Professional Documents
Culture Documents
Nutrition Assessment
6. Overweight or obesity in adults is defined by BMI. Children and
adolescents are often times classified as overweight or at risk
for overweight based on their BMI percentiles, but this
classification scheme is by no means universally accepted. Use
three different professional resources and compare/contrast their
definitions for overweight conditions among the pediatric
population.
According to Nelms, overweight in pediatrics is
defined as, an excess of body weight in relationship
to height; for children and adolescents, overweight
can be defined as a BMI-for-age-and-sex at or above
the 85th percentile using the CDC growth charts
(Nelms, 239).
BMI ranges for children and teens are defined so that
they take into account normal differences in body fat
between boys and girls and differences in body fat at
various stages. Overweight is defined as a BMI at or
above the 85th percentile and lower than the 95th
percentile for children of the same age and sex
(Centers for Disease Control and Prevention, 2013).
5
Intake Domain
9. Dietary factors associated with increased risk of overweight are
increased dietary fat intake and increased kilocalorie-dense
beverages. Identify foods from Missys diet recall that fit these
criteria. Calculate the percentage of kilocalories from each
macronutrient and the percentage of kilocalories provided by
fluids for Missys 24-hour recall.
Just after quickly assessing Missys 24-hour recall, it
is apparent to me that she is consuming excessive
amounts of fat and excessive amounts of added
sugar in her diet as evidenced by the whole milk,
added cream and sugar to her coffee, mayonnaise,
Frito corn chips, Twinkies, fried chicken, fried okra,
microwave popcorn and the Coca-Cola. As you can
see below, after entering Missys 24-hour recall data
into SuperTracker, it is apparent that she is taking in
too many calories throughout the day. Her total
caloric intake for her 24-hour recall was 4,558 kcals
nearly three times the amount she needs in a day.
% kilocalories Carbohydrates: 35%
% kilocalories Protein: 15%
% Kilocalories Fat: 43%
% kilocalories from beverages: 12%
It is important to note that about 1,000 kcals came
from Missys beverage intake alone.
Food Groups
Target
Average Eaten
Grains
5 ounce(s)
13 ounce(s)
Whole Grains
3 ounce(s)
1 ounce(s)
Refined Grains
2 ounce(s)
12 ounce(s)
2 cup(s)
1 cup(s)
Dark Green
1 cup(s)/week
0 cup(s)
4 cup(s)/week
0 cup(s)
1 cup(s)/week
0 cup(s)
Vegetables
Starchy
4 cup(s)/week
1 cup(s)
Other
3 cup(s)/week
cup(s)
1 cup(s)
cup(s)
Whole Fruit
No Specific Target
0 cup(s)
Fruit Juice
No Specific Target
cup(s)
3 cup(s)
6 cup(s)
No Specific Target
3 cup(s)
Cheese
No Specific Target
2 cup(s)
5 ounce(s)
12 ounce(s)
Seafood
8 ounce(s)/week
0 ounce(s)
No Specific Target
10 ounce(s)
No Specific Target
2 ounce(s)
Oils
5 teaspoon
15 teaspoon
Limits
Allowance
Average Eaten
Total Calories
1600 Calories
4558 Calories
121 Calories
1643 Calories
Solid Fats
1133 Calories
Added Sugars
509 Calories
Fruits
Dairy
Protein Foods
Empty Calories*
10.
Increased fruit and vegetable intake is associated with
decreased risk of overweight. Using Missys usual intake, is
Missys fruit and vegetable intake adequate?
Using Missys usual intake, it is apparent that she is not
consuming adequate amounts of fruits and vegetables.
According to the MyPlate SuperTracker tool, she is under in
both of those categories. The servings of fruits that she did
get were primarily from fruit juices. Her 24-hour recall does
not show any signs that Missy consumes whole fruits and
vegetables, which puts her at an increased risk for
remaining obese and only continuing to gain more weight.
11.
Use MyPlate Plan online tool to generate a personalized
MyPlate for Missy. Using this eating pattern, plan a 1-day menu
for Missy.
12.
Now enter and assess the 1-day menu you planned for
Missy using the Myplate SuperTracker online tool. Does your
menu meet macro- and micronutrient recommendations for
Missy?
Food Groups
Target
Average Eaten
Grains
5 ounce(s)
8 ounce(s)
Whole Grains
3 ounce(s)
3 ounce(s)
Refined Grains
2 ounce(s)
5 ounce(s)
2 cup(s)
3 cup(s)
Dark Green
1 cup(s)/week
0 cup(s)
4 cup(s)/week
1 cup(s)
1 cup(s)/week
0 cup(s)
Starchy
4 cup(s)/week
cup(s)
Vegetables
Other
3 cup(s)/week
1 cup(s)
1 cup(s)
2 cup(s)
Whole Fruit
No Specific Target
2 cup(s)
Fruit Juice
No Specific Target
0 cup(s)
3 cup(s)
3 cup(s)
No Specific Target
3 cup(s)
Cheese
No Specific Target
cup(s)
5 ounce(s)
7 ounce(s)
Seafood
8 ounce(s)/week
0 ounce(s)
No Specific Target
5 ounce(s)
No Specific Target
2 ounce(s)
Oils
5 teaspoon
2 teaspoon
Limits
Allowance
Average Eaten
Total Calories
1600 Calories
1738 Calories
121 Calories
180 Calories
Solid Fats
102 Calories
Added Sugars
78 Calories
Fruits
Dairy
Protein Foods
Empty Calories*
Clinical Domain
13.
