Emma Craig
Professor Matuszak
KNH 411
5 October 2014
Weight Management Case Study
I. Understanding the Disease and Pathophysiology
1. Current research indicates that the cause of childhood obesity is multifactorial. Briefly discuss
how the following factors are though to play a role in the development of childhood obesity:
biological (genetics and pathophysiology); behavior-environmental (sedentary lifestyle,
socioeconomic status, modernization, culture and dietary intake); and global (society,
community, organizational, interpersonal and individual).
Based on research, it is evident that childhood obesity and overweight occurs to do a
variety of factors. The first, biological, focuses on genetics and pathophysiology. It has been
shown that genes influence a person’s weight. If a person’s parents are overweight, this person
has a greater chance of being overweight as well. Additionally, children tend to pick up the
habits of their parents, which is especially true in the case of people who are overweight/obese.
Genes may also affect the amount of fat that is stored in the body and where this fat is located.
Pathophysiology plays a role when dealing with some hormone problems that can cause
overweight and obesity. These disorders include hypothyroidism, where the metabolism is
slowed down, Cushing’s syndrome, where too much cortisol is produced, and polycistic ovarian
syndrome, which occurs due to high levels of androgens.
Other influences on weight are behavioral-environmental factors, which include a
sedentary lifestyle, socioeconomic status, modernization, culture and dietary intake. These
aspects are interrelated. People who are inactive are more likely to gain weight because they are
eating more calories then they are burning. Often times, these people spend more time on the TV
and computer as well as other leisure activities. This relates to the modernization of culture,
because people rely on cars instead of walking, work at home due to technology and there is also
a lack of physical education classes in school. Dietary intake is also important, because people
who eat high-calorie, high-fat foods are more likely to be overweight/obese and live a sedentary
lifestyle. As for culture, society is at a point where portion sizes become bigger and bigger, yet
people still eat them. Additionally, as mentioned before children who grow up in an overweight
family often adopt the same lifestyle as their parents. It is also true that people who are of a
lower socioeconomic status tend to be overweight due to their lack of access to healthy foods. It
is cheaper to buy a fast food meal to feed a family compared to buying fresh fruits and
vegetables or there is just no grocery store with these healthy options.
Society, communities, organizations, interpersonal and individual factors play a role in
obesity and overweight as well. A lot of factors have been mentioned, for example
socioeconomic status relates to what sort of community a person lives in, and therefore what
access to foods they have. What sort of parents a person has plays a big role as well
interpersonally. Individual factors may relate to one’s dietary intake or current stress level, which
may cause him/her to eat more. A community without sidewalks may correlate to higher rates of
obesity due to a lack of physical inactivity. Additionally, in society food advertising plays a huge
role in what people eat. Often times, the benefits mentioned during the food advertisements are
exaggerated to seem much better than they really are. Depending on a person’s education level,
they may be led to believe the ads.
What Causes Overweight and Obesity? (n.d.). Retrieved October 13, 2014, from
http://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes.html
2. Describe health consequences associate with an overweight condition. Describe how these
health consequences differ for an overweight versus obese condition.
When dealing with overweight and obesity, many of the health consequences related to
the disease are similar. When dealing with obesity, a patient is at much higher risk for these
consequences, and at a much higher risk for morbid obesity as well. There are psychosocial and
emotional consequences, such as feeling the pressure of being thin. Additionally, they may feel
guilt, depression, anxiety and self-worth. Type two diabetes, metabolic syndrome, high blood
pressure, lipid abnormalities, hepatobiliary disorders, cancers, reproductive disorders and
premature death are all major health consequences overweight and obese people need to be
aware of (Nelms, 253).
3. Missy has been diagnosed with obstructive sleep apnea. Define sleep apnea. Explain the
relationship between sleep apnea and obesity.
Sleep apnea is a disorder where there is one or more pauses in breathing while sleeping.
When breathing resumes, there is often a snort or choking sound. Specifically, obstructive sleep
apnea occurs when the throat muscles intermittently relax and block areaway during seep. This
causes a child to stop breathing repeatedly during sleep. Obesity is a major risk factor for sleep
apnea because as more weight is stored in the trunk and neck area, the harder it is for the
respiratory tract to function properly. All of the pressure applied to the trunk and neck area when
a child is laying on a flat surface may cause the throat muscles to relax.
Obesity and Sleep. (n.d.). Retrieved October 13, 2014, from http://sleepfoundation.org/sleeptopics/obesity-and-sleep/page/0,1/
II. Understanding the Nutrition Therapy
4. What are the goals for weight loss in the pediatric population? Under what circumstances
might weight loss in overweight children not be appropriate?
