Zach Wallace / William Norris

Anthony Zamora / Aaron Robert Hight

Case Study One: Pediatric Weight Management

Childhood Obesity/Overweight
-

On the rise

Immediate Health Effects

Long-term Health Effects

How?

The Causes
-

Available options

Screen time

Parents

Acceptance

Household Income

Physical Education

Advertising

Its Serious

Domain 5
Personal History:

Patient is a 10 y.o. Caucasian female with no known allergies.

Patient was a full-term infant with a birth weight of 10 lbs 5 0z; 23

length.

Chief Complaint: Parents concerned that the patient ceases to

breathe while sleeping for at least 10 seconds per episode.

Domain 5
Parents also report snoring, restlessness during sleep, enuresis,
and morning headaches

Onset approximated a year prior to arrival.

According to parents, patients teacher reports that the patient has

difficulty concentrating in class and is not performing as well.

Domain 5
Past Medical History: None

Past Surgical History: None

Past Family History: Mother was diagnosed with possible gestational

diabetes. Mother and grandmother was diagnosed with type 2 DM.

Social History:
The second of three children.
Elementary grade: 3rd

Domain 1
The Patients Dietary History (24-hour recall):
Morning

Lunch

Dinner

Snacks

2 breakfast burritos

2 bologna and
cheese sandwiches

Fried chicken (2
legs and 1 thigh)

2 slices enriched
bread

8 oz whole milk

2 tsp mayonnaise

1 cup mashed
potato

2 tbsp crunchy
peanut butter

4 oz apple juice

1 oz corn chips

1 cup fried okra

2 tbsp grape jelly

6 oz coffee

2 twinkies

20 oz sweet tea

12 oz whole milk

cup cream

8 oz whole milk

2 tsp sugar

3 cup popcorn
12 oz Coca Cola

Patients Dietary History (24-hour recall)

Lack of fruits and vegetables
Presence of processed foods:
o Ex. Fried chicken, breakfast burritos, bologna with mayonnaise, corn
chips, sweet tea, and coca-cola.

Domain 1
Analysis of Dietary Intake:

Percent kcal from macronutrients:

o Total- 4,251 kcal
o Protein- 580 kcal (~14%)
o Fat- 2079 kcal (~49%)
o Carbohydrates- 1592 kcal (~37%)
Percent of kcal from fluids:
o milk- 160 kcal
o apple juice- 78 kcal
o creamer- 80 kcal
o sugar- 33 kcal
o sweet tea- 77 kcal
o milk- 160 kcal
o coca-cola- 140 kcal
o milk- 192 kcal
o Total kcal from fluids: 920 kcal (22% kcal from fluids)
Diet analyzed using SuperTracker

Domain 1
Food and Nutrient Administration: Per Os

Food Allergies/ intolerances/ aversions: NKA

No previous nutrition therapy

Prescription Medication: None

Vitamin Supplementation: Flintstones Vitamin Daily

Domain 1
Behavior
o Very good appetite
o Consumes a wide variety of foods
Factors Affecting Access to Food
o Food purchased/prepared by parent(s)
Physical Activity and Function
o Low levels of physical activity
o Spends free time playing video games/ reading
o Decreased level of school work performance

Domain 3
Biochemical Data: Chemistry

Ref. Range

9/22

Sodium (mEq/L)

136-145

142

Potassium (mEq/L)

3.5-5.5

4.3

Chloride (mEq/L)

95-105

101

BUN

8-18

Creatine

0.6-1.2

0.6

Glucose

70-110

112*

HDL-C (mg/dL)

>55 F, >44 M

34*

LDL (mg/dL

<3.22 F, <3.55 M

3.23*

HbA1C

3.9-5.2

4.9

Domain 4
Nutrition Focused Physical Findings (PD)

Body Language: Somewhat tired and irritable

Cardiovascular/pulmonary: Regular rate and rhythm

Extremities: No joint deformity or muscle tenderness- complains of occasional

knee pain
Head/Eyes/Ears/Nose/Throat: normal- Tonsillar hypertrophy (Dx)
Nerves and Cognition: Alert, oriented x 3 (person,place,time)

Domain 4
Skin: Warm, dry; reduced capillary refill (~2 seconds); slight rash in skin folds

Abdomen: Obese
Vital Signs: normal temperature/pulse/BP
Weight: 115 lbs
BMI: 24.9

