Pediatric Obesity A Case Study -...
Transcript of Pediatric Obesity A Case Study -...
![Page 1: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/1.jpg)
Pediatric Obesity – A Case StudyMEGAN SOLLOWAYUniversity of Maryland Dietetic Intern
March 20, 2015
![Page 2: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/2.jpg)
Objectives
▪ Utilize ADIME in a pediatric weight management intervention
▪ Review the R.D.’s role in pediatric obesity treatment
▪ Discuss an alternative approach to traditional physical activity
![Page 3: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/3.jpg)
Pediatric Overweight and Obesity
![Page 4: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/4.jpg)
BMI Classification and Statistics
BMI Classification Percentile
Underweight <5th percentile
Heathy Weight 5th - <85th percentile
Overweight 85th - <95th percentile
Obese >95th percentile
Severely Obese >99th percentile
16.9 % of 2- to 19-year-olds have a BMI >95th percentile
![Page 5: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/5.jpg)
Pediatric Obesity – A Case Study
![Page 6: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/6.jpg)
Background
▪ Referred by Pediatrician and Cardiologist
▪ Reason for visit
▪ Abnormal weight gain & weight management
![Page 7: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/7.jpg)
Assessment
![Page 8: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/8.jpg)
Patient History
▪ PMH
▪ Dextrocardia w/mitral atresia and double outlet right ventricle s/p Fontan Palliation (2010)
▪ Per mom – always overweight, weight 10 lb at birth
▪ Family History
▪ Diabetes (mom & maternal grandmother)
▪ Weight history
▪ Weight gain of 13.1 kg (29 lb) since 1/28/14 (14 months)
▪ Gaining 31 g/day over 14 months
▪ Appropriate weight gain for 6-10 year olds = 7-9 g/day
![Page 9: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/9.jpg)
Anthropometrics and Nutrition Focused Physical Findings
RD Visit (3/17/15)
Weight (kg) 49.8 kg Weight-for-age >99th percentile
Height (cm) 127.0 cm Height-for-age 75th percentile
BMI (kg/m2) 30.9 BMI/age >99th percentile
IBW (kg) 28 kg % IBW 178% (based on 85th percentile)
▪ Obese, otherwise well-nourished
▪ No swallowing difficulties
▪ Does not tolerate certain foods (vomits after consuming Gatorade, cheese pizza)
▪ Good appetite, will ask for more of favorite foods
▪ Lab data and other medical tests unremarkable
![Page 10: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/10.jpg)
Stature-for-Age and Weight-for-Age
Date Weight
(%ile)
Height
(%ile)
Jan. 28,
2014
36.7 kg
(>99th %ile)
118.0 cm
(75th %ile)
Jan 27,
2015
47.8 kg
(>99th %ile)
125.8 cm
(75th %ile)
March 17,
2015
49.8 kg
(>99th %ile)
127.0 cm
(75th %ile)
![Page 11: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/11.jpg)
BMI-for-Age
Date BMI
(%ile)
Classification
Jan. 28,
2014
26.9
(>99th %ile)
Overweight
Jan 27,
2015
30.7
(>99th %ile)
Overweight
March 17,
2015
30.9
(>99th %ile)
Overweight
![Page 12: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/12.jpg)
Food/Nutrition Related History
▪ Current Medications: Enalapril, baby aspirin
▪ No daily vitamin/minerals
▪ No food allergies
▪ Food preparation
▪ Mom packs lunch everyday and makes dinner most night. Rarely eats out when with mom, but will occasionally go to Ledos or IHOP. Recently stopped McDonalds.
▪ Grandma/aunt will take XX out to eat after school 2x per week (Cheesecake factory)
![Page 13: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/13.jpg)
Food/Nutrition Related History
Diet History
Bre
ak
fast
7:00 am Home – 1 sausage link, egg & cheese sandwich, water
OR
School – organic muffin or cereal w/yogurt
Lu
nch 12:00 am PB&J sandwich on wheat, applesauce, juice, Ritz crackers, 4 cookies (packed)
Sn
ack
4:00 pm Typically leftovers from lunch
Yesterday – vending machine Funyuns & pink lemonade
Din
ne
r 7:30-8:00 pm 3 homemade, hard-shell tacos with ground turkey, cheese and taco sauce. No veggies, but
will eat salad if offered. Lemonade to drink.
![Page 14: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/14.jpg)
Diagnosis
Unintended weight gain related to excess caloric intake as evidence by BMI>99th percentile
![Page 15: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/15.jpg)
History of Diagnosis
1. History of Overweight/Obesity
▪ High birth weight (10 lb per mom)
2. Frequent consumption of calorically dense foods
▪ Cookies, crackers, packaged snacks etc.