Weight loss goals include gradual weight loss until BMI is less than 85th percentile.
Weight loss should not exceed 1 lb/month in children 2-5 years or 2 lbs/week in older obese
children and adolescents. Weight loss is not recommended for children seven years or younger,
as they are still growing and developing. Extra calories and energy may be needed for essential
growth spurts in such a young age of children. Weight loss may also not be necessary if a child
has a preexisting condition. Treating the condition should be the main focus. If weight loss is
absolutely necessary, the previous state goals should be taken into account for the pediatric
population.
Weight Management. (n.d.). Retrieved October 13, 2014, from
http://www.stanfordchildrens.org/en/topic/default?id=weight-management-andadolescents-90-PO1626
5. What would you recommend as the current focus for nutritional treatment of Missy’s obesity?
For Missy’s obesity, I would recommend the main focus to be cutting down on caloric
content by replacing high-calorie “empty” foods with lower calorie foods that will offer her more
nutrients, but are still filling to her. For example Missy drinks whole milk, which can easily be
replaced with skim milk. She also has fried chicken and fried okra, which could be replaced with
grilled chicken and okra. She eats a lot of processed food as sides, which I would recommend
she switch out for apples, carrots or other fruits and vegetables. It would be small, subtle changes
like this that would help Missy the most in the long run. Another important factor I would focus
on would be to increase Missy’s physical activity. I would recommend she join some sort of
team, this way she is exercising in a fun way and with children her age. I would also recommend
her parents go on walks with her after dinner when the weather is appropriate. It would be
extremely important to handle the weight loss and physical activity in a way in which Missy will
not have emotional issues in later years.
III. Nutrition Assessment
A. Evaluation of Weight/Body Composition
6. Overweight or obesity in adults is defined by BMI. Children and adolescents are often times
classified as “overweight” or at the “risk for overweight” based on their BMI percentiles, but
this classification scheme is by no means universally accepted. Use three different professional
resources and compare/contrast their definitions for overweight conditions among the pediatric
population.
According to the Harvard School of Public Health, there are three sources which each
have definitions of overweight and obesity for children and adolescents. The first is the World
Health Organization, which for children age five to nineteen, obese is classified as a BMI greater
than 2 standard deviations above the WHO growth standard medium, and overweight is greater
than 1 standard deviations above the WHO growth standard medium. According to the CDC,
overweight is classified as between the 85th and 95th percentile of children their age, and obese is
above the 95th percentile. The third is the International Obesity Task Force which classifies
overweight and obese based on cut points for age and sex for children age 2 to 18. These cut
points correspond to an adult BMI of 25 (overweight) or 30 (obesity). The World Health
Organization and the International Obesity Task Force are similar in that they both use BMI in
some sort of way, but do not just use solely BMI, rather they compare it to data. The CDC is
different in that it uses a weight-for-height chart, which places the child in a certain percentile.
The World Health Organization cut points are much higher than those of the International
Obesity Task Force. This meaning that more children are classified as obese when using the
International Obesity Task Force cutoff as compared to the World Health Organization cutoff.
Defining Childhood Obesity. (n.d.). Retrieved October 13, 2014, from
http://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/definingchildhood-obesity/#References
7. Evaluate Missy’s weight using the CDC growth charts provided. What is Missy’s BMI
percentile? How would her weight status be classified by each of the standards you identified in
question 6?
Missy’s BMI:
115lbs/2.2kg=52.3 kg
57inchx2.54cm=144.7cm/100=1.45m
52.3/(1.452)= 24.9
Missy’s BMI percentile is right at the 97th percentile. According to the CDC, she would be
classified as obese. According to the following chart from the World Health Organization
Missy is at least 2 standard deviations over the growth standard medium, placing her in the obese
category.
According to the International Obesity Task Force
,
Missy would be classified as obese as she is on track to have a BMI above 30kg/m2 by the time
she turns 18.
BMI-for-age girls. (n.d.). Retrieved October 13, 2014, from
http://www.who.int/growthref/cht_bmifa_girls_z_5_19years.pdf?ua=1
Cole, T., Bellizzi, M., Flegal, K., & Dietz, W. (2000, May 6). Abstract. Retrieved October 13,
2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27365/
B. Calculation of Nutrient Requirements
8. If possible, RMR should be measured by indirect calorimetry. Identify two methods for
determining Missy’s energy requirements other than indirect calorimetry and then use them to
calculate Missy’s energy requirements.
