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Abstrak :
Latar belakang dan tujuan: Area kumuh identik dengan permasalahan gizi pada anak. Salah satunya adalah masih terdapatnya anak pendek di daerah tersebut. Perawakan pendek dapat disebabkan oleh berbagai faktor, diantaranya dikarenakan oleh dysbiosis. Penelitian ini bertujuan untuk menganalisis komposisi mikrobiota pada anak pendek dan tidak pendek di daerah kumuh di Jakarta serta faktor-faktor yang mempengaruhinya. Metode: Penelitian ini menggunakan desain comparative cross sectional study yang dilakukan di RW 9 dan 11, Kelurahan Kebon Bawang, Jakarta Utara. Subjek dalam penelitian ini adalah 21 anak pendek (HAZ £ -2SD) dan 21 anak tidak pendek (-1SD £ HAZ £ 3SD) usia 2-5 tahun. Data yang dikumpulkan meliputi karakteristik subjek dan keluarga, riwayat cara lahir, riwayat asi eksklusif, riwayat sakit serta higiene dan sanitasi. Selain itu juga dilakukan pengumpulan asupan zat gizi melalui Semi Quantitative Food Frequency Questionnaire (SQFFQ). Analisis mikrobiota dilakukan dengan mengekstraksi DNA dari feses subjek kemudilan dilakukan sekuensing 16S rRNA menggunakan Next Generation Sequencing (NGS). Analisis bioinformatika dilakukan untuk membandingkan komposisi mikrobiota pada kedua kelompok. Uji Manova dan korelasi Spearman dilakukan untuk menganalisis kaitan antara faktor-faktor dan asupan zat gizi dengan komposisi mikrobiota. Hasil: Berdasarkan asupan zat gizi, pada kelompok anak pendek, asupan energi, zat gizi makro (karbohidrat, protein, dan lemak) dan zat gizi mikro (Zn dan Fe) lebih rendah dibandingkan anak yang tidak pendek. Pada kelompok anak pendek terdapat kecenderungan jumlah anak yang dilahirkan secara Caesar lebih banyak, yang memiliki riwayat sakit lebih banyak, konsumsi air minum air isi ulang lebih banyak dan yang tidak mencuci tangan sebelum makan lebih banyak dibandingkan kelompok anak tidak pendek. Dilihat dari komposisi mikrobiota, terdapat perbedaan komposisi mikrobiota pada kedua kelompok, baik pada tingkat genus maupun spesies. Pada kelompok pendek terdapat kelimpahan yang lebih tinggi pada genus Mitsuokella and Alloprevotella serta spesies Providencia alcalifaciens. Sedangkan pada kelompok tidak pendek terdapat kelimpahan lebih tinggi pada genus Blautia, Lachnospiraceae, Bilophila, Monoglobus dan spesies Akkermansia municiphila, Odoribacter splanchnicus and Bacteroides clarus. Perbedaan komposisi mikrobiota ini dipengaruhi oleh riwayat cara kelahiran, riwayat ASI eksklusif, sumber air minum, sumber air untuk aktivitas lain, kebiasaan mencuci tangan sebelum makan serta asupan energi, makronutrient dan mikronutrient. Kesimpulan: Secara umum kelimpahan mikrobiota yang bersifat patogen pada anak pendek lebih tinggi dibandingkan kelompok tidak pendek. Hal ini dipengaruhi oleh asupan zat gizi serta faktor-faktor lainnya. Faktor-faktor yang berpengaruh ini dapat diterapkan oleh anak pendek di daerah kumuh sebagai upaya perbaikan status gizi. ......Background and objective: Slum areas are identic with nutritional problems in children including stunted children. Incidence of stunted can be caused by various factors, one of which is dysbiosis. This study aims to analyze the microbiota composition of stunted and non-stunted children in Jakarta slum areas and related contributing factors. Method: This study used a comparative cross-sectional study design which was conducted in RW 9 and 11, Kebon Bawang Village, North Jakarta. The subjects in this study were 21 stunted children (HAZ£-2SD) and 21 non-stunted children (-1SD£HAZ£3SD) ages 2-5 years. The data collected included subject and family characteristics, mode delivery history, exclusive breastfeeding history, history of illness and hygiene and sanitation. In addition, nutrient intake was also collected through the Semi Quantitative Food Frequency Questionnaire (SQFFQ). Microbiota analysis was performed by extracting DNA from the subject's feces and then 16S rRNA sequencing using Next Generation Sequencing (NGS). Bioinformatics analysis was performed to compare the composition of the microbiota in the two groups. Manova test and Spearman correlation were performed to analyze the association between factors and nutrient intake with gut microbiota composition. Results: Based on nutrient intake, in the stunted children, energy intake, macronutrients (carbohydrates, protein, and fat) and micronutrients (Zn and Fe) were lower than non-stunted children. In the stunted group there was a tendency for the number of children born by Caesarean section to be higher, to have a higher history of illness, to consume more refillable drinking water and not to wash their hands before eating than non-stunted group. There were differences in the composition of the microbiota in the two groups, both at the genus and species levels. In the stunted group there were higher abundance in the genera Mitsuokella and Alloprevotella and the species Providencia alcalifaciens. Whereas in the stunted group there was a higher abundance in the genera Blautia, Lachnospiraceae, Bilophila, Monoglobus and the species Akkermansia municiphila, Odoribacter splanchnicus and Bacteroides clarus. Conclusion: In general, the abundance of pathogenic microbiota in stunted children was higher than in the non-stunted children. This is influenced by nutrient intake and other factors. These influencing factors can be applied by stunted children in slum areas as an effort to improve nutritional status.

