CHILDHOOD

OBESITYBy Jenn Derasmo

BACKGROUND

• More than one-third (34.9% or 78.6 million) of U.S. adults are obese. (2) One in three children ages 2-19 are overweight or obese. (2)

• Childhood Obesity alone is estimated to cost 14 billion annually in direct health care expenses (2)

• The term “obese” describes children and adolescents who have a body mass index (BMI) at or above the 95th percentile for their gender and age, while “overweight” describes those with a BMI at or above the 85th but below the 95th percentile. (2)

• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, are some of the leading causes of preventable death. (2)

• The prevalence of obesity in children more than tripled from 1971 to 2011 (1)

MORE

BACKGROUND

• It is predicted 3%-5% of obesity in children can be attributed to short sleep duration. (7)

• According to the National Sleep Foundation (NSF), extra pounds on children can put them at risk for Obstructive Sleep Apnea (OSA) which affects mood, difficulty in concentrating at school, headaches and changes in performance . (3)

• The main causes of excess weight in youth are similar to those in adults, including individual causes such as behavior and genetics. (2)

PATIENT

BACKGROUND/

ASSESSMENT

SC is 10 years old

Weight: 115lbs BMI: 24.9% (97th percentile) Birth weight was 10lbs 5 oz.

B/P :123/80

Difficulty sleeping at night, morning headaches and concentrating during the day

Mother and grandmother: Type 2 DM

Very good appetite!

Low physical activity level

3rd grader

Parents: Father 36 YO Mother 35 YO

DX: R/O OSA (Obstructive Sleep Apnea)

Lover of video games and reading

OSA Problems

Growth Chart

MEDICAL

COMPLICATIONS

OF CHILDHOOD

OBESITY

24 HOUR RECALL 2 breakfast burritos

8 oz. whole milk

4 oz. apple juice

6 oz. coffee with ¼ c cream and 2 tsp sugar

2 bologna and cheese sandwiches with 1 tbsp. of mayo

1 oz. package of Fritos corn chips

2 Twinkies

8 oz. whole milk

Peanut Butter and Jelly sandwich on white bread

12 oz. whole milk

1 cup fried okra

Fried chicken

1 cup mashed potatoes

20 oz. sweet tea

3 cups microwave popcorn

DIAGNOSIS

Obese, pediatric related to excessive energy intake and lack of physical activity as evidenced by BMI of 24.9% (˃95 percentile) and 24 hour recall.

Excessive oral food/beverage intake related to calorically dense foods and beverages such as fried foods, fatty/processed meats, sugary sodas and juices and whole milk as evidenced by 24 hour recall.

Physical inactivity related to sedentary lifestyle as evidenced by self-reported video game use and physical activity class discontinued at school.

Poor nutrition quality of life related to sleep disturbances as evidenced by feeling tired and irritable daily and difficulty concentrating in school.

Excessive energy intake related to unchanged dietary intake as evidenced by >10lb steady increase over past several years.

INTERVENTION

Review lab values immediately such as B/P, FBG, HbA1C, lipid panel & take a Polysomnography test to diagnose to see if SC has OSA.

Get her parents on board- they are the gatekeepers for SC!!!! Educate her parents on the dangers of potential medical complications such as diabetes, cardiovascular diseases, hypertension, hyperlipidemia, and many more!

Reduce access to the high-calorie foods and poor choices immediately and replace with nutrient-dense foods, incorporate more fruits and vegetables to her daily intake, low sugar beverages, foods with high-fiber by teaching her family how to read food labels, meal prep and meal plan .(5)

Establish regular meals patterns that include three meals a day with two snacks.

Get SC into a better nightly routine to provide a better night sleep

Refer SC to an exercise physiologist, Children's Heart Center and a psychiatrist

Discuss age-appropriate portions and snacks: show her parents child-sized plates and utensils with sample portion sizes look like. (5)

Maintain SC’s self-image through positive reinforcement- KEY! Don’t have a “diet calorie counting” mentality which several studies have shown to have an increased risk for eating disorders.. (6)

MONITOR &

EVALUATION

Continue to monitor weight- gradual weight loss of no more than 1 pound per week is the goal until the BMI-for-age percentile drops to < 85th (9)

Pay attention to SC’s emotional state (9)

SC to have a food log for at least two days a week and one weekend day-mention an incentive to be provided upon return of completed diary and monitor the food log.

Maintain optimal metabolic outcomes within three months following initiation of dietary and behavioral modifications

Monitor how hunger scale is working for SC

Eliminate caffeinated beverages from daily intake completely and replace with water

Get SC a pedometer and track her steps which we can make it fun for her.

Continue to monitor her lab values

SUMMARY

Goals are to achieve healthy eating habits by providing sample meals plans, grocery lists and sample snack ideas

Include daily activity such as bike riding, swimming or jogging and limit video game use to twice a week for thirty

minutes.

Have SC and her family involved in meal planning and food swapping.

Have ongoing family support. Do motivational interviewing which is a patient-centered communication style that

uses techniques such as reflective listening and shared decision-making to elicit how and why patients might change

their health behaviors. –(8)

Using tools such as “MyPyramid Food Guidance System and food and plate samples.(4)

Have a balanced macronutrient intake of 45-60% of kcal from CHO, 25-40% from fat and 10-35% from protein.

(5)

Continue to monitor lab values.

Lastly, all of these changes will help the overall big picture and will allow SC to sleep better at night!

The

End

References 1. NCCOR Childhood Obesity in the United States. (n.d.). Retrieved February 10, 2016, from http://www.nccor.org/

2. Childhood Obesity Causes & Consequences. (2015). Retrieved March 02, 2016, from

http://www.cdc.gov/obesity/childhood/causes.html

3. Children and Sleep. (n.d.). Retrieved March 07, 2016, from https://sleepfoundation.org/sleep-topics/children-and-sleep

4. Thurlow, J. (2008). Krause's Food and Nutrition Therapy, 12th Edition. Medicine & Science in Sports & Exercise, 40(10),

1861

5. Escott-Stump, S. (2012). Nutrition and diagnosis-related care. Philadelphia: Wolters Kluwer Health/Lippincott Williams &

Wilkins.

6. Willeford, G., RD. (2016). Pediatric Weight Management. 12-13. Retrieved April 08, 2016.Academy of Nutrition and

Dietetics

7. Nahikian-Nelms, M. (2011). Nutrition therapy and pathophysiology (3rd ed.). Belmont, CA: Wadsworth, Cengage Learning.

8. Motivational Interviewing Can Positively Impact Childhood Obesity. (n.d.). Retrieved March 24, 2016, from

https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Motivational-Interviewing-Can-Positively-Impact-

Childhood-Obesity.aspxx

9. Brown, J. E. (n.d.). Nutrition Through the Life Cycle (4th ed.).

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