Height:57 (49)

Domain 2
Anthropometrics Measurements (AD)

Height:57
Weight: 115 lbs

Weight change: steady weight gain for past several years >10 lbs/yr
BMI: 24.9 kg/m2

Growth Pattern/Percentile Rank: >95 percentile for weight for age (CDC)

Domain 6
-Weight and Growth
Recommendations
-CDC BMI for Female
Age 2-20yrs

Domain 6
Comparative Standards (CS)

-Energy Needs: TEE (for weight maintenance in overweight 3-18)

= 389 (41.2 x age) + PA x (15 x weight [kg] + 701.6 x height [m])
=2317kcal

For weight loss in pediatric patients, Recommendations for Treatment of Child

and Adolescent Overweight and Obesity from Pediatrics gives one
recommendation of a restricted calorie diet (not less than 1200 kcals).
MICRONUTRIENT REQUIREMENTS

Domain 6
Comparative Standards (CS)
-Macronutrient Requirements:
TEE= 2317
Carbohydrates: 260-375g or 1040-1500 kcal

Fat: 65-90g or 580-810 kcal

Protein: 60- 175g or 230-695 kcal

*Macronutrient intake recommendations from AND

(Academy of Nutrition and Dietetics)

Nutrition Diagnosis
1. Excessive energy intake related to energy dense food choices as
evidenced by intake of high fat, high sugar foods and BMI of 24.9 kg/m2.
1. Physical inactivity related to sedentary lifestyle as evidenced by lack of PE
in school and primary free time activities consisting of video games and
reading.

Nutrition Intervention
Goal: Weight loss with an emphasis on weight management
Skill development for selecting healthy options, being more energy conscious
Education (child and parents) regarding priorities, nutritions relationship to
health, and recommended modifications by support team

Nutrition Monitoring / Evaluation

Weight:
Goal: Stop weight gain- reach weight of 55-90 lbs
Energy Intake:
Goal: Reduce energy intake to 1600 kcals/d

Self-Monitoring
Goal: Increase client awareness about nutrient intake- client keeps track of
intake
Physical Activity
Goal: Increase physical activity to moderate exercise 3 times per week for
60 minutes.

ADIME Note
A:

CH:

Personal Hx: Age: 10 Gender: F

Race/Ethnicity: Caucasian

Tobacco: No

Patient nutrition medical history:

Chief Complaint: Parents describe patient has been experiencing disturbed sleeping for past several
years. Symptoms include sleeping with mouth open, cessation of breathing for periods of 10s, snoring,
enuresis, and morning headaches.
Endocrine/metabolism: Maternal grandmother and mother with T2DM
Medical History: none
Surgical History: none

ADIME Note
A:

FH:

Food purchasing: Parents

ADIME Note
A:

D:

AD:

Height: 49

Weight: 115 lbs

Weight Change: >10 lbs increase per year

BD:

Glucose: 112 mg/dL

PD:

Vital Signs: BP: 123/80 mm Hg

CS:

TEE: 1711-2378 kcal/d (Mifflin St. Jeor with 1.39 AF)

HDL-C: 34 mg/dL
Pulse: 85

BMI: 24.9

LDL/HDL: 3.23
Resp Rate: 27

Inadequate energy expenditure r/t lack of activity (and removal of PE, art, and music classes) as evidenced by steady
weight gain (>10 lbs) over past several years.
Excessive energy intake r/t lack of access to healthy food choices (parents buy/prepare) as evidenced by diet history and
BMI of 24.9

AIDME Note
I: Nutrition Prescription: Patient should work to consistently follow her planned menus and maintain an energy balance of 1600
kcals a day. Nutrition education-content included recommended modifications of dietary intake to reduce high-fat food choices.

ME: Weight, energy intake, lipid profile, BMI, and blood glucose,

Real Life: What can we do?

1.
2.
3.
4.
5.

Small steps, big wins

Practice what you preach
Take out the trash
Its a lifestyle change
Let them be kids
- In Moderation
6. Encourage physical activity
7. Educate

Key Resources
University of Southern California - Understanding Childhood Obesity

Center for Disease Control and Prevention - Childhood Obesity

SPARK: Countering Childhood Obesity since 1989

School Health Guidelines to Promote Healthy Eating and Physical Activity

Let's Move