Natalie Rohr

KNH 411
Professor Matuzsak
Case Study #1: Childhood Overweight
1. Current research indicates that the cause of childhood obesity is multifactorial.
Briefly discuss how the following factors are thought to play a role in the
development f childhood obesity: biological (genetics and pathophysiology);
behavioral-environmental (sedentary lifestyle, socioeconomic status, modernization,
culture, and dietary intake); and global (society, community, organizational,
interpersonal, and individual).
a) Biological Factors: It is thought that biological factors, such as genetics and
pathophysiology, can influence whether or not a child will be obese as they age.
Genetics affects body weight and body composition by influencing such factors as
appetite, taste preferences, energy intake, resting energy expenditure, the thermic
effect of food, non-exercise activity thermogenesis (NEAT), rate of metabolism,
and the bodys efficiency in storing energy (Nelms 261). Children who have two
obese parents have an 80% chance of themselves being obese; while children with
only one obese parent have only a 40% chance of being obese. Despite more
research leading to a greater understanding of how genetics contribute to obesity,
genetics alone does not explain the rapid increase in its prevalence (Nelms 262).
b) Behavioral-environmental Factors: There are many behavioral-environmental
factors that can contribute to the onset of obesity in children. Living in a
socioeconomically advantaged area was associated with greater fruit and
vegetable consumption, whereas living in a socioeconomically deprived area was
consistently associated with a number of obesogenic dietary practices and with
overweight and obesity (Nelms 262). A sedentary lifestyle can also contribute to
obesity by having a caloric expenditure lower than the amount of calories being
consumed. When it comes to culture, some families may stay away from certain
foods or teach their kids how to eat differently solely based on the culture from
which they are from and know. This can influence the childs dietary intake in
regards to what they eat and how much. Dietary intake is one of the biggest

factors in the development of obesity, especially when kids tend to go for the
more high-sugar and high-fat foods.
c) Global Factors: Today, global factors contribute to obesity more so than ever. A
big factor is the rise in fast food restaurants and the eating behaviors of kids and
their families. Eating at a fast food restaurant is a quick and easy way to get a
meal, but also a high-calorie, high-sodium, high-fat meal. Convenience foods are
very prevalent in todays society, which are often full of preservatives, sodium,
saturated fat, and cholesterol, which in large amounts, can contribute highly to the
development of obesity.
Cited: Nelms, M., Sucher, K., & Lacey, K. (2016). Disease of the Cardiovascular System.
In Nutrition Therapy and Pathophysiology (Third ed., pp. 256-262). Boston, MA:
Cengage Learning.

2. Describe health consequences associated with an overweight condition. Describe

how these health consequences differ for overweight versus an obese condition.
The health effects of being overweight and obese are significant. Research has shown that
the risk of developing type 2 diabetes, hypertension, stroke, coronary heart disease, sleep
apnea, liver and gallbladder disease, osteoarthritis, and cancers of the endometrium,
breast, prostate, and colon are all increased as people become overweight or obese
(Nelms 260). The health consequences for obese people almost double those than of
overweight individual. For example if an overweight individual has an increased risk of
developing hypertension, than an obese individual will have double that risk of
developing hypertension.
Cited: Nelms, M., Sucher, K., & Lacey, K. (2016). Disease of the Cardiovascular System.
In Nutrition Therapy and Pathophysiology (Third ed., pp. 256-262). Boston, MA:
Cengage Learning.

