FN 418/618: Medical Nutrition Therapy II Spring 2017

Pediatric Weight Management Case Study

Dakota Cossairt
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Need to plot her BMI on the growth chart

Need to assess her oral intake...is it high in fat or calories? based on what you stated it would lead me to be
concerns.

Protein recommendations?

Be more specific on the Nutrition prescription. be more specific on what nutrition education you would provi

A
Jamey Whitmer is a 10 yo white female whose parents brought her into her
pediatrician with concerns about her breathing patterns in her sleep. She has
been diagnosed with sleep apnea r/t her weight. Onset of disease includes
sleep disturbance for the past several years, including: sleeping with her
mouth open, cessation of breathing for at least 10 sec (per episode), snoring,
restlessness during sleep, enuresis, and morning headaches.
Jamey has a very good appetite with consumption of a wide variety of foods.
Her physical activity level is generally low, and she has steadily gained
weight over past several years >10#/year. Physical finding show she has
dry mucous membranes, slight rash in skin folds, occasional knee pain, and
is a somewhat tired and irritable 10 yo. Family medical history includes
mother and grandmother with possible gestational diabetes and type 2 DM.
Her most recent lab values indicate increased levels of glucose and LDL/HDL
ratio, and decreased levels in HDL-C. Nutritional intake from 24-hr recall =
4,488 kcal

Ht. = 57 Wt. = 115# BMI = 24.9 BP =

123/80 mmHg

Recommended kcals = 1,200-1,360 kcal/day

D Excessive energy intake R/T increased consumption of high fat foods and
high calorie beverages AEB 24-hr recall and BMI of 24.9.

I RD recommends patient to reduce about of calories, which come from fat

to 25-35% of total calories. RD recommends patient to increase physical
activity level to help reduce BMI to a healthy range. RD educated patient on
portion control. RD provided healthier snack option ideas.

ME
Schedule f/u in 1 week. RD will have patient and family keep food diaries for
f/u. Run pertinent labs

1-Day Meal Plan

Total Calories = 1,330

Breakfast
1 cup oatmeal
cup raspberries
8 oz. skim milk

Snack
2 cups popcorn
cup strawberries

Lunch
2 slices WW bread
2 tbsp. peanut butter
cup raw carrots
cup celery
cup apple slices

Snack
1 cup frozen yogurt

Dinner
3 oz. grilled or baked chicken
1 cup lettuce w/ lite dressing
cup carrots
cup tomatoes
cup brown rice
8 oz. skim milk
Education/Counseling Tool
https://cspinet.org/protecting-our-health/nutrition/healthy-school-snacks

Questions
1. Current research indicates that the cause of childhood obesity
is multifactorial. Briefly outline the roles of genetics,
environment, and nutritional intake in development of obesity
in children.
a. Genetics
i. They could gain genes from their parents which help them
easily gain weight
ii. They could also inherit medical disorders caused by their
overweight parents.
b. Environment
i. Children with parents, siblings, or other family members
who are overweight have an increased risk of becoming
overweight.
ii. Many families live very busy, on the go lifestyles, which
gives them less time to prepare meals, resulting in more
fast food and convenience store food consumption
iii. Most kids spend a large chunk of their life at school and
around friends. This can lead to peer pressure, as well as
give them easy access to vending machines that dont
typically supply healthy food options.
c. Nutritional Intake
i. Many children now consume an increased amount of kcals
and fat and a decreased amount of fruit and vegetables.
This is partially due to restaurants and food companies
overemphasizing large portion sizes, buffets, and
processed foods.

2. Describe health consequences of overweight and obesity for

children
 a. They could have high blood pressure and high cholesterol, which
are risk factors for CVD
b. They have increased risks of impaired glucose intolerance,
insulin resistance, and type 2 DM
c. They could also develop breathing problems like sleep apnea and
asthma, as well as joint problems, and musculoskeletal
discomfort

3. Jamey has been diagnosed with obstructive sleep apnea.

Define sleep apnea.
a. Sleep apnea is a disorder, which causes someone to have one or
more pauses in breathing or shallow breaths while sleeping.

4. What are the goals for weight loss in the pediatric population?
a. According to the Academy of Nutrition and Dietetics the main
goal is to avoid restrictive diets and excessive exercise regimens.
b. Another goal is to ensure that children grow and develop
normally in order to reach a health weight.

5. Under what circumstances might weight loss in overweight

children not be appropriate?
a. Children need calories for growth and development, in addition
to the calories that their body requires for daily metabolism and
physical activity. If you cut a childs calorie intake, you could
affect their bodys ability to grow and develop properly.

6. What would you recommend as the current focus for

nutritional treatment of Jameys obesity?
a. Increasing physical activity by playing outside more and going on
family walks
b. Slowly start to introduce more healthy food options into her diet
and cut back on the amount of saturated fat and sodium she
eats.
c. Being more aware of portion control. For example, reducing her 2
breakfast burritos in the morning to 1 burrito and having 1
bologna sandwich instead of 2 would be a appropriate meal
portions for a 10 yo.