▪ Sugary beverages 1-2 times per day
▪ Fast food or eats out >2 times/week
3. Physical Inactivity
▪ Right leg injury – recent knee sprain and chronic poor blood flow (per mom)
▪ No P.E. class
▪ Mild right ankle edema – hx of bilateral femoral vein thrombosis, doctor considering a diuretic
▪ Note – cardiologist supports as much physical activity as possible
Unintended weight gain related to excess caloric intake as evidence by BMI>99th percentile
![Page 16: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/16.jpg)
Intervention
![Page 17: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/17.jpg)
Nutrition Counseling Approaches
▪ Multidisciplinary treatment of pediatric obesity: nutrition evaluation and management
▪ Nutrition Assessment – 24hr recall + suggestions for change
▪ Tailor behavior intervention to Stages of Change
▪ Motivational Interviewing w/R.D
▪ Components of pediatric behavior change
▪ Self- Monitoring
▪ Stimulus control
▪ Goal Setting
▪ Diet intervention – Stop Light Diet, glycemic index, low-carb
▪ Step-wise multidisciplinary treatment
▪ Identify psychological and financial stressors via 24 hr recall and refer out
In Practice – allow the client to choose or suggest the behavior change
![Page 18: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/18.jpg)
Increasing Physical Activity with Video Games
▪ Effects of a Pediatric Weight Management Program With and Without Active Video Games
▪ Active video games have a positive effect on physical activity and relative weight
▪ Program with active gaming group vs. program-only group
▪ Program-only group
▪ Decline or no change in moderate-to-vigorous activity and vigorous activity
▪ Significant reduction in percentage overweight and BMI z-scores
▪ Active gaming group
▪ Significant increase in moderate-to-vigorous activity and vigorous activity
▪ Significantly greater reduction in percentage overweight and BMI z-scores
In Practice – children with lower leg injuries or unsafe outdoor environments
![Page 19: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/19.jpg)
Estimated Energy Requirements
▪ Mifflin St. Jeor = 5 + (10 x 28 kg) + (6.25 x 127.0 cm) – (5 x 7 years) = 1,040 cal
▪ Activity Factor (1.3) x 1,200 calories = 1,350 cal/day
▪ IBW used
▪ Protein = 0.95 g x 49.8 kg = 47 g pro/d
▪ DRI for children 7-8 years-old used
▪ Fluid = 1500 ml + [(49.8 kg – 20kg) x 20] = 2,100 ml/d
▪ Holiday-Segar method and ABW used
![Page 20: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/20.jpg)
Nutrition Education
▪ Healthier beverage and snack options
▪ More accurate portion sizes
▪ Limiting fast food
▪ Increasing physical activity (with a leg injury)
▪ Exclude starch/carbohydrates at dinner time
Handouts Provided
▪ Ideas for healthy snacks and school lunches
▪ Age specific sample meal plan
▪ Portion sizing guide
![Page 21: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/21.jpg)
Goal Setting
1. Choose water over sugary beverages
2. Measure portion sizes according to guide provided
▪ Limit starches to one serving per meal
3. Limit eating out to once/week
▪ Regardless of caretaker!
4. Pack a healthier lunch and snack
▪ Recommend ½ sandwich, fruit, vegetables, and water
5. Increase physical activity
▪ Ex. Just Dance Wii, indoor swimming
![Page 22: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/22.jpg)
Monitoring & Evaluation
![Page 23: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/23.jpg)
Follow-up (2-3 Months)
▪ Weight & weight-for-age
▪ Height & height-for-age
▪ BMI & BMI-for-age
▪ Types of food/meals
▪ Amount of food
▪ Physical Activity (type, duration, frequency)
![Page 24: Pediatric Obesity A Case Study - …megansolloway.weebly.com/uploads/2/4/6/6/24662010/case_study... · Pediatric Obesity –A Case Study MEGAN SOLLOWAY University of Maryland Dietetic](https://reader034.fdocuments.in/reader034/viewer/2022052309/5b81b9827f8b9a2b6f8cecf6/html5/thumbnails/24.jpg)
References
▪ Krebs NF, Jacobson MS. Prevention of pediatric overweight and obesity. Pediatrics. 2003;112(2):424-30.
▪ Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-14.
▪ Ross MM, Kolbash S, Cohen GM, Skelton JA. Multidisciplinary treatment of pediatric obesity: nutrition evaluation and management. Nutr Clin Pract. 2010;25(4):327-34.
▪ Trost SG, Sundal D, Foster GD, Lent MR, Vojta D. Effects of a pediatric weight management program with and without active video games a randomized trial. JAMA Pediatr. 2014;168(5):407-13.