3. Missy has been diagnosed with obstructive sleep apnea. Define sleep apnea.
Explain the relationship between sleep apnea and obesity.
Sleep apnea is a common disorder in which you have one or more pauses in breathing or
shallow breaths while you sleep. Breathing pauses can last from a few seconds to
minutes. In obstructive sleep apnea, the airway collapses or becomes blocked during
sleep. This causes shallow breathing or breathing pauses. It is predicted that 5%-13% of
obese children can be attributed to short sleep duration. The reasons decreased sleep
contribute to obesity are unclear but may be related to decreased physical activity from a
decrease in core temperature; more time to eat, especially late at night; or changes in
hormonal influences on hunger and satiety (Nelms 266). In obese people, the respiratory
system can be compressed by excess fat and weight that surrounds the airways, ergo
exerting pressure and causing a blockage in the airflow. Many obese people with sleep
apnea will report being very tired the next day, which may decrease ability to do any
physical activity.
Cited: What Is Sleep Apnea? (2012, July 10). Retrieved October 9, 2015, from
http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea
Sleep Apnea Tied to Increased Risk of Stroke, April 8, 2010 News Release - National
Institutes of Health (NIH). (n.d.). Retrieved October 9, 2015, from
http://www.nih.gov/news/health/apr2010/nhlbi-08.htm
Nelms, M., Sucher, K., & Lacey, K. (2016). Disease of the Cardiovascular System. In
Nutrition Therapy and Pathophysiology (Third ed., pp. 256-262). Boston, MA:
Cengage Learning.
4. What are the goals for weight loss in the pediatric population? Under what
circumstances might weight loss in overweight children not be appropriate?
The goals for weight loss in the pediatric population are a little different than in the adult
population. Generally, weight loss is not recommended for babies and young children
who are still growing and developing. The goal of treatment is to maintain their weight

while they continue to grow taller. Maintain baseline weight initially and then add slow
changes in eating and exercise to achieve slow weight loss. Children should limit their fat
intake and eat a variety of foods low in calories. However, calories should not be cut back
so much that the childs energy needs are not met. Some dietary goals include: decrease
consumption of high-fat foods, eat more vegetables and fruits, eat fewer sweets, candy,
cookies, chips, and sodas, change to skim milk and low fat dairy products. An increase in
physical activity is also recommended.
Weight loss in overweight children may not be appropriate if the child is an infant. Infant
through toddler years should be able to grow to their fullest potential before determining
whether or not weight should be of concern. If the child also does not pose any
intermediate health concerns or is recovering from surgery, weight should also not be of
concern.
Cited: Weight Management. (n.d.). Retrieved October 9, 2015, from
http://www.stanfordchildrens.org/en/topic/default?id=weight-management-andadolescents-90-P01626
5. What would you recommend as the current focus for nutritional treatment of
Missys obesity?
I would recommend a few dietary changes for Missy as the current focus for her
nutritional treatment. Based on her 24-hour diet recall, it was shown that she consumes a
lot of high-fat foods as well as some sugary beverages. Emphasis on increasing her fruit
and vegetable intake will be an important part of the process. Eating more whole grains
will also be emphasized. Since her parents are the main givers of food, educating them as
well as Missy on these new dietary changes will be key to having a successful nutritional
treatment.
6. Overweight or obesity in adults is defined by BMI. Children and adolescents are
oftentimes classified as overweight or at risk for overweight based on their BMI
percentiles, but this classification scheme is by no means universally accepted. Use

three different professional resources and compare/contrast their definitions for

overweight conditions among the pediatric population.
a) Overweight is a body weight in excess of some standard weight, usually in
relation to height. For children and adolescents, overweight is defined using the
U.S. Centers for Disease Control and Prevention growth charts that provide the
body mass index-for-age percentiles. Children having a BM-for-age greater than
or equal to 85th percentile but less than the 95th percentile are considered
overweight, while those have a BMI-for-age greater than 95th percentile are
considered obese (Nelms 256).
Cited: Nelms, M., Sucher, K., & Lacey, K. (2016). Disease of the Cardiovascular System.
In Nutrition Therapy and Pathophysiology (Third ed., pp. 256-262). Boston, MA:
Cengage Learning.
b) In children, there are no risk-based fixed values of BMI used to determine
overweight, because it is unclear what risk-related criteria to use. The long time
span before adverse outcomes appear and the small samples identifying
cardiovascular risks in youth make finding risk-related cutoffs difficult.
Consequently, a statistical definition of overweight based on the 85th and 95th
percentiles of BMI-for-age in a specified reference population is often used in
childhood.
Cited: Health Education Research. (n.d.). Retrieved October 9, 2015, from
http://her.oxfordjournals.org/content/21/6/755.full
c) Body mass index (BMI) is a measure used to determine childhood overweight and
obesity. Overweight is defined as a BMI at or above the 85th percentile and below
the 95th percentile for children and teens of the same age and sex. Obesity is
defined as a BMI at or above the 95th percentile for children and teens of the
same age and sex.