There are two ways in which Missy’s energy requirements can be calculated. These are the
Mifflin-St. Jeor and Harris Benedict equation.
UBW: 100-(5*3)=75lbs
75 + .25 (115-75)= 85lbs
85/2.2=38.6kg
Mifflin-St. Jeor= 10x38.6 + 6.25 (145m)-5(10)-161= 1081.25
1081 x 1.5=1621kcal
Harris Benedict:
655+(9.56x38.6) + (1.85 x 145) – (4.68x10)= 1245.47
1245.47x1.5=1867.65
Based on these two equations, Missy should be eating around 1600-1800 kcal per day.
C. Intake Domain
9. Dietary factors associated with increased risk of overweight are increased dietary fat intake
and increased kilocalorie-dense beverages. Identify foods from Missy’s diet recall that fit this
criteria. Calculate the percentage of kilocalories from each macronutrient and the percentage of
kilocalories provided by fluids for Missy’s 24-hour recall.
Missy is eating many high-fat, high-calorie foods. These include: mayonnaise, bologna with
cheese, peanut butter, fried chicken, breakfast burritos, whole milk, frito’s, twinkies, fried okra,
and mashed potatoes. The high calorie drinks she has are whole milk, coffee creamer, sweetened
tea and coca-cola.
Based on the content above, the following can be calculated:
Total calories: 3954
% fat=175.3x9=1577/3954=39.9% fat
%carbs:440x4=1760/3954=44.5% carbs
%protein:156x4=624/3954=15.8% protein
The total percent of calories from drinks can be calculated as:
109 (coca-cola) +115 (tea)+208 (milk) +138 (milk) +138 (milk) +113 (coffee) + 138 (milk) + 52
(apple juice)=
1011/3954=25.5% calories from drinks
Based on her food log, Missy consumes 40% fat, 45% carbs and 16% protein per day. Her total
percent of calories from drinks is 26%.
Fitday.com
10. Increased fruit and vegetable intake is associated with decrease risk of overweight. Using
Missy’s usual intake, is Missy’s fruit and vegetable intake adequate?
No, Missy’s fruit and vegetable intake is not adequate. According to the USDA girls age
10 should be having 1.5 cups of fruit and 2 cups of vegetables per day. Missy did have apple
juice which counts as a fruit and fried okra and mashed potatoes which count as a vegetable. Her
choices could be a lot healthier. For example she could have an apple or a banana instead of the
juice. She could also have broccoli, green beans or mashed potatoes made with skim milk instead
of fried, high fat vegetables.
Choose a Food Group. (n.d.). Retrieved October 13, 2014, from
http://www.choosemyplate.gov/food-groups/
11. Use the MyPyramind Plan online tool to generate a personalized MyPyramid for Missy.
Using this eating pattern, plan a 1-day menu for Missy.
According to Choose MyPlate, Missy requires:
Fruit: 1.5 servings
Vegetable: 2 serving
Grains: 5 ounces (1/2 whole grains)
Protein: 5 ounces
Dairy: 3 cups
Empty: 120 kcal
According to the DRIs, the total percent of carbohydrates should be 45-65%, the total percent of
protein should be 10-35% and total percent of fat should be 20-35%.
Based on this information, Missy can follow this food schedule:
Breakfast:
1 slice whole wheat toast
2 tbsp peanut butter
1 cup skim milk
1 banana
Lunch:
2 ounce turkey
1 ounce swiss cheese
2 pieces whole wheat bread
2 tbsp hummus
1 cup carrots
After school snack:
6 oz cup yogurt
1/3 cup granola
½ cup orange juice
Dinner:
1 grilled turkey breast
½ cup green beans
½ cup broccoli
½ cup brown rice
Dessert:
1 cup chocolate skim milk
**Drink water throughout the day when needed
12. Now enter and assess the 1-day menu you planned for Missy using the MyPyramid Tracker
online tool. Does your menu meet macro-and micronutrient recommendations for Missy?
Based on this information her kcal can be broken down into:
Fat: 51.9X9=467.1/1760=26.5% fat
Carbs: 240.9x4=54.8% carb
Protein: 95.7x4=382/1760=21.2% protein
These values fall within the micronutrient range.
Based on the micronutrient range, there are a few changes I would recommend the family make
of the diet plan created. First, I would recommend the family have red meat 1-2 times a week in
order to increase the iron in Missy’s diet. Iron is extremely important for Missy as she is a young
girl who will be entering puberty soon. I would also recommend Missy have a citrus fruit at
some days in her diet in order to increase her Vitamin C levels. The final major change I would
make is for Missy’s family to buy low-sodium foods in order to decrease her sodium intake.
