Grace Burton
NTR 573 case study 1
2. Describe health consequences of overweight and obesity for children.
Health consequences of overweight and obesity for children include risks of
cardiovascular diseases, such as hyperlipidemia, hypertension, or hyperinsulinemia.
There is also an increased risk for type 2 diabetes, development of other chronic
diseases, and health care costs. Furthermore, there are psychosocial difficulties,
such as discrimination from peers, a negative self-image, depression, and decreased
socialization.
3. Jamey has been diagnosed with obstructive sleep apnea. Define sleep apnea.
It is a common disorder in which you have 1 or more pauses in breathing or shallow
breaths while you sleep.
4. Explain the relationship between sleep apnea and obesity.
Sleep apnea can be caused in obese individuals due to enlarged tonsils, tongue, and
fat in the neck, which can obstruct the airway, causing breathing difficulties.
5. What are the goals for weight loss in the pediatric population?
The primary goal is to achieve healthy eating and activity, not to achieve IBW. This
will slow the rate of weight gain in kids and help them to maintain their weight,
which will cause their BMI to drop as they get taller. It is a long-term approach to
teach the children lifetime behavioral habits. It is a family-involved intervention
with plenty of support.
6. Under what circumstances might weight loss in overweight children not be
appropriate?
Weight loss in overweight children would not be recommended in babies and
children that are still growing and developing.
7. What would you recommend as the current focus for nutritional treatment of
Jamey’s obesity.
I would recommend maintaining her weight and adding in slow changes to her diet
and exercise habits to hopefully slow her weight gain. Overall, she eats high-fat
foods, so one way to limit these is to switch to skim milk and low-fat dairy products.
Furthermore, she needs to try to incorporate fruits and vegetables into her diet. She
should drink more water and less coke and sweet tea. Substitute the fruit and
vegetables for the chips and sweets. Basically, just aim for small gradual eating and
diet changes to improve her diet quality and slow her weight gain.
Grace Burton
NTR 573 case study 1
8. Evaluate Jamey’s weight using the CDC growth charts provided : What is Jamey’s
BMI percentile? How is her weight status classified? Use the growth chart to
determine Jamey’s optimal weight for height and age.
Her BMI is in the 97th percentile which classifies her as obese. Her optimal weight
for her age is 73 lbs and her optimal height for her age is 54 inches.
9. Identify two methods for determining Jamey’s energy requirements other than
indirect calorimetry, and then use them to calculate Jamey’s energy requirements.
Using prediction equations:
TEE=389-41.2 X age + PA X (15 X weight (kg) + 701.6 X height (m))
TEE= 389-41.2(10) + 1 X (15*52.27) + (701.6 *1.45)
TEE=389-412 + (784.05+1,017.32)
TEE=1778.37 calories per day
EER=1470 calories per day based on the IOM’s EER chart for adolescent females
10. Dietary factors associated with increased risk of overweight are increased
dietary fat intake and increased calorie-dense beverages. Identify foods from
Jamey’s diet recall that fit these criteria.
High fat foods in her diet include breakfast burritos, bologna and cheese sandwiches
with mayonnaise, fritos, twinkies, fried chicken, mashed potatoes, and fried okra.
Calorie-dense beverages in her diet include whole milk, cream, coke, and sweet tea.
11. Calculate the percent of kcal from each macronutrient and the percent of kcal
provided by fluids for Jamey’s 24-hour recall.
Total calories consumed: 4,917
Protein: 189 g ; 15% of total kcal
Carbohydrates: 458 g ; 37% of total kcal
Fat: 262 g ; 48% of total cal
Percent of kcal provided by fluids: 912/4917 = 18.5% kcal from fluids
12. Increased fruit and vegetable intake is associated with decreased risk of
overweight. What foods in Jamey’s diet fall into these categories?
Jelly, okra, and mashed potatoes, all of which contained high fat or high sugar.
13. 1-day menu for Jamey
Breakfast: ½ cup oatmeal, 1 cup FF milk, 2 tbsp raisons, 1 cup orange juice
Grace Burton
NTR 573 case study 1
Lunch: 2 slices whole wheat bread, 2 oz lean roast beef, 1 slice part-skim cheese, 2
slices tomato, 1 tsp mustard, medium peach, cup of FF milk
Dinner: 3 oz cooked chicken breast, whole wheat roll, ½ cup cooked green beans, ½
large baked potato, 1 cup water
Snack: 1 cup yogurt, ½ cup berries
15. Why did Dr. Lambert order a lipid profile and blood glucose test? What lipid and
glucose levels are considered altered for the pediatric population? Evaluate Jamey’s
lab results.
She is overweight and she consumes a high-fat, high-sugar diet, putting her at risk
for high cholesterol and high blood glucose levels. Her blood glucose levels are
higher than normal, her HDL levels are lower than normal, and her LDL/HDL ratio is
larger than normal. These levels can put her at an increased risk for chronic diseases
later in life, such as diabetes, hypertension, high blood pressure, and cardiovascular
disease.
16. What behaviors associated with increased risk of overweight would you look for
when assessing Jamey’s and her family’s diets? What aspects of Jamey’s lifestyle
place her at increased risk for overweight?
Their food preparation methods can lead to a risk of being overweight. They
consume fried instead of baked foods, and they prepare their foods with high-fat
dairy products and butter. The fact that her physical activity level is low along with
no physical education in school combined with the fact that she likes to spend time
playing video games and reading all shows signs of an increased risk for being
overweight.
17. Jamey’s 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?
If she is hungry, feed her healthy snacks so that she does not overeat at dinner time.
If she gets a dessert reward for every time she exercises, it would kind of cancel out
her exercise time. Instead of a reward every time she exercises, maybe have dessert
be a treat on the weekends, for example.
18. Identify one specific physical activity recommendation for Janey.
60 minutes of physical activity per day.
21. Mr. and Mrs. Whitmer ask about using over-the-counter diet aids, specifically Alli
(orlistat). What would you tell them?
I would not recommend any diet pills or supplements because it is important that
she learn healthy long-term lifestyle habits so that she can maintain a healthy
weight and lead a healthy life rather than a quick fix type of approach.
Grace Burton
NTR 573 case study 1
22. Mr. and Mrs. Whitmer ask about gastric bypass surgery for Jamey. Using the EAL,
what are the recommendations regarding gastric bypass surgery for the pediatric
population?
It is not recommended that obese children under the age of 13 get weight-loss
surgery.
23. What is the optimal length of weight management therapy for Jamey?
An optimal length for weight management therapy would last until Jamey is finished
growing and developing.
24. Should her parents be included? Why or why not?
Yes, because it makes the adjustment much easier for her if the whole family is
practicing a healthy lifestyle and diet behaviors together. She is still a child and does
not make the food choices and she does not buy any of the food either, so therefore,
it is extremely important that her family support her and adopt the healthy lifestyle
along with her.
25. What would you assess during this follow-up counseling session?
I would ask if any lifestyle changes had been made and how they made Jamey and
her parents feel. Did they feel like they were overall positive or negative changes?
Are there any questions or concerns? I would use positive reinforcement to
encourage them to keep up any positive changes and to gradually add more in to
ensure they are doing everything possible to lead a healthy life.