Cited: Defining Childhood Obesity. (2015, June 19). Retrieved October 9, 2015, from
http://www.cdc.gov/obesity/childhood/defining.html

When comparing all three of these definitions, they all are saying relatively the same
thing: BMI percentile is the main factor when determining childhood overweight and
obesity.
7. Evaluate Missys weight using the CDC growth charts provided. What is Missys
BMI percentile? How would her weight status be classified by each of the standards
you identified in question 6?
Based on Missys weight and height, 115 pounds and 57 inches respectively, and with her
age of 10 years old, she falls within the 80-85th percentile for her height and the 97th
percentile for her weight. Her BMI is between 24-25 kg/m2 and this value, based on her
anthropometric data, would place her in the 97th percentile. Therefore, Missy is
considered obese using all three of the standards that were identified in question 6.
8. If possible, RMR should be measured by indirect calorimetry. Identify two
methods for determining Missys energy requirements other than indirect
calorimetry and then use them to calculate Missys energy requirements.
a) EER for Females 9 through 18 years. PA = 1.16 for low active
EER = 135.3 30.8 x age + PA x ((10 x weight) + 934 (height)) +25
135.3 30.8(10) + 1.16((10x52.2) + 934(1.45)) + 25
= 2029
(2000-2100 calories in order to maintain current weight)
b) TEE for overweight females aged 3-18. PAL = 1.18 for low active
TEE = 389 41.2 x age + PA x 15 x weight + 701.6 x height
389 41.2(10) + 1.18 x 15(52.2) + 701.6 x 1.45
= 1918 calories (1900-2000 calories)
REE = TEE/PAL 1918/1.18 = 1626 calories (1600-1700)
Weight: 115 lbs x 0.4536 kg = 52.2 kg
Height: 57 x 2.54 cm = 145 cm = 1.45 m

9. Dietary factors associated with increased risk of overweight are increased dietary
fat intake and increased kilocalorie-dense beverages. Identify foods from Missys
diet recall that fit these criteria. Calculate the percentage of kilocalories from each
macronutrient and the percentage of kilocalories provided by fluids for Missys 24hour recall.
Foods from Missys diet recall that fit the criteria of high fat and kilo-calorie dense
beverages include: the two breakfast burritos (most likely containing cheese and meat
which can be high in fat), whole milk (high fat), coffee with cream (cream adds fat), two
pieces of bologna and cheese (both high fat), 1 tbsp mayo (high fat), corn chips and 2
Twinkies (both high fat), grape jelly (high sugar), fried chicken (high fat), mashed
potatoes (would be fine, except prepared with whole milk and butter for more fat), fried
okra (high fat), and the Coke she consumes for a snack (high sugar). Below is the
breakdown of Missys macronutrients based on her dietary recall:
Nutrients

Target

Average Eaten

Status

Total Calories

1600 Calories

5178 Calories

Over

Protein (g)***

34 g

240 g

OK

Protein (% Calories)***

10 - 30% Calories

19% Calories

OK

Carbohydrate (g)***

130 g

463 g

OK

Carbohydrate (% Calories)***

45 - 65% Calories

36% Calories

Under

Dietary Fiber

26 g

24 g

Under

Total Sugars

No Daily Target or Limit

194 g

No Daily Targ
Limit

Added Sugars

No Daily Target or Limit

115 g

No Daily Targ
Limit

Total Fat

25 - 35% Calories

46% Calories

Over

Saturated Fat

< 10% Calories

15% Calories

Over

Polyunsaturated Fat

No Daily Target or Limit

10% Calories

No Daily Targ
Limit

Monounsaturated Fat

No Daily Target or Limit

16% Calories

No Daily Targ
Limit

Linoleic Acid (g)***

10 g

51 g

OK

Linoleic Acid (% Calories)***

5 - 10% Calories

9% Calories

OK

-Linolenic Acid (% Calories)***

0.6 - 1.2% Calories

0.8% Calories

OK

-Linolenic Acid (g)***

1.0 g

4.4 g

OK

Omega 3 - EPA

No Daily Target or Limit

49 mg

No Daily Targ
Limit

Omega 3 - DHA

No Daily Target or Limit

232 mg

No Daily Targ
Limit

Cholesterol

< 300 mg

1360 mg

Over

Percentage of kilocalories for each macronutrient:

Protein = 19%
Carbohydrates = 36%
Fat = 46%
(Saturated fat = 15%)
Calories provided by fluids:
28 oz whole milk = 521
4 oz apple juice = 57
6 oz coffee = 2
20 oz sweet tea = 119
12 oz Coca cola = 136
Total calories from beverages = 835
Percentage of calories from fluids = 5178 kcal/ 835 kcal = 0.16 16%

10. Increased fruit and vegetable intake is associated with decreased risk of
overweight. Using Missys usual intake, is Missys fruit and vegetable intake
adequate?
Missys fruit and vegetable intake is extremely low. As far as her fruit intake, she
consumes hardly any. She drinks apple juice for breakfast and has grape jelly on her
sandwich at lunch. Both of which will have lots of added sugars and are both processed.
The nutritional value of these two fruit items is limited and not what they could be if
she would eat an apple or a bag of grapes instead. Her only source of vegetable intake
occurs at dinner with mashed potatoes and fried okra. While this may account for a few

servings of vegetables, the mashed potatoes will most likely have added fat to them and
the okra is fried in fat as well.
11. Use the MyPyramid Plan online tool to generate a personalized MyPyramid for
Missy. Using this eating pattern, plan a 1-day menu for Missy.

eal Plan A(based on a 1600

Afternoon Snack

Calorie Plan)

Dinner

Morning
cup(s) Vegetables Lunch
Snack 2 ounce(s) Grains
cup(s) Dairy
Breakfast
1 cup(s) Vegetables
1 ounce(s)
1 ounce(s)1 Grains
cup(s)
Dairy Grains
cup(s) Vegetables
cup(s) Fruits
2ounce(s)
Protein Foods
1 ounce(s) Grains
Above is a
generalized eating pattern for Missy

cup(s)
Fruits
cup(s) Fruits
based
on
a
1600-calorie
diet.
1 cup(s) Dairy
cup(s) Dairy
2 ounce(s) Protein Foods
Meal
Food
Grai
Vegetables
Fruit Dair Protei
Item
n
s
y
n
Goal
5 oz 2 cups
1.5
3
5 oz
Amount
cups cups
Breakfa
st
Scrambled
1 oz
Egg (1)
Whole
1 oz
wheat
toast (1
slice)
Banana (1)
I cup
Skim Milk
1
cup
AM
Snack
Celery
1 cup
Peanut
2 oz
butter (2
T)
Lunch
Low2 oz
sodium

ham
sandwich
Low fat
cheese
Apple

cup
1
cup

Small
salad lowfat
dressing

cup

PM
Snack
Low-fat
yogurt
Strawberri
es

cup

cup

Dinner
Grilled
Chicken
Brown
Rice

2 oz
2 oz
(1/2
cup)

Cooked
Carrots
Skim Milk
Totals

cup

5 oz

2 cups

1.5
cups

1
cup
3
cups

5 oz

Above is a personalized 1-day meal plan for Missy using her generalized meal pattern.
Water will also be drunk throughout the day as well as meals that do not include milk.
12. Now enter and assess the 1-day menu you planned for Missy using the
MyPyramid Tracker online tool. Does this menu meet macro- and micronutrient
recommendations for Missy?
Yes, the above menu meets Missys macro- and micronutrient recommendations:
Nutrients

