case study Childhood obesity

CDC Definitions
• Childhood overwieght
• BMI at or above the 85th percentile and lower than than
the 95th percentile.
• Childhood obesity
• BMI at or above the 95th percentile
Contributions to Obesity:
Sugar drinks and less healthy
foods on school campuses.
Limited access to healthy
affordable foods.
Advertising of less healthy
Greater availability of highenergy dense foods and sugar
Lack of daily, quality physical
activity in all schools
No safe and appealing place, in
many communities, to play or
be active
Television and media
Increasing portion sizes
Lack of breastfeeding
Contributions to Obesity:
Familial clustering of obesity in families
Parent-child relationship
Studies show that children have a relative risk
for obesity if parent/s are obese
Twin Studies
Bouchard Studies
Overfeeding trail:
-12 male monzygotic twins (age 21,BMI 19)
-overfed 1,000 extra kcals/day six days/week for 84 days
-wt gain range: 9 lbs-29 lbs
-less varitation within twins than between twins
Underfeeding Trial:
-7 pairs of male monozygotic twins
-kcal deficit (mainly exercise)
-bike for 2 hours per day (2x/day)
-1,000 kcal/day deficit for 9 days out of 10 for 93 total days
results similar to overfeeding study
Health Consequences
Diseases and Conditions:
Coronary heart disease
Type 2 diabetes
Hypertension (high blood pressure)
Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Psychological :
low self-esteem
negative body image
EAL: Pediatric Weight Management
• Children Six to 12 Years Old
• PWM: Energy Restricted Diets
– If energy-restriction is appropriate, based on the
registered dietitian's professional judgment-
balanced macro-nutrient diet recommended.
– 900kcal-1,200kcal per day
– multi-component pediatric weight management
– medically monitored.
Dieting Cycle
Want to lose
Weight Gain
Binge ( using
food as
Diet (restriction)
Obsess over
Related Research
Obesity, Disordered Eating, and Eating Disorders in a
Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years
Conclusion: Dieting and unhealthful weight-control behaviors
predict outcomes related to obesity and eating disorders 5 years
later. A shift away from dieting and drastic weight-control
measures toward the long-term implementation of healthful
eating and physical activity behaviors is needed to prevent
obesity and eating disorders in adolescents.
Non-Diet Approach
• What is a non-diet approach?
– Takes focus off weight and on to normalizing
– Encourages a variety
– Eating in a flexible way for pleasure and in honor
of hunger and fullness cues
– Finding Joy in moving your body
Case Study
Missy Bloyd
Age: 10 years old
Gender: Female
Occupation: Student in 5th grade
Ethnic Background: Biracial
(African American and Caucasion)
• Household members: Father age
36, mother age 35, sister age 5
Case Study
Chief Complaint:
“We’ve noticed that Missy appears to stop breathing
for several seconds several times a night. She is
really cranky when se gets up for school. Her teacher
says Missy gets very sleepy during school…She fell
asleep in class yesterday”
Case Study
Patient History
• Past several years:
Sleeping with mouth open
Sleep disturbances
Cessation of breathing (at least 10 sec)
Morning headaches
Tired and irritable
Has been “overweight” all her life
Occasional knee pain
Rash in skin folds
Abdomen: obese
Labs: normal
Current Medications: none
Case Study
Patient History
• Family History
• Type 2 DM
• Heart Attack
• High BP
• Nutrition History
• Very good appetite
• Consumes variety of foods
• Low physical activity
• Flinstones multi-vitamin daily
• No previous nutrition therapy
• Medical DX: Obstructive sleep apnea (OSA) 2’ obesity and physical
Dietary History
24 hour recall
2 breakfast burritos, 8 oz whole milk, 4 oz apple juice,
6 oz coffee with ¼ c cream and 2 tsp sugar
2 bologna and cheese sandwiches with 1 tbsp mayonnaise, 1oz pkg
Frito corn chips, 2 Twinkies, 8 oz whole milk
Peanut butter and jelly sandwich (2 slices enriched bread with 2 tbsp
crunchy peanut butter and 2 tbsp grape jelly), 12 oz whole milk
Fried chicken ( 2 legs and 1 thigh), 1 c mashed potatoes (made with
whole milk and butter), 1 c fried orka, 20 oz Coca-Cola
3 c microwave popcorn, 12 oz Coca-Cola
Case Study: Assessment
• Height: 57 in
• Weight: 115
• BMI=24.9
• 97th percentile for age & gender
Case Study: Assessment
Energy and Protein Requirements:
Case Study: Diagnosis
• Food and nutrition-related knowledge deficit
(NB-1.1) related to intake of low nutrient
dense foods and 24 hour recall as evidenced
by 97th percentile for age and weight.
Eating Competence
Positive attitude about food
Willing to try new foods
Able to plan enjoyable meals
In touch with hunger and fullness cues
Focused on enjoying food and activity, not
Child Feeding
• Division of Responsibility:
• Parents-what, when, and where of feeding
• Children- how much and whether of eating
Nutrition Intervention
• Nutrition Education
– Initial/Brief Nutrition Education (E-1)
• Educate Missy’s Mom and Dad on division of
responsibility of child feeding
• Including parent training or modeling as part of a multicomponent
program to treat adolescent overweight is associated with improvement in
adiposity. Grade II
Nutrition Intervention
• Nutrition-Related Behavior Modification
Therapy (C-1)
• Eating Competence
– Honoring hunger and fullness cues
» check in with yourself after first burrito
» If still hungry, eat more, if not stop
• Move her body
– Plan time into her schedule for an activity Missy enjoys doing
(swimming, dancing, walking )
Nutrition Intervention
• Outcome Goals:
– To be able to sleep better at night
– To have more energy throughout the day
– To increase physical activity
• Action Goals:
– Missy will ____ 2 times a week for 2 weeks
– Missy will check into her hunger and fullness four
times over a two week period at dinner.
Scope of Practice
• Check for improvements in sleep and increases in energy
• Check in with Missy about her ability to stop eating when full
• Check in with Missy about her physical activity
• Follow up with Missy in 2 weeks for another counseling

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