Childhood Overweight

Kayla Kmet
Lora Lee Aaron
Rebecca Willis
Stephanie Hunley

Case Study 1
Missy Bloyd’s Story
10/28/09
 Missy
•Client
Name: Missy Bloyd
•Date of
Birth: 10/9
•Age: 10
•Sex:
Female
•Education:
(5th grade) Less than high school
•Occupatio
n: Student
 Missy
• Hours of Work: Regular school hours
• Household members: Father (36),
mother (35), sister (5)
• Ethnic Background: Biracial (African
American and Caucasian)
• Religious Affiliation: Catholic
• Referring Physician: D. Null, MD
4
 Missy’s Hx
• Sleep disturbance in last several years-
sleeping with mouth open, cessation of
breathing for 10 sec, snoring, restlessness,
enuresis, morning headaches
• Changes in school grades/success
• Change in attention span
• Onset: unspecific, about a year ago
• Tx: none
• Meds: none
• Smoker: no
• Family Hx:gestational diabetes, type 2 DM, in
mother and grandmother
 Anthropometrics
Height: 57 in
Weight: 115 lbs
Percentile: 98th
BMI: 24.95
• According to the CDC, overweight in children 2-19 yo. is classified as
being at or above a BMI in the 85th percentile. Obesity in 2-19 yo. is
defined as being at or above a BMI in the 95th percentile.
• For every five point increase in BMI a person enters a higher bracket of
disease risk. The diseases and conditions do not necessarily increase in
number, but in likelihood
• Overweight and obesity can come with several co morbidities and
complications including: diabetes, gall bladder disease, hypertension,
dyslipidaemia (too much fat in the blood), sleep apnea, coronary heart
disease, osteoarthritis (deterioration of cartilage in knees),
hyperuricaemia (too much uric acid in the blood) which may result in
gout (swelling in feet from deposited uric acid), cancer, reproductive,
hormone abnormalities, polycystic ovarian syndrome, impaired
fertility, low back pain, increased anaesthetic risk (loss of sensation or
consciousness), and fetal defects from maternal obesity.
Text
 Missy’s Complaint
• “We’ve noticed that Missy appears
to stop breathing for several
seconds several times a night. She
is really cranky when she gets up
for school. Her teacher says Missy
gets very sleepy during
school...She fell asleep in class
yesterday.”
 Missy’s Nutritional Hx
• General: very good appetite, wide
vatiety of food
• Food allergies/intolerances: NKA
• Previous Nutrition Therapy? No
• Food Purchase/Preparation: Parent(s)
• Vit/Min Intake: Flintstones vitamin
daily
 24 Hour Recall
• AM: 2 breakfast burritos, 8oz whole milk,
4oz apple juice, 6oz coffee with 1/4 c
cream and tsp sugar

• LUNCH: 2 bologna and cheese sandwiches

with 1tbsp of mayo, 1 oz package Frito
corn chips, 2 twinkies, 8 oz whole milk
 24 Hour Recall
• AFTER SCHOOL SNACK: Peanut butter and jelly sandwich (2
slices enriched bread with 2 tbsp crunch peanut butter and
2 tbsp grape jelly), 12 oz whole milk

• DINNER: Fried chicken (2 legs and 1 thigh), 1 c mashed

potatoes (whole milk/butter), 1 c fried okra, 20 oz sweet tea

• SNACK: 3 c microwave popcorn, 12 oz Coca-Cola

 Dx
• R/O Obstructive Sleep Apnea (OSA) secondary
to obesity and physical activity
• OSA: Sleep apnea is a breathing disorder
characterized by brief interruptions of breathing
during sleep.
• There are two types of sleep apnea: central and
obstructive.
• Central sleep apnea occurs when the brain fails
to send the appropriate signals to the breathing
muscles to initiate respirations.
• Obstructive sleep apnea occurs when air cannot
flow into or out of the person's nose or mouth
although efforts to breathe continue.
 Tx Plan
• Polysomnography
• FBG
• HbA1C
• Lipid Panel
• Psychological Evaluation
• Nutrition Assesment
 Missy’s Assesment

• Two Part Analysis

•Testing

•Lab Results
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 Testing
•Blood Glucose Test
-Helps to determine whether individuals are
hyperglycemic, hypoglycemic, or if individuals
have diabetes

•Lipid Profile
-Helps to determine whether there is a risk
for heart disease by measuring cholesterol,
triglycerides, HDL, and LDL levels.
Blood Glucose Levels

•Missy’s Blood Glucose Level- 108 mg/dL

•Normal Levels- 70-110 mg/dL

Prediabetes- 100 mg/dL
Diagnosis of Diabetes- 100-126 mg/dL
 Evaluation of Missy’s
Blood Glucose Level
• Missy’s Blood Glucose Level- 108 mg/dL
• -Her current level places her in the higher end of the
normal range and in the prediabetes area.