Missy could follow this diet one day but would need to be sure she balances out the
micronutrient range throughout the week. A good aspect of the food plam is Missy is within her
micronutrient and calorie range for the day.
Fitday.com
D. Clinical Domain
13. Why did Dr. Null order a lipid profile and blood glucose test?
Dr. Null ordered a lipid profile and glucose test for Missy to check for any values that were
abnormal due to her being considered obese for such a young age. As mentioned previously,
there are many health complications that come with being obese such as: diabetes, hypertension
and many more. The chances of these could be seen through her HDL, LDL, cholesterol, glucose
and A1C levels. It would be extremely important to try and resolve any health issues that could
be seen through tests before Missy gets older and it gets harder for her to make changes.
14. What lipid and glucose levels are considered to be abnormal for the pediatric population?
The following values are considered to be normal for the pediatric population, anything outside
of these ranges would be abnormal:
Value
CHOL
HDL
LDL
LDL/HDL Ratio
VLDL
TG
HbA1c
Glucose
Normal Range
120-199 mg/dL
>55 mg/dL
<130 mg/dL
3.22
7-32 mg/dL
35-135 mg/dL
3.9-5.2 %
70-110 mg/dL
15. Evaluate Missy’s lab results.
Value
Normal Range
Missy’s Values
CHOL
120-199 mg/dL
190
HDL
>55 mg/dL
50
LDL
<130 mg/dL
110
LDL/HDL Ratio
3.22
2.2
VLDL
7-32 mg/dL
30
TG
35-135 mg/dL
114
HbA1c
3.9-5.2 %
5.5
Glucose
70-110 mg/dL
108
Missy’s values are very indicative of her current weight status. She shows borderline high levels
of TG, HDL, VLDL and glucose. She has low levels of LDL, meaning she is not getting enough
healthy fats in her diet. These levels put her at a high chance of developing many of the health
consequences that come with being obese. At such a young age, the development of these
complications should prevented as soon as possible. Her high HbA1c levels as well as glucose
could be indicative of diabetes, as she also has family history of diabetes.
E. Behavioral-Environmental Domain
16. What behaviors associated with increased risk of overweight would you look for when
assessing Missy’s and her family’s diet?
The behaviors I would look at when assessing Missy’s family is their physical activity, general
daily activities, where they live, what they have access to (sidewalks, parks, etc.) and hobbies the
family has. It would be important to know their daily activities to see if the family drives, takes
the bus or walks to places. If the family has access to sidewalks and parks, it would be a good
way to get in exercise, but not necessarily to follow an “exercise regimen”. Also, I would want
to suggest to the family fun hobbies that require physical activity.
When it comes to Missy’s family’s diet history, I would be very interested in many
factors. I would want to know the education level of the parents and if they are aware of healthy
foods vs. unhealthy foods. I would also want to know who does the cooking and shopping in the
family. I would look into where most of the calories from Missy’s diet come from and also
where the high levels of fat come from. I would want to know if most of the food she is eating is
processed or fresh. The quality of the food would also be another major factor I would consider.
For example if she is eating white bread instead of whole grains, or having whole milk yogurt vs.
skim milk yogurt. I would also look into when and where she is eating. For example, she may eat
breakfast before school but not have lunch until noon, so I may need to add in a healthy snack in
her diet.
17. What aspects of Missy’s lifestyle place her at increased risk for overweight?
There are many aspects of Missy’s lifestyle that place her at an increased risk for
overweight. To begin, she has a family history of gestational diabetes, type 2 diabetes and has
been overweight since she was born. She has occasional knee pain, which may contribute to her
sedentary lifestyle. She also enjoys video games and reading, which are sedentary. She also eats
a very high-calorie diet with poor nutrition.
18. You talk with Missy and her parents. They are all friendly and cooperative. Missy’s mother
asks if it would help for them to not let Missy snack between meals and to reward her with
dessert when she exercises. What would you tell them?
I would recommend Missy’s parents allow her to have snacks in between meals.
Allowing her to eat small smacks will prevent her from overeating at main meals. The parents
need to be sure Missy is eating healthy, small snacks. According to Missy’s food recall, she had
a sandwich and whole milk, which could be considered a full meal. Instead, Missy should
consider a snack to be a ½ cup of carrots with 2 tbsp hummus or an apple with 1 tbsp peanut
butter.