Why did Dr. Null order a lipid profile and blood glucose
test?
Dr. Null ordered a lipid profile to evaluate the damage of
Missys lipids such as her cholesterol levels- HDL and LDL
in particular.
The glucose test was ordered because it would not be
surprising if Missys pancreas were struggling to produce
insulin- resulting in type 2 diabetes as a result of her being
obese for her age. Her family history indicates a
prevalence of type 2 diabetes in both her mother and her
10
14.
What lipid and glucose levels are considered to be
abnormal for the pediatric population?
The normal blood glucose range for the pediatric
population should be between 70-110 mg/dL. Missys BG
was 108, which isnt quite out of range, but it should be
lower than that. According to the NIH, it is normal for a
fasting pediatric blood glucose level to be anywhere
between 70-85mg/dL, so with this information, Missy has
indications that her pancreas is struggling. She is inevitably
on the brink of type 2 diabetes (NIH, 2013).
According to the American Academy of Pediatrics, Lipid
levels that are considered to be normal for the pediatric
population are 120-199 mg/dL. Missy has total cholesterol
of 190mg/dL, which is in fact on the high side. Having high
cholesterol at the mere age of 10 can potentially be
detrimental to Missys heart health and her overall well
being (AAP, 2015).
15.
11
Behavioral-Environmental Domain
16.
What behaviors associated with increased risk of
overweight would you look for when assessing Missys and her
familys diets?
I would look for sedentary lifestyle behaviors, high-stress,
lack of sleep, poor diet and overall well being (i.e.socioeconomic status and state of nutrition related
education).
17.
What aspects of Missys lifestyle place her at increased risk
for overweight?
Missy lives a sedentary lifestyle for a child her age.
According to her 24-hour dietary recall, she is uneducated
on what foods she should consume and what foods are
detrimental to her health. She also consumes a very
calorie-dense diet with little to no fruits and vegetables,
which is inevitably going to be damaging to her health. The
fact that she is not very active in general combined with
her diet is directly related to her Missy being obese.
18.
You talk with Missy and her parents. They are all friendly
and cooperative. Missys mother asks if it would help for them to
not let Missy snack between meals and to reward her with
dessert when she exercises. What would you tell them?
I would kindly tell them that it is better for Missy to eat in
between meals; in fact, thats what I would recommend in
her dietary prescription because eating more often keeps
the bodys metabolism running and helps keep the body
full longer (granted that Missy is consuming foods that are
nutrient dense).
As for rewarding Missy with dessert when she exercises, I
would curb them away form this idea because it will only
set Missy up for disaster in the end. I would encourage the
family to help Missy out by exercising with her, and eating
healthier meals and snacks with her to positively reinforce
what she should be doing. If the family participates with
12
19.
Identify one specific physical activity recommendation for
Missy.
One specific physical activity recommendation for Missy
would be to go outside and play more often. In todays
society, unfortunately kids are more exposed to technology
and being indoors, resulting in a lack of creativity and lack
of exercise overall. I would encourage Missy to play outside
more with her neighbors or siblings if she has any. This will
enable her to become more active overall, and she will
have fun being active, too!
Nutrition Diagnosis
20.
Select two high-priority nutrition problems and complete
PES statements for each.
Excessive oral intake (NI 2.2) related to 24-hour recall as
evidenced by total daily caloric intake of 5,558 kilocalories.
Physical inactivity (NB 2.1) related to exercise and nutrition
related knowledge deficit as evidenced by documentation
of obese abdomen.
(IDNT, 2011)
Nutrition Intervention
21.
For each PES statement written, establish an ideal goal
(based on signs and symptoms) and an appropriate intervention
(based on etiology).
13
22.
Mr. and Mrs. Bloyd ask about using over-the-counter diet
aids such as Alli (Orlistat). What would you tell them?
I would encourage Mr. and Mrs. Bloyd to avoid diet aids
such as Alli. Diet aids usually have more disadvantages
than advantages and the weight that typically is lost with a
14
23.
Mr. and Mrs. Bloyd ask about the gastric bypass surgery
for Missy. What are the recommendations for the pediatric
population for gastric bypass surgery?
According to the American Society for Metabolic and
Bariatric Surgery, selection criteria for adolescents for
bariatric surgery are as follows:
The child has to have a BMI greater than or equal to
35kg/m2 with major co-morbidities (i.e., type 2 diabetes
mellitus, moderate to severe sleep apnea, pseudo tumor
cerebri, