Download File - Zachary Pfirrman

Zach Pfirrman
10/8/13
KNH 411
Pediatric Weight Management
Understanding the Disease and Pathophysiology
1. Current research indicates that the cause of childhood obesity is multifactorial. Briefly outline
the roles of genetics, environment, and nutritional intake in development of obesity in children.
Genetics affects body weight and body composition by influencing such factors as appetite, taste
preferences, energy intake, resting energy expenditure, the thermic effect of food, and the body’s
efficiency at storing energy. Each person’s body may have a genetically determined metabolic “set
point. It has been researched that people below the poverty line are more likely to be overweight. This
may be due living in a “toxic food environment”, meaning they are surrounded by the convenient
availability of low-cost, tasty, energy-dense foods, in large portion sizes. We now live in the fast-food
era so we end up eating out much more often. If one is engaging in a sedentary lifestyle the risk of
being overweight is increased. Physical activity is important to remove or burn off excess calories in
one’s body.
Nutrition Therapy & Pathophysiology p.257-258
2. Describe health consequences of overweight and obesity for children.
Children who are overweight or obese are at higher risk of developing health problems such as heart
disease, Type II diabetes, asthma, sleep apnea, and social discrimination.
http://www.letsmove.gov/health-problems-and-childhood-obesity
3. Jamey has been diagnosed with obstructive sleep apnea. Define sleep apnea.
Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow
breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30
times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or
choking sound.
http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/
4. Explain the relationship between sleep apnea and obesity.
Sleep apnea is said to be caused when the breathing passage can narrow so much that no air can get
through and the patient stops breathing. This can be increased in patients who are overweight. The most
common cause of obstructive sleep apnea is excess weight and obesity, which is associated with soft
tissue of the mouth and throat. During sleep, when throat and tongue muscles are more relaxed, this
soft tissue can cause the airway to become blocked.
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_apnoea
Understanding the Nutrition Therapy
5. What are the goals for weight loss in the pediatric population?
Goals for weight loss for the pediatric population would include reducing the amounts of fat consumed
by children to a normal range, eating nutrient dense foods, mainly fruits and vegetables, and finally
ensuring that children get in a fair amount of exercise to avoid a sedentary lifestyle.
6. Under what circumstances might weight loss in overweight children not be appropriate?
Weight loss would not be appropriate in children who are just barely overweight because they are at
that point right before puberty when it is normal for children to put on a little weight before they grow
taller and slim down. Weight loss in children should only be done when the kids are in the obese
percentile.
7. What would you recommend as the current focus for nutritional treatment of Jamey's obesity?
The current focus nutritionally for Jamey's obesity would be to reduce her fat intake to a level suitable
for a female at her age. We would also need to focus on reducing her calories as a whole and replacing
a lot of the processed foods with fresh fruits, vegetables, and whole grains.
Nutrition Assessment
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.
Jamey's BMI is 24.9, which puts her in the 97th percentile for females her age. Anything above the 95th
percentile is classified with a weight status of Obese. Based upon Jamey's height and age, her optimal
weight should be between 65 lb-92 lb. That would put her in the BMI percentile range of 5-85 with is
the healthy range.
Medical Nutrition Therapy: A Case Study Approach p.8
9. Identify two methods for determining Jamey's energy requirements other than indirect
calorimetry, and then use them to calculate Jamey's energy requirements.
I decided to use the Mifflin-St. Jeor Method and the Harris Benedict Method to calculate Jamey's
energy requirements.
Mifflin-St. Joer:
10 x 52.2kg + 6.25 x 144.8cm – 5 x 10y/o – 161 = 1216
Harris Benedict:
655 + (9.56 x 52.2kg) + (1.85 x 144.8cm) – (4.68 x 10) = 1375
I multiplied these answers by a PAL of 1.4 for her very low activity level. This puts the numbers at
1702 and 1925.
Nutrition Therapy & Pathophysiology p.241-242
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.
The foods and beverages that fit the high fat content criteria are bologna and cheese sandwich, mayo,
Twinkies, Frito chips, fried chicken, and fried okra. The calorie-dense beverages that Jamey consumes
are Whole milk, Sweet tea, and Coca-Cola.
Medical Nutrition Therapy: A Case Study Approach p.5
11. Calculate the percent of kcal from each macronutrient and the percent of kcal provided by
fluids for Jamey's 24-hour recall.
I entered Jamey's 24 hour recall into fitday.com to find the amount of grams of each macronutrient and
the total calories consumed. Total kcal was 3809 and this consisted of 160.7g FAT, 452g CHO, and
146.9g PRO. Of the calories consumed, 894kcal came from fluids.
Fat- 160.7 x 9 = 1446.3kcal / 3809 = 0.3797 x 100 = 38%
Protein- 146.9 x 4 = 587.6kcal / 3809 = 0.1542 x 100 = 15%
Carbohydrate- 452 x 4 = 1808 / 3809 = 0.4746 x 100 = 47%
Fluids- 894kcal / 3809 = 0.2349 x 100 = 23%
http://www.fitday.com/
12.Increased fruit and vegetable intake is associated with decreased risk of overweight. What
foods in Jamey's fall into these categories?
Really the only foods that can truly fall into this category is the apple juice. Other than that only the
fried okra and jelly come even remotely close to servings of fruits and vegetables. This is going to be
one of the biggest reforms that needs to take place in her diet.
Medical Nutrition Therapy: A Case Study Approach p.5
13. Use the ChooseMyPlate online tool to generate a customized daily food plan. Using this eating
pattern, plan a 1-day menu for Jamey.
Breakfast
Egg White Omelet
Turkey Bacon
Whole Wheat Toast w/ Jelly
Apple Slices
Orange Juice
Lunch
Turkey on Whole Grain Bread w/ cheese and lite Miracle Whip
Banana
Baby carrots and Peanut butter
Fat free Vanilla Yogurt
Apple Juice
Snack
Orange Slices
Water
Dinner
Marinated Chicken Breast
Green beans
Seasoned Red Potatoes
Dessert
Fat Free Frozen Yogurt
14. Now enter and assess the 1-day menu you planned for Jamey using the MyPlate
SuperTracker online tool. Does your menu meet macro- and micronutrient recommendations for
Jamey?
When my 1-day menu was put into Fitday.com and was assessed, the macronutrient percentages were
as followed: Carbohydrates- 55%, Protein- 22%, and Fat- 23%. The carbohydrate percentage is spot on
while the percentage of fat and protein are a little off. I would like to decrease protein a small amount.
These percentages are not bad in any sense. As far as micronutrients, I need to increase the amount of
iron and vitamin D in the menu. Otherwise the menu meets that recommended amounts of
micronutrients.
http://www.fitday.com/
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.
Dr. Lambert ordered the lipid profile test to assess her total cholesterol, HDL, LDL, and triglyceride
levels. High LDL and lipid levels contribute to adverse affects to ones health. The blood glucose test
measures the amount of sugar called glucose in a sample of Jamey’s blood. Dr. Lambert ordered the
test to check for diabetes since Jamey has a family history of it and signs connected to the disease. Her
mother and grandmother experienced gestational diabetes.
Abnormal levels of lipids for pediatrics are an amount greater than 140mg/dL. Abnormal glucose levels
would be anything above 110 mg/dL
She is low in her HDL levels and just barely within the healthy LDL range. Her glucose level is on the
high side as well.
Medical Nutrition Therapy: A Case Study Approach p.6
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?
There is a lot of processed foods and which tend to have higher fat and sodium content. Another
behavior would be the fact that Jamey eats multiple snacks between her major meals which is a concern
for her diet. The large portions play a critical role in Jamey's diet, which may be caused by her parents’
inability to control her consumption. Aspects of Jamey's life that place her at an increased risk for
overweight include: her appetite with a wide variety of food, her low physical activity level, and hobby
of playing video games and reading.
17. You talk to Jamey and her parents, who are friendly and cooperative. 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?
Snacks in between meals are an ok thing to have, given that the snacks are healthy. This would include
fruits, vegetables, and maybe some whole grains. This could in fact help her by decreasing the size of
her major meals by including small snacks between. Desserts should never be given as a reward for
exercise. One, it is not a good fuel for the body and two, it will put the idea in her head to always eat
bad foods after exercise.