I would also not recommend Missy’s parents reward her with dessert when she exercises.
Using food as a reward has been linked to children overeating foods that are high in sugar, fat
and empty calories. It also disrupts a child’s usual dietary intake. It also may encourage children
to eat when they are not hungry as a reward. Missy will learn to exercise only because she wants
a reward, not because she wants to be healthy. Also, the calories from the dessert may
completely cancel out the calories Missy burned off during exercise. Instead, Missy should have
goals set in mind with a reward not related to food. For example, if she works out four days a
week for three weeks, she can have a sleepover with friends or go to a movie. This way, she still
is being rewarded but not with food.
University of Rochester Medical Center. (n.d.). Retrieved October 13, 2014, from
http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=160&Conten
tID=32
19. Identify one specific physical activity recommendation for Missy.
I would recommend Missy’s parents sign up her for a youth club soccer team. This will
have multiple benefits for Missy. To begin, the CDC recommends youths get at least 60 minutes
of moderate-vigorous physical activity daily. Generally, sports team practice every day for at
least an hour. In addition, Missy will be with a team. The people on the team can help keep her
motivated and Missy may look forward to going to practice if she has friends on the team. Also,
by playing a sport, Missy will not feel like she is being forced to exercise. It is not like running
on the treadmill everyday for an hour. Hopefully this will also help strengthen her knee that
occasionally has pain. This will give her an opportunity to compete, be physically active and
make friends.
Physical activity guidelines. (2014, March 5). Retrieved October 13, 2014, from
http://www.cdc.gov/healthyyouth/physicalactivity/guidelines.htm
IV. Nutrition Diagnosis
20. Select two high-priority nutrition problems and complete PES statements for each.
1) Undesirable food choices (NB-1.7) related to high-calorie, high-fat consumption of processed
foods and beverages as evidenced by 24-hour recall and macronutrient distribution of 40% fat,
45% carbs and 16% protein per day.
2) Excessive energy intake (NI-1.3) related to consumption of unhealthy food choices and a 4000
calorie diet as evidenced by being in the 97th percentile and classified as obese.
V. Nutrition Intervention
21. For each PES statement written, establish and ideal goal (based on signs and symptoms) and
an appropriate intervention (based on etiology).
1) Goal: The goal I would set for Missy for the first PES statement is to eliminate the highcalorie beverages as well as the high-calorie, high-fat foods Missy is eating in her diet.
Intervention: In order to do this, I will create a weekly meal plan for Missy. In this meal plan, I
will substitute her whole-milk choices for skim milk. Instead of eating process foods, I will place
fresh fruit and vegetables in her diet plan. I will ask her to write down the ones she does and does
not like so I can make a better meal plan the next week. Missy is still young, so I will allow for
one treat week, such as ice cream or a cookie.
2) Goal: Reduce Missy’s calories to her recommended 1700-1800 kcal per day.
Intervention: As mentioned previously, I would create a food plan that Missy can follow every
day. It will be very detailed with portions sizes that her parents can follow as they feed her
everyday. This diet plan will build down about 500-600 calories per week until she is set at her
1700. I do not want Missy to cut down her calories sudden and feel hungry all the time.
22. Mr. and Mrs. Bloyd ask about using over-the-counter diet aids, specifically ALLI (orlistat).
What would you tell them?
I would not recommend Missy use over-the-counter diet aides, specifically ALLI. Alli is
specifically designed for overweight adults. I would tell them the FDA and the manufacturer
both state that anyone younger than 18 should not use Alli. This is due to the fact experts are
unsure if the drug interferes with the way a teen’s body grows and develops. There is a drug that
is similar to Alli but it is prescribed and only for people who are 12 or older. Missy would not
qualify for this either. Due to Missy’s young age, it is completely possible for Missy to lose the
weight without having to rely on diet aides. This will also teach her how to lose weight in a
healthy way and not rely on diet aides for her whole life.
Is the Alli Diet Pill Right for Me? (n.d.). Retrieved October 13, 2014, from
https://www.brennerchildrens.org/KidsHealth/Teens/Diseases-andConditions/Overweight-and-Obesity/Is-the-Alli-Diet-Pill-Right-forMe.htm?__taxonomyid=1641
23. Mr. and Mrs. Bloyd ask about gastric bypass surgery for Missy. What are the
recommendations regarding gastric bypass surgery for the pediatric population?