7. Evaluate Jameys weight using the CDC growth charts

provided: What is Jameys BMI percentile? How is her weight
status classified? Use the growth chart to determine Jameys
optimal weight for height and age.
a. Jameys BMI places her in the 97th percentile. This classifies her
weight status as obese. Looking at the chart, her optimal weight
for height and age is 92#.
8. Identify two methods for determining Jameys energy
requirements other than indirect calorimetry, and then use
them to calculate Jameys energy requirements.

Mifflin St. Joer

(10 x weight kg) + (6.25 x height cm) (5 x age) 161
(10 x 52.2 kg) + (6.25 x 145 cm) (5 x 10 yr old) -161
= 1,217 kcals

Harris Benedict
655 + (9.56 x wt (kg)) + (1.85 x ht (cm)) (4.68 x age (yrs))
655 + (9.56 x (52.2 kg)) + (1.85 x (145cm)) (4.68 x (10))
=1,376 kcals

9. Dietary factors associated with increase risk of overweight are

increased dietary fat intake and increased calorie-dense
beverages. Identify foods from Jameys diet recall that fit
these criteria.
a. Dietary fat intake
i. Whole milk, cream, bologna, cheese, mayo, Fritos,
Twinkies, fried chicken, mashed potatoes with whole milk
and butter, and fried okra
b. Calorie-dense beverages
i. Whole milk, Coca-cola, sweet tea, and apple juice

10. Calculate the percent of kcal from each macronutrient

and the percent of kcal provided by fluids for Jameys 24-hour
recall.
Total kcals = 4,488
Fat= 200.8 grams x 9g = 1807.2/4,488 = 40.3%
Protein = 188.6 grams x 4 g = 754.4 / 4,488 kcals= 17%
Carbs= 486.0 grams x 4g= 1,944/4,488 kcals= 43.3%
Beverage= 810 kcals/4,488 kcals= 18%

15. Why did Dr. Lambert order a lipid profile and blood
glucose tests? What lipid and glucose levels are considered
altered (outside of normal limits) for pediatric population?
Evaluate Jameys lab results.
 a. To assess her current health state, and make sure she doesnt
have any other greater health risks.
b. Abnormal glucose levels = <70mg/dL and >110mg/dL
c. Abnormal cholesterol levels = <120 mg/dL and >199 mg/dL
d. Abnormal HDL levels = <55 mg/dL
e. Abnormal LDL levels = >130mg/dL
f. Jameys lab results indicated increased glucose levels
(112mg/dL), LDL/HDL ratio (3.23), and decreased HDL levels (34
mg/dL). All other results were within normal ranges.

16. What behaviors associated with increased risk of

overweight would you look for when assessing Jameys and her
familys diets? What aspects of Jameys lifestyle place her at
increased risk for overweight?
a. Total fat and saturated fat intake, portion sizes, meal
consumption frequency, and the amount of time they go out to
eat and/or eat fast foods.
b. Aspects of her lifestyle that place her at increased risk for
overweight include her sedentary physical activity level, the
large consumption of fatty foods, and the large portion sizes she
consumes.

17. You talk with Jamey and her parents, who are friendly and
cooperative. Jameys mother asks if it would help for them to
not let Jamey snack between meals and to reward her with
dessert when she exercises. What would you tell them?
a. I would tell her parents that giving Jamey snacks between meals
isnt a bad thing, its just the types of snacks that are chosen to
give her. I would recommend them to start giving her snacks like
fruits and vegetables, instead of Twinkies and Fritos. I would
advise her parents not to reward her with desserts when she
exercises, because this can not only send her mixed messages
about rewards, but it also defeats the purpose of increasing
physical activity and burning calories/fat. I would reward her with
things like movie night or family game nights instead.

18. Identify one specific physical activity recommendation for

Jamey.
a. I would recommend Jamey to find a sport or some sort of
extracurricular activity outside of school that she can become
part of. Even if its a couple of different things, she should aim to
get at least 30-60 minutes of physical activity 3 days a week.
She can then increase it up to 4-5 days a week.

19. Select two nutrition problems and complete PES

statements for each.
 a. Excessive energy intake R/T increased consumption of high fat
foods and high calorie beverages AEB 24-hr recall and BMI of
24.9.
b. Overweight/obesity R/T physical inactivity and increased energy
intake AEB BMI of 24.9

20. For each PES statement written, establish an ideal goal

(based on signs and symptoms) and an appropriate
intervention (based on etiology).

Goal- Control portion sizes of foods consumed and reduce BMI to

a healthy range.
Intervention- Decrease amount of kcals consumed from fat to 25-
35% of total calories.

Goal- lower BMI to 85th percentile

Intervention- Educate on healthy eating and provide examples on
foods that are nutrient-dense and low fat.