childhood obesity/overweight case study presentation

8/10/2019 Childhood Obesity/Overweight Case Study Presentation

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Zach Wallace / William Norris

Anthony Zamora / Aaron Robert Hight

Case Study One: Pediatric Weight Management


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Childhood Obesity/Overweight

- On the rise

- Immediate Health Effects

- Long-term Health Effects

- How?


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- Available options

- Screen time

- Parents

- Acceptance

- Household Income

- Physical Education

- Advertising

The Causes


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Its Serious


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Domain 5

Personal History: Patient is a 10 y.o. Caucasian female with no known alle

Patient was a full-term infant with a birth weight of 10 lbs

length.

Chief Complaint: Parents concerned that the patient cea

breathe while sleeping for at least 10 seconds per episod


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Domain 5

Parents also report snoring, restlessness during sleep, e

and morning headaches

Onset approximated a year prior to arrival.

According to parents, patients teacher reports that the p

difficulty concentrating in class and is not performing as


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Domain 5

Past Medical History:None

Past Surgical History:None

Past Family History:Mother was diagnosed with possible gediabetes. Mother and grandmother was diagnosed with type 2 DM.

Social History: The second of three children.

Elementary grade: 3rd


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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 3 cup popcorn

2 tsp sugar 12 oz Coca Cola


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Patients Dietary History (24-hour recall)

Lack of fruits and vegetables

Presence of processed foods:

o Ex. Fried chicken, breakfast burritos, bologna with mayonn

chips, sweet tea, and coca-cola.


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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 kcalo 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


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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


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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


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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 8

Creatine 0.6-1.2 0.6

Glucose 70-110 112

HDL-C (mg/dL) >55 F, >44 M 34*

LDL (mg/dL


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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 oknee pain

Head/Eyes/Ears/Nose/Throat:normal- Tonsillar hypertrophy (Dx)

Nerves and Cognition:Alert, oriented x 3 (person,place,time)


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Domain 4

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

Abdomen: Obese

Vital Signs: normal temperature/pulse/BP Height:57 (4

Weight: 115 lbs

BMI: 24.9


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Domain 2

Anthropometrics Measurements (AD)

Height:57

Weight: 115 lbs

Weight change: steady weight gain for past several years >10 lbs

BMI: 24.9 kg/m2

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


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Domain 6

-Weight and Growth

Recommendations

-CDC BMI for Female

Age 2-20yrs


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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 he

=2317kcal

For weight loss in pediatric patients, Recommendations for Treatme

and Adolescent Overweight and Obesity from Pediatrics gives one

recommendation of a restricted calorie diet (not less than 1200 kca

MICRONUTRIENT REQUIREMENTS


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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 Diet


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Nutrition Diagnosis

1. Excessive energy intake related to energy dense food choices

evidenced by intake of high fat, high sugar foods and BMI of 24

1. Physical inactivity related to sedentary lifestyle as evidenced b

in school and primary free time activities consisting of video ga

reading.


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Nutrition Intervention

Goal: Weight loss with an emphasis on weight management

Skill development for selecting healthy options, being more energy

Education (child and parents) regarding priorities, nutritions relation

health, and recommended modifications by support team


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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 ke

intake

Physical Activity

Goal: Increase physical activity to moderate exercise 3 times p

60 minutes.


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ADIME NoteA: 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 pas

years. Symptoms include sleeping with mouth open, cessation of breathing for periods of 10

enuresis, and morning headaches.

Endocrine/metabolism: Maternal grandmother and mother with T2DM

Medical History: none

Surgical History: none


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ADIME NoteA: FH:

Food purchasing: Parents


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ADIME NoteA: AD: Height: 49 Weight: 115 lbs Weight Change: >10 lbs increase per year BMI: 24.

BD: Glucose: 112 mg/dL HDL-C: 34 mg/dL LDL/HDL: 3.23

PD: Vital Signs: BP: 123/80 mm Hg Pulse: 85 Resp Rate: 27

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

D: Inadequate energy expenditure r/t lack of activity (and removal of PE, art, and music classes) as evidenceweight 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

BMI of 24.9


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AIDME NoteI: Nutrition Prescription: Patient should work to consistently follow her planned menus and maintain an ener

kcals a day. Nutrition education-content included recommended modifications of dietary intake to reduce high-

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


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Real Life: What can we do?

1. Small steps, big wins

2. Practice what you preach

3. Take out the trash

4. Its a lifestyle change

5. Let them be kids

- In Moderation

6. Encourage physical activity7. Educate


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Key Resources

University of Southern California - Understanding Childhood Obesit

Center for Disease Control and Prevention - Childhood Obesity

SPARK: Countering Childhood Obesity since 1989

School Health Guidelines to Promote Healthy Eating and Physical A

Let's Move
http://rossieronline.usc.edu/understanding-childhood-obesity/http://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://www.sparkpe.org/http://www.cdc.gov/healthyyouth/npao/strategies.htmhttp://www.letsmove.gov/http://www.letsmove.gov/http://www.letsmove.gov/http://www.cdc.gov/healthyyouth/npao/strategies.htmhttp://www.sparkpe.org/http://www.sparkpe.org/http://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://www.cdc.gov/healthyyouth/obesity/facts.htmhttp://rossieronline.usc.edu/understanding-childhood-obesity/http://rossieronline.usc.edu/understanding-childhood-obesity/http://rossieronline.usc.edu/understanding-childhood-obesity/http://rossieronline.usc.edu/understanding-childhood-obesity/

childhood obesity/overweight case study presentation

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