18. Identify one specific physical activity recommendations for Jamey.
Even though Jamey's school no longer has a physical education program, I would see if they had any
sports teams that Jamey might want to participate in. If the school did not, I sure there are city leagues
and sports clubs she could join.
Nutrition Diagnosis
19. Select two nutrition problems and complete PES statements for each.
1) Excessive fat intake (NI-5.6.2) related to lack of knowledge of fat content in foods eaten on a
regular basis as evidenced by Jamey's 24 hour recall.
2) Physical inactivity (NB-2.1) related to school physical education program suspended as
evidenced by personal statement that her physical activity level is generally low.
Medical Nutrition Therapy: A Case Study Approach p.5
Nutrition Intervention
20. For each PES statement written, establish an ideal goal and an appropriate intervention.
1) The goal for Jamey would be to keep her fat intake at 25% of her total kcal. This should be
done by removing foods high is saturated fat and foods that are processed. Incorporating
vegetables and fruits into her diet along with whole grains will hopefully cause her to eat less
fat.
2) The goal for Jamey would be to get in at least 30 minutes of exercise a day. I know that her
school no longer has a physical education class but it may have after school sports programs. If
it does not then she should look for community or club sports teams to participate in.
21. Mr. and Mrs. Whitmer ask about using over-the-counter diet aids, specifically Alli. What
would you tell them?
I would not recommend she use over-the-counter diet aids. This would cause her to be reliant on diet
pills over the consumption of healthy foods. The best and healthiest way for Jamey to lose weight and
get healthy is to eat a better diet and become more physically active. This will bring the best and most
long lasting results.
22. Mr. and Mrs. Whitmer ask about gastric bypass surgery for Jamey. Using EAL, what are
recommendations regarding gastric bypass surgery for the pediatric population?
It is a controversial topic and often depends on the severity of the obesity of the patient, and the
individual patient themselves. I would not recommend this surgery for Jamey because she is at the age
where her body is about to or already is going through puberty. At this this in her life it would be more
wise to change her diet and lifestyle over having her go through an intense procedure in hopes of
weight loss.
Nutrition Monitoring and Evaluation
23. What is the optimal length of weight management therapy for Jamey?
We would try to go as long as needed to get Jamey into the healthy BMI percentile for her age. We
would do this by trying to lose 2 pounds a week for the first six months and then 1-2 pounds a week
from then on.
Nutrition Therapy & Pathophysiology p.264
24. Should her parents be included? Why or why not?
Yes. Jamey’s parents should be included because she is at that age where she is largely dependent on
her parents. Jamey's parents are also probably not knowledgeable about what foods are good for them
and how a proper diet should be. If Jamey is going to make successful changes in her lifestyle, her
parents need to be encouraging and be educated on the positive lifestyle and nutrition choices that will
allow Jamey to succeed.
25. What would you assess during this follow-up counseling session?
I would start out asking if her sleep apnea is still occurring. Then I would assess the food journal I
would have had her do to see if there is a positive change to the diet we came up with. I would also
assess if there is an improvement in her physical activity level.
Work Cited
FitDay - Free Weight Loss and Diet Journal. (n.d.). FitDay - Free Weight Loss and Diet Journal.
Retrieved October 15, 2013, from http://www.fitday.com/
Health Problems and Childhood Obesity | Let's Move!. (n.d.). Let's Move!. Retrieved October 13, 2013,
from http://www.letsmove.gov/health-problems-and-childhood-obesity
Nelms, M. (2013). Medical nutrition therapy: a case study approach (4th ed.). Stamford, Connecticut:
Cengage Learning.
Nelms, M. N. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA: Wadsworth,
Cengage Learning.
Sleep apnoea | Better Health Channel. (n.d.). Home | Better Health Channel. Retrieved October 9,
2013, from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_apnoea
What Is Sleep Apnea? - NHLBI, NIH. (n.d.). NIH Heart, Lung and Blood Institute. Retrieved October
8, 2013, from http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/