CDC Definitions

• Childhood overwieght• BMI at or above the 85th percentile and lower than than

the 95th percentile.

• Childhood obesity• BMI at or above the 95th percentile

Contributions to Obesity:Environmental

Sugar drinks and less healthy foods on school campuses. Advertising of less healthy foods. Lack of daily, quality physical activity in all schools No safe and appealing place, in many communities, to play or be active Television and media

Limited access to healthy affordable foods.

Greater availability of high-energy dense foods and sugar drinks. Increasing portion sizes Lack of breastfeeding support.

Contributions to Obesity:Genetics

Familial clustering of obesity in familiesParent-child relationship

Studies show that children have a relative risk for obesity if parent/s are obese

Twin Studies

Bouchard Studies Overfeeding trail:-12 male monzygotic twins (age 21,BMI 19)-overfed 1,000 extra kcals/day six days/week for 84 days-wt gain range: 9 lbs-29 lbs -less varitation within twins than between twins Underfeeding Trial: -7 pairs of male monozygotic twins-kcal deficit (mainly exercise)-bike for 2 hours per day (2x/day) -1,000 kcal/day deficit for 9 days out of 10 for 93 total daysresults similar to overfeeding study

Health Consequences Diseases and Conditions:Coronary heart diseaseType 2 diabetesHypertension (high blood pressure)Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) Sleep apnea and respiratory problemsOsteoarthritis (a degeneration of cartilage and its underlying bone within a joint)

Psychological : low self-esteemnegative body image depression

EAL: Pediatric Weight Management

• Children Six to 12 Years Old• PWM: Energy Restricted Diets – If energy-restriction is appropriate, based on the

registered dietitian's professional judgment- balanced macro-nutrient diet recommended.

– 900kcal-1,200kcal per day – multi-component pediatric weight management

program– medically monitored.

Dieting Cycle

Want to lose weight

Diet (restriction)

Obsess over food

Binge ( using food as

comfort)

Weight Gain

Related ResearchObesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later?

Conclusion: Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Non-Diet Approach

• What is a non-diet approach?– Takes focus off weight and on to normalizing

eating– Encourages a variety– Eating in a flexible way for pleasure and in honor

of hunger and fullness cues– Finding Joy in moving your body

Case Study

• Missy Bloyd• Age: 10 years old • Gender: Female • Occupation: Student in 5th grade• Ethnic Background: Biracial

(African American and Caucasion)• Household members: Father age

36, mother age 35, sister age 5

Case Study

Chief Complaint:“We’ve noticed that Missy appears to stop breathing for several seconds several times a night. She is really cranky when se gets up for school. Her teacher says Missy gets very sleepy during school…She fell asleep in class yesterday”

Case StudyPatient History • Past several years:

• Sleeping with mouth open• Sleep disturbances• Cessation of breathing (at least 10 sec)• Morning headaches• Tired and irritable

• Has been “overweight” all her life• Occasional knee pain• Rash in skin folds• Abdomen: obese• Labs: normal • Current Medications: none

Case Study Patient History• Family History

• Type 2 DM• Heart Attack• High BP

• Nutrition History• Very good appetite• Consumes variety of foods• Low physical activity• Flinstones multi-vitamin daily

• No previous nutrition therapy• Medical DX: Obstructive sleep apnea (OSA) 2’ obesity and physical

inactivity

Dietary History

24 hour recall

Breakfast 2 breakfast burritos, 8 oz whole milk, 4 oz apple juice, 6 oz coffee with ¼ c cream and 2 tsp sugar

Lunch 2 bologna and cheese sandwiches with 1 tbsp mayonnaise, 1oz pkg Frito corn chips, 2 Twinkies, 8 oz whole milk

Snack Peanut butter and jelly sandwich (2 slices enriched bread with 2 tbsp crunchy peanut butter and 2 tbsp grape jelly), 12 oz whole milk

Dinner Fried chicken ( 2 legs and 1 thigh), 1 c mashed potatoes (made with whole milk and butter), 1 c fried orka, 20 oz Coca-Cola

Snack 3 c microwave popcorn, 12 oz Coca-Cola

Case Study: Assessment

• Height: 57 in• Weight: 115• BMI=24.9

• 97th percentile for age & gender

Case Study: Assessment

Energy and Protein Requirements:

Case Study: Diagnosis

• Food and nutrition-related knowledge deficit (NB-1.1) related to intake of low nutrient dense foods and 24 hour recall as evidenced by 97th percentile for age and weight.

Eating Competence

• Positive attitude about food• Willing to try new foods• Able to plan enjoyable meals • In touch with hunger and fullness cues • Focused on enjoying food and activity, not

weight

Child Feeding

• Division of Responsibility:• Parents-what, when, and where of feeding• Children- how much and whether of eating

Nutrition Intervention

• Nutrition Education – Initial/Brief Nutrition Education (E-1)• Educate Missy’s Mom and Dad on division of

responsibility of child feeding

• Including parent training or modeling as part of a multicomponent program to treat adolescent overweight is associated with improvement in adiposity. Grade II

Nutrition Intervention

• Nutrition-Related Behavior Modification Therapy (C-1)

• Eating Competence– Honoring hunger and fullness cues

» check in with yourself after first burrito » If still hungry, eat more, if not stop

• Move her body– Plan time into her schedule for an activity Missy enjoys doing

(swimming, dancing, walking )

Nutrition Intervention

• Outcome Goals: – To be able to sleep better at night– To have more energy throughout the day– To increase physical activity

• Action Goals: – Missy will ____ 2 times a week for 2 weeks– Missy will check into her hunger and fullness four

times over a two week period at dinner.

Scope of Practice

Monitor/Evaluation • Check for improvements in sleep and increases in energy

levels• Check in with Missy about her ability to stop eating when full• Check in with Missy about her physical activity• Follow up with Missy in 2 weeks for another counseling

appointment