Target

Average Eaten

Total Calories

1600 Calories

1523 Calories

Protein (g)***

34 g

95 g

Protein (% Calories)***

10 - 30% Calories

25% Calories

Carbohydrate (g)***

130 g

176 g

Carbohydrate (% Calories)***

45 - 65% Calories

46% Calories

Dietary Fiber

26 g

21 g

Total Sugars

No Daily Target or
Limit

87 g

Added Sugars

No Daily Target or
Limit

5g

Total Fat

25 - 35% Calories

31% Calories

Saturated Fat

< 10% Calories

10% Calories

Polyunsaturated Fat

No Daily Target or
Limit

5% Calories

Monounsaturated Fat

No Daily Target or
Limit

12% Calories

Linoleic Acid (g)***

10 g

8g

Linoleic Acid (% Calories)***

5 - 10% Calories

5% Calories

-Linolenic Acid (% Calories)***

0.6 - 1.2% Calories

0.3% Calories

-Linolenic Acid (g)***

1.0 g

0.5 g

Omega 3 - EPA

No Daily Target or
Limit

10 mg

Omega 3 - DHA

No Daily Target or
Limit

35 mg

Cholesterol

< 300 mg

361 mg

Minerals

Target

Average Eaten

Calcium

1300 mg

1391 mg

Potassium

4500 mg

3489 mg

Sodium**

< 2300 mg

2754 mg

Copper

700 g

1001 g

Iron

8 mg

8 mg

Magnesium

240 mg

354 mg

Phosphorus

1250 mg

1715 mg

Selenium

40 g

110 g

Zinc

8 mg

10 mg

Vitamins

Target

Average Eaten

Vitamin A

600 g RAE

1278 g RAE

Vitamin B6

1.0 mg

2.2 mg

Vitamin B12

1.8 g

4.9 g

Vitamin C

45 mg

75 mg

Vitamin D

15 g

7 g

Vitamin E

11 mg AT

7 mg AT

Vitamin K

60 g

72 g

Folate

300 g DFE

320 g DFE

Thiamin

0.9 mg

1.4 mg

Riboflavin

0.9 mg

2.4 mg

Niacin

12 mg

26 mg

Choline

375 mg

434 mg

13. Why did Dr. Null order a lipid profile and a blood glucose test?
Dr. Null ordered a lipid profile and blood glucose test in order to assess her overall health
status. She is considered obese based on her BMI-to-age percentile. By doing a lipid
profile test, the doctor can assess how much fat is in the blood. This will show her LDL,
HDL, and overall cholesterol levels which is important when figuring out if Missy is at
risk for cardiovascular disease. Abnormal lipid levels for children is anything greater than
170 mg/dL for total cholesterol, greater than 110 mg/dL for LDL, and less than 55 mg/dL
for HDL. By performing a blood glucose test, this will show is Missy is at risk for
developing type 2 diabetes, since that is a risk factor of obesity. The test will show signs
of insulin resistance. A normal level for glucose in children is 70-110 mg/dL and any
value outside of this is considered abnormal. Missys glucose level is 108 mg/dL, which
is on the higher end of the acceptable range but still okay. Her HDL level is 50 mg/dL and
her LDL level is 110 mg/dL which both fall into the abnormal range (LDL is right on the
border of the high end). Her total cholesterol is 190 mg/dL, which is also above the
normal recommended value.
Cited: University of Rochester Medical Center. (n.d.). Retrieved October 9, 2015, from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90&ContentID=P01593
14. What lipid and glucose levels are considered to be abnormal for the pediatric
population?
In the pediatric population, abnormal lipid levels are as follows:

Total cholesterol greater than 170 mg/dL

LDL levels less than 130 mg/dL
HDL levels less than 55 mg/dL
Glucose levels: anything outside of 70-110 mg/dL is considered abnormal

Based on these values, and as stated in the previous question, Missy has abnormal total
cholesterol, HDL and LDL levels. Her glucose value is considered okay but still on the
higher end of the recommended value.
Cited: University of Rochester Medical Center. (n.d.). Retrieved October 9, 2015, from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90&ContentID=P01593

15. Evaluate Missys lab results.

Cholesterol
HDL
Glucose
A1C

Normal Range
120-199 mg/dL
> 55 mg/dL
110 mg/dL
3.9-5.2%

Missys Value
190 mg/dL
50 mg/dL
108 mg/dL
5.5%

Above are Missys abnormal lab values. Her total cholesterol, while still falling in the
normal range, is on the higher end, which should be monitored to make sure she does not
fall into the abnormal range. Her HDL value should be higher than what it currently is as
well. Her glucose level is also still within the normal range but on the higher end as well.
Her A1C level was greater than the normal range, indicating that Missy could have
already developed type 2 diabetes. The A1C test is a common blood test used to diagnose
type 1 and type 2 diabetes. The test reflects your average blood sugar level for the past
two to three months.
Cited: A1C test. (n.d.). Retrieved October 9, 2015, from http://www.mayoclinic.org/testsprocedures/a1c-test/basics/definition/prc-20012585

