Healthy Habits Treatment Plan
Name:
Date of Visit:
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SMART Goals
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Medical Screening
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Body Mass Index: ____, ____- goal is < 85%
Blood pressure: ____
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Fasting blood sugar: ___
Hemoglobin A1c : ____
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Liver function tests: ___
Complete blood count:
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Vitamin D: ___
Thyroid function tests: ____
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LH/FSH: ___
Testosterone panel: ____
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Cholesterol: total cholesterol ____, triglycerides ____, LDL ____, HDL ____
Interpretation of medical screening:
Your BMI is > 85% which is placing you at risk for certain medical conditions.
Currently your screening tests are all normal. We recommend continued follow up in the Healthy
Habits Clinic to work on managing your weight to decrease the risk of developing future weight
related medical problems.
Your thyroid function tests are consistent with possible hypothyroidism. You should have your
thyroid function tests repeated when you come back for your follow up visit. A consult has been
placed to pediatric endocrinology to further investigate this concern.
Your complete blood count shows that you are slightly anemic. I would recommend starting a daily
iron supplement and repeating labs in 3 three months.
Your history and physical exam suggest obstructive sleep apnea. A consult will be placed to
pediatric pulmonology for further evaluation.
Your vitamin D level is low. Your level is consistent with vitamin D insufficiency or deficiency. I
would recommend a vitamin D and calcium supplement taken twice a day with meals. In addition I
would recommend a weekly high dose vitamin D regimen for the first 6 weeks of therapy. Your
vitamin D levels should be repeated in 3 months.
Based on the history you provided of irregular periods and your physical examination or elevated
testosterone levels, the possibility of polycystic ovarian syndrome should be investigated further.
You have been referred to pediatric endocrinology.
Your blood pressure is elevated for your age. Your blood pressure will continue to be monitored at
your follow up visits
Your blood sugar level/Hgb A1c indicates that you have impaired glucose tolerance/pre-diabetes.
You have been referred to Pediatric endocrinology for further evaluation of this concern.
Your liver function tests are elevated. This is associated with fat deposits in your liver (non –
alcoholic fatty liver disease, NAFLD) A consult has been placed to pediatric gastroenterology for
further evaluation of this condition.
Your cholesterol levels are elevated.
The first line of treatment for this/these medical condition is weight loss. Continued participation in
the Healthy Habits clinic with a goal of weight reduction equal to 10% of your current body weight is
recommended.
Your lab tests will be repeated in 6 months.
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Medications: (medications will be available for pick up at ____ pharmacy)
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Ferrous sulfate 325 mg by mouth twice a day or three times a day
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Vitamin D 50,000 international units once a week x 6 weeks
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Oscal 600mg Ca/400 international units Vit D one tab by mouth twice daily
Referrals: Call Central appointments in 2 business days to schedule appointment
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Pediatric Endocrinology
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Pediatric Pulmonology
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Pediatric Gastroenterology
Lab tests:
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Repeat ________ at next visit
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Repeat _________ in 3 months
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Repeat _________ in 6 months
Your Healthy Habits f/u visit is scheduled for: __________. Please arrive at building 17 (the gym) on
the WRNMMC campus at 1400. You and your parent (s) should wear clothes that are comfortable
for exercise.
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Bring to your next visit: Healthy Habits binder, power of 3 homework.
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Other Instructions:
Important phone numbers:
General Pediatrics Clinic WRNMMC Bethesda: 301-295-4941
Pediatric Subspecialty Clinic WRNMMC Bethesda: 301-295-4959
Central appointments: Bethesda: 1-866-628-9633 or 301-295-6289
For Developmental Pediatrics (Stacey Williams), call 301-319-4095 to schedule