Abstrak :
Prediabetes adalah kondisi peningkatan kadar glukosa darah dari normal, tetapi belum memenuhi kriteria diagnosis diabetes mellitus (DM). Prediabetes menjadi hal yang penting berdasarkan fakta bahwa sebagian besar kasus prediabetes akan berkembang menjadi DM, dan di sisi lain, dengan diagnosis dini dan intervensi yang tepat, dapat pula mengalami regresi menjadi normoglikemia. Intervensi gizi, merupakan salah satu pilar intervensi yang dapat dilakukan untuk mencegah progresivitas prediabetes menjadi diabetes. Adanya faktor polimorfisme genetik menyebabkan penerapan rekomendasi diet yang umum tidak menunjukkan hasil yang memuaskan pada sebagian orang. Penelitian bertujuan untuk mengembangkan rekomendasi diet spesifik untuk pencegahan progresivitas prediabetes menjadi diabetes berdasarkan analisis terhadap 8 single nucleotide polymorphisms (SNPs) yang terkait dengan resistensi insulin, komposisi tubuh, dan preferensi makanan. Penelitian dilakukan di Tangerang Selatan terhadap 193 subjek prediabetes sebagai kasus dan 376 subjek normoglikemia sebagai kontrol. Pengambilan data dilakukan pada Oktober 2019 hingga Juni 2021. Wawancara dilakukan untuk memperoleh data demografi dan faktor risiko; tingkat aktivitas fisik diukur dengan kuesioner IPAQ; data asupan nutrien didapat dengan menggunakan FFQ semikuantitatif dan 24 hours food recall sebanyak 3 kali lalu dianalisis menggunakan Nutrisurvey. Skor Dietary Inflammatory Index (DII) dihitung berdasarkan 29 parameter nutrien. Kadar insulin, leptin, dan adiponektin diukur menggunakan ELISA, DNA diekstraksi dari darah vena dan polimorfisme genetik ditentukan dengan pemeriksaan genotyping. Analisis data untuk menentukan adanya asosiasi dan interaksi antar variabel yang diteliti menggunakan aplikasi Rstudio. Rekomendasi diet spesifik disusun berdasarkan hasil interaksi varian genetik dan asupan nutrien yang ditemukan bermakna. Genotip C/C pada GCKR rs780094 dan genotip G/G pada LEPR rs1137101 merupakan faktor protektif terhadap prediabetes dengan nilai odds berturut-turut adalah 0,48 (IK95% 0,3-0,75, p=0,00097) dan 0,53(IK95% 0,36-0,76, p=0,0014). Analisis interaksi mendapatkan bahwa kecukupan kalori, proporsi karbohidrat, proporsi lemak, proporsi PUFA, proporsi SAFA, kecukupan MUFA, asupan serat, serta skor DII memodulasi varian genetik yang diteliti sehingga berpengaruh terhadap risiko prediabetes, komposisi tubuh, resistensi insulin dan disharmoni adipokin. Atas dasar ini, telah dikembangkan rekomendasi diet spesifik untuk genotip berisiko tinggi pada 8 SNPs yang terkait dengan resistensi insulin, komposisi tubuh, dan preferensi makanan. ......Prediabetes is when the blood glucose level is higher than normal but does not meet the diagnostic criteria for diabetes mellitus (DM). Prediabetes is crucial because most cases of prediabetes will develop into DM; on the other hand, with early diagnosis and appropriate intervention, it can also regress into normoglycemia. Nutrition intervention is one of the pillars of intervention to prevent the progression of prediabetes to diabetes. The existence of genetic polymorphism factors causes the implementation of general dietary recommendations to be unsuccessful for some people. This study aims to develop specific dietary recommendations for preventing the progression of prediabetes to diabetes based on an analysis of 8 single nucleotide polymorphisms (SNPs) associated with insulin resistance, body composition, and food preferences. The study was conducted in South Tangerang on 193 prediabetic subjects as cases and 376 normoglycemic subjects as controls. Data collection was carried out from October 2019 to June 2021. Interviews were conducted to obtain demographic and risk factor data; physical activity level was measured by IPAQ questionnaire; data on nutrient intake was obtained using a semi-quantitative FFQ and 24-hour food recall three times and then analyzed using Nutrisurvey. The Dietary Inflammatory Index (DII) score is calculated using 29 nutrient parameters. Insulin, leptin, and adiponectin levels were measured using ELISA, DNA extracted from venous blood and genetic polymorphisms were determined by genotyping examination. Data analysis to determine the existence of associations and interactions between the variables studied using the Rstudio application. Specific dietary recommendations were prepared based on the results of the interaction of genetic variants and nutrient intake, which were found to be significant. C/C genotype on GCKR rs780094 and G/G genotype on LEPR rs1137101 are protective factors against prediabetes with odds values of 0.48 (95% CI 0.3-0.75, p=0.00097) and 0.53(95% CI 0.36-0.76, p=0.0014). The interaction analysis found that the adequacy of calories, the proportion of carbohydrates, the proportion of fat, the proportion of PUFA, the proportion of SAFA, the adequacy of MUFA, fiber intake, and the DII score modulated the genetic variants studied so that they affected the risk of prediabetes, body composition, insulin resistance, and adipokine disharmony. On this basis, specific dietary recommendations for high-risk genotypes at 8 SNPs related to insulin resistance, body composition, and food preferences have been developed.

Abstrak :
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]. ......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

Abstrak :
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]. ......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