16. What behaviors associated with increased risk of overweight would you look for
when assessing Missys and her familys diets?
When assessing Missys and her familys diets, I would want to look at multiple factors in
order to determine any behaviors associated with increased risk of overweight. First, I
would want to look at what types of foods are being purchased (high-fat, high-sodium,
etc.) and then how those foods are being prepared, for example are their vegetables being
fried or steamed. I would want to look at who in the family prepares the meals to see if
they have any sort of nutritional education in order to know how to prepare healthy
family dinners. By seeing how often the family eats at home will give a good picture on
how often they also eat out at restaurants, which can be high-fat and high-sodium meals. I
would also want to look at how the family eats dinner. Whether the family sits down all
together to share the meal, if they eat it on the go, or in front of the TV, can change a
childs perspective on food.
17. What aspects of Missys lifestyle place her at increased risk for overweight?
Obviously Missys high-fat, high-sodium diet is a big aspect that puts her at increased
risk for being overweight. Another big aspect that can contribute to her being overweight
is her low activity level. By evaluating how the family lives, ergo whether they put
emphasis on watching TV or on physical activity, can give a good picture on why Missy
lives this sedentary lifestyle.
18. You talk with Missy and her parents. They are all friendly and cooperative.
Missys mother asks if it would help for them to not let Missy snack between meals
and to reward her with dessert when she exercises. What would you tell them?
I would tell them that snacking in between meals is fine and highly encouraged as long as
the snacks have a nutritional quality to them. It is recommended to eat six small meals a
day in order to keep the metabolism working efficiently and since Missy is still young,
having a high metabolism will be a good start to a healthy lifestyle. A snack in between
breakfast and lunch and then again in between lunch and dinner would be advised, just as
long as the snack is healthy such as a piece of fruit or some vegetables. Since Missy
probably goes to bed at an earlier time due to her age, a snack after dinner will most

likely not be needed. As far as dessert goes, I would tell them not to reward their daughter
with food, especially food of high fat, high sugar content. If they need a motivational
factor for Missy to start exercising, I would suggest doing a fun activity instead. For
example, if Missy exercises 30 minutes, 3 times a week, then on the weekend, the family
can take a family hike or play a board game together. Desserts should be limited in
portion size and in how often they are given; 2-3 times a week will be advised.
19. Identify one specific physical activity recommendation for Missy.
Since Missy is still of a younger age, I would recommended getting in involved in a
sports team or after school activity. Children at that age are usually very involved with
sports in general so it would be a great way for her to get exercise in as well as make
friends of her own age. If she meets new friends, maybe then she will also want to have
play dates with them instead of playing video games in the afternoons.
20. Select two high-priority nutrition problems and complete PES statements for
each.
Excessive fat intake (NI-5.5.2) related to consumption of foods high in fat as well as
saturated fats as evidenced by the patients 24-hour diet recall.
Physical Inactivity (NB-2.1) as related to a sedentary lifestyle as evidenced by BMI-forage in the 97th percentile and obesity.
21. For each PES statement written, establish an ideal goal (based on signs and
symptoms) and an appropriate intervention (based on etiology).
Goal Decrease fat intake to less than 30% of her total calories. Saturated fat should
also be decreased to below 7% of her total calories.
Intervention Reduce whole milk to 1% or skim, chose low-fat cheese and mayonnaise,
grilled chicken instead of fried, replace the corn chips and Twinkies in her lunch with a
piece of fruit or some vegetables.
Goal Increase her physical activity level to 30 minutes, 4-5 times a week.

Intervention Find out what sports Missy is interested in and then have her parents sign
her up for a club team or an after school program that will emphasize the need for
activity. Instead of having Missy play video games or read all the time, maybe have her
play outside to increase even more physical activity.
22. Mr. and Mrs. Bloyd ask about using over-the-counter diet ads, specifically Alli
(orlistat). What would you tell them?
I would advise them to avoid using over-the-counter diet ads. Alli specifically is a
medication approved by the US Food and Drug Administration for treatment of obesity in
adolescents; however, they must be aged 12 years and older. Other over-the-counter drugs
are not recommended for children under 18. Even for most adults, these diet ads are not
recommended. I would suggest increasing her physical activity and implementing a
healthier diet while Missy is still growing into her body. The family should be educated
on healthy eating habits that will allow Missy to make steady improvements appropriate
to her age and weight.
Cited: Rogovik, A., & Goldman, R. (n.d.). Pharmacologic treatment of pediatric obesity.
Retrieved October 9, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038814/

23. Mr. and Mrs. Bloyd ask about gastric bypass surgery for Missy. What are the
recommendations regarding gastric bypass surgery for the pediatric population?
Recommendations regarding gastric bypass surgery for the pediatric population are as
follows:

The child must have failed six or more attempts at weight management (this is

Missys first attempt).

