8 health coaches consisting of family medicine and primary care specialists, internal medicine specialists, sports medicine specialists, faculty study program manager doctors, and coaches who were experienced with coaching approach in the workplace. The coaching session was divided into six meetings every two weeks online via a zoom meeting with the help of a host from the research team. However, the increasing conditions of pandemic restrictions on community activities at this stage, students who completed the program were 23 students in the intervention group and 18 students in the control group. The value of change in the intervention group was significantly greater than the control group in the component of total body fat [-0.9 (-12.9, 0.70) vs 0.0 (-6.9, 3.50), p=0.02 ) and healthy behaviour habit [13.5 ± 11.85 vs. 7.5 ± 8.08, p=0.04].

The value of the change in the healthy behaviour habit satisfaction scale was significantly greater than the control group in the hobby/passion aspect [2(-4.6) vs 1(-2.2), p=0.02], move exercise [2,3 ± 2.11 vs 1.2 ±1.93, p=0.03], sleep rest [2(-6.5) vs 1(-3.2), p=0.01], and spiritual [1( 0.6) vs 0( -1.3), p=0.00]. This method has been proven to be able to be applied and is effective in reducing total body fat and significantly increasing healthy behaviour habits. This coaching method, which is following self-empowerment-based patient-centred care, has been proven to be able to be applied in the university's primary health services. However, support is needed from supportive university policies so that students participating in the program could follow it completely until all the expected output indicators are achieved properly"