According to the EAL, gastric bypass surgery is not recommended unless adolescents are
severely obese and have not achieved weight-loss goals with less-invasive methods. It is a very
risky surgery. Also, the children who qualify must be severely obese, have co-morbities that will
be resolved with weight loss and have attained a majority of skeletal maturity. These children
must also have a supportive family and want the intervention. There have also been no long-term
effect studies of children having this surgery.
EAL. (n.d.). Retrieved October 13, 2014, from
http://www.andeal.org/template.cfm?template=guide_summary&key=1383&highlight=p
wm&home=1
VI. Nutrition Monitoring and Evaluation
24. When should the next counseling session with Missy be scheduled?
According to the American Journal of Pediatrics, since Missy is having a comprehensive
multidisciplinary intervention, we should have weekly visits for the next 8-12 weeks, and then
month follow-up visits after this. If this is not possible, weekly phone calls should take place. I
would schedule the first meeting exactly a week from the date she came in. I would try and have
the meetings the same time every week to set a schedule for Missy.
Recommendations for Treatment of Child and Adolescent Overweight and Obesity. (n.d.).
Retrieved October 13, 2014, from
http://pediatrics.aappublications.org/content/120/Supplement_4/S254/T1.expansion.html
25. Should her parents be included? Why or why not?
According to the American Journal of Pediatrics, parents should be involved. This way
the parent can watch over the child and become educated themselves. This will ensure the child
is on the right path and the parents are being completely supportive of the child. It will also allow
the parents to communicate any issues with the dietitian instead of having to relay the
information through Missy and possible having miscommunications.
Recommendations for Treatment of Child and Adolescent Overweight and Obesity. (n.d.).
Retrieved October 13, 2014, from
http://pediatrics.aappublications.org/content/120/Supplement_4/S254/T1.expansion.html
26. What would you assess during this follow-up counseling session?
I would monitor Missy’s weight every week to make sure she is losing weight, but no
more than two pounds a week. If she has access to a cellphone or computer I would ask her to
write down a general idea of what she is eating, as a casual food log. I would want to know her
hunger levels throughout the week too in case more or less food needs to be added. Depending
on what foods Missy says she likes or dislikes, I will adjust her food log accordingly. I would
ask how her new exercise routine is going and see if she enjoys being on a team. I would ask if
she is interested in any other sorts of physical activity. If the parents were interested in more
educational resources, I would also offer those.
I would also wait about three weeks to check her blood levels so that there is time to
adjust. I would hope her HDL increases, and LDL, TG, Cholesterol and A1c have decreased.
References
BMI-for-age girls. (n.d.). Retrieved October 13, 2014, from
http://www.who.int/growthref/cht_bmifa_girls_z_5_19years.pdf?ua=1
Choose a Food Group. (n.d.). Retrieved October 13, 2014, from
http://www.choosemyplate.gov/food-groups/
Cole, T., Bellizzi, M., Flegal, K., & Dietz, W. (2000, May 6). Abstract. Retrieved October 13,
2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27365/
Defining Childhood Obesity. (n.d.). Retrieved October 13, 2014, from
http://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/definingchildhood-obesity/#References
EAL. (n.d.). Retrieved October 13, 2014, from
http://www.andeal.org/template.cfm?template=guide_summary&key=1383&highlight=p
wm&home=1
Is the Alli Diet Pill Right for Me? (n.d.). Retrieved October 13, 2014, from
https://www.brennerchildrens.org/KidsHealth/Teens/Diseases-andConditions/Overweight-and-Obesity/Is-the-Alli-Diet-Pill-Right-forMe.htm?__taxonomyid=1641
Nelms, M. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA: Wadsworth,
Cengage Learning.
Obesity and Sleep. (n.d.). Retrieved October 13, 2014, from http://sleepfoundation.org/sleeptopics/obesity-and-sleep/page/0,1/
Physical activity guidelines. (2014, March 5). Retrieved October 13, 2014, from
http://www.cdc.gov/healthyyouth/physicalactivity/guidelines.htm
Recommendations for Treatment of Child and Adolescent Overweight and Obesity. (n.d.).
Retrieved October 13, 2014, from
http://pediatrics.aappublications.org/content/120/Supplement_4/S254/T1.expansion.html
University of Rochester Medical Center. (n.d.). Retrieved October 13, 2014, from
http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=160&Conten
tID=32
Weight Management. (n.d.). Retrieved October 13, 2014, from
http://www.stanfordchildrens.org/en/topic/default?id=weight-management-andadolescents-90-P01626
What Causes Overweight and Obesity? (n.d.). Retrieved October 13, 2014, from
http://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes.html