• Contributing Factors
• -weight, poor insulin circulation, over consumption of
carbohydrates

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 Missy’s Lipid Profile
Results
Cholesterol 190

LDL 110

HDL 50

TG 114
 Evaluation of Missy’s
Lipid Profile
• Normal Levels vs. Missy’s
Levels
• Cholesterol-120-199mg/dL 190mg/dL

• LDL- <130mg/dL 110mg/dL

• HDL- >55mg/dL 50mg/dL

• TG- 35-135mg/dL 114mg/dL

 Activity Level
• Physical Activity Level- sedentary

• -Includes reading and playing video

games
 Missy’s Energy
• EER for Girls 9 Through 18 Years
• EER = TEE + energy deposition
• EER = 135.3 − (30.8 × age [y]) + PA × (10.0 × weight [kg]
+ 934 × height [m]) + 25 kcal
• Where PA is the physical activity coefficient:
• PA = 1.00 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)
• PA = 1.16 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)
• PA = 1.31 if PAL is estimated to be ≥ 1.6 < 1.9 (active)
• PA = 1.56 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

• Missy: Age 10 yrs PA 1.0 Weight kg=52.3 Height m=

1.45
• EER= 135.3- (30.8 x10) + 1.0 x (10.0 x 52.3kg + 934x
1.45m) + 25 kcal
• EER= 135.3- 308 + 1.0 x 1877.3 + 25kcal
• EER= 1729.6 kcal
 Missy’s Energy
• Energy Requirements
• 1729.6 kcal

• Energy Intake
• -includes high fat and high starch foods with
inadequate fruit and vegetable intake

• Energy Breakdown:
• Total calories= 4435 kcals
• Energy dense beverages= 402 kcals
• 9.06% of total calories
• High fat foods= 2697 kcals
• 60.81 % of total calories
 Missy’s Assessment
• Energy Intake- High fat and high carbohydrate
content of food with a low energy output.
• Blood Glucose Test- Due to her weight and
high carbohydrate consumption her insulin levels are
not keeping up with her blood glucose levels, which
places her at risk for type II diabetes.
• Lipid Profile- Elevated levels indicate she is at
risk for developing cardiovascular disease as well.
 Missy’s Diagnosis and
Treatment Plan
• Missy’s Nutrition Diagnosis ~ PES

• Excessive energy intake related to energy-dense

food choices as evidenced by estimated energy
intake of 4,435 kcals based on 24 hour recall.

• Physical inactivity related to preference for

sedentary activities as evidenced by report of
enjoying video games and reading.
 Missy’s Treatment
• Missy’s Nutrition Intervention-Based on PES
statements
• 1) Excessive energy intake.
• Goal: for Missy to achieve appropriate energy intake
levels. 
• Intervention: nutrition education for Missy and her
parents covering:
• Portion Control
• Balancing intake based on physical activity level
• Healthy cooking techniques/ meal and snack ideas
• Health risks of chronic overweight
 Missy’s Treatment
• Missy’s Nutrition Intervention-Based on PES
statements
• 2) Physical Inactivity.
• Goal: to increase Missy’s physical activity.
• Intervention: encourage her to play more outside the
house, in addition, we recommend that she enroll in
an after school sports program of her choice (soccer,
basketball, volleyball, swimming, etc) so that she
can be more active and enjoy it. 
• Also, we recommend Missy get a Wii system so she
can be more active during her screen time.
Missy’s MyPyramid

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 Missy’s Menu
• Day 1
• Breakfast
• 1% milk (low fat)
• Oatmeal (plain)
• 1% milk (low fat)
• Blueberries (raw)

• Lunch
• Fat free milk (skim)
• Wrap sandwich (meat, vegetables, rice)
 Missy’s Menu
• Dinner
• Fat free milk (skim)
• Chicken, veggies & noodles (cream sauce)
• Raw carrots
• Creamy dressing (ranch)
• Wheat roll (part whole wheat)  

• Snack
• Banana
• Lowfat cottage cheese
• Cucumber
• Italian dressing (oil and vinegar)

• Canned tuna (in oil)

Missy’s Menu
Assessment

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 Monitoring and
Evaluation
• Next counseling session for Missy should be
scheduled as soon as possible, needs to get
appropriate treatment for sleep apnea and then
start Nutrition counseling immediately.
• Her parents should definitely be included in her
counseling sessions, they are preparing her
meals.
• In follow up visit, assess short term goals that
were originally set, these are first steps to her
long term goals.  We would assess any changes
in physical activity and dietary behavior.
 Missy’s Lifestyle
and Our Culture
• What put Missy at risk for
becoming overweight?
• Childhood Obesity~ Causes
• Genetics
• Behavioral/environmental
• Global trends/ Personal Habits
 Missy’s Weight Loss
Options
• Alli/Orlistat
• Not For Children

• Gastric Bypass Surgery

• Not For Children

• Healthy Diet and Physical Activity

• Appropriate for Anyone
 Missy and Her Peers
• Goals for pediatric weight loss
• Who is involved?
• Family
• What are they eating?
• Food Diary
• Portion Control
• Weight management
• Healthier eating choices
• More physical activity/less sedentary
activity