Have attained skeletal maturity (Missy is still 10 years old, therefore she has not

grown as much as she can)

Be severely obese (Missy falls into the obese category but she is not severely yet)

Some doctors also recommend this surgery if the childs weight poses a greater health
threat than the potential risk of surgery. At the current moment, Missy has no known
health threats, such as heart disease. Due to these recommendations and the stage at
which Missy is at, it is not recommended that she undergo such a drastic surgery.
Cited: Adolescent Bariatric Surgery :: The Cleveland Clinic. (n.d.). Retrieved October 9,
2015, from https://weightloss.clevelandclinic.org/bsurgeryadolesandteen.aspx

24. When should the next counseling session with Missy be scheduled?
I would like to see Missy again in about 2-3 weeks. With diet change and an increase
of physical activity, weight loss will not happen as rapidly as some people think it
should. As long as Missy does not have any serious health concerns, giving her time
to get used to the lifestyle change will be beneficial to an overall success rate. I would
like to see if her sleep apnea episodes have decreased or if more action should be
taken. I would also like to take another 24-diet recall to make sure her diet is more
nutritious and includes less high-fat foods and less high-sugary beverages.
25. Should her parents be included? Why or why not?
Her parents should definitely still be included because Missy is still 10 years old. Her
parents are her main source for food and preparation of food so I would like them to
come in and so I can educate and assess how they have altered their daughters eating
habits. They also are in charge of monitoring her physical activity and I will want to
know how that is progressing as well. Since her parents seem to be cooperative and
willing to get involved, I dont see any problem with them being included on the
meeting. Missys parents will also be able to provide a level of support and
motivation for their daughter as she loses weight.
26. What would you assess during this follow-up counseling session?
During her follow-up counseling session, I will want to assess her weekly activity
levels as well as a food journal, or at minimum a 24-hour diet recall. I will want to see

if her consumption of fats (especially saturated), sugary beverages, and calories has
decreased at all. I will want to look at her lab values again, specifically lipid panels
and glucose, to see if any progress has been made. I will also assess her
anthropometric data, such as BMI and height, to see if any progress has been made. I
would also like to talk with her parents to see if she has been compliant with the diet
changes and what they have been doing in order to support their daughter in the
weight loss process.

Resources:
A1Ctest.(n.d.).RetrievedOctober9,2015,fromhttp://www.mayoclinic.org/tests
procedures/a1ctest/basics/definition/prc20012585
AdolescentBariatricSurgery::TheClevelandClinic.(n.d.).RetrievedOctober9,2015,
fromhttps://weightloss.clevelandclinic.org/bsurgeryadolesandteen.aspx
DefiningChildhoodObesity.(2015,June19).RetrievedOctober9,2015,from
http://www.cdc.gov/obesity/childhood/defining.html
HealthEducationResearch.(n.d.).RetrievedOctober9,2015,from
http://her.oxfordjournals.org/content/21/6/755.full
Nelms, M., Sucher, K., & Lacey, K. (2016). Disease of the Cardiovascular System. In
Nutrition Therapy and Pathophysiology (Third ed., pp. 256-262). Boston, MA:
Cengage Learning.
Rogovik,A.,&Goldman,R.(n.d.).Pharmacologictreatmentofpediatricobesity.
RetrievedOctober9,2015,from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038814/
SleepApneaTiedtoIncreasedRiskofStroke,April8,2010NewsReleaseNational
InstitutesofHealth(NIH).(n.d.).RetrievedOctober9,2015,from
http://www.nih.gov/news/health/apr2010/nhlbi08.htm
UniversityofRochesterMedicalCenter.(n.d.).RetrievedOctober9,2015,from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90&ContentID=P01593
WeightManagement.(n.d.).RetrievedOctober9,2015,from
http://www.stanfordchildrens.org/en/topic/default?id=weightmanagementand
adolescents90P01626
WhatIsSleepApnea?(2012,July10).RetrievedOctober9,2015,from
http://www.nhlbi.nih.gov/health/healthtopics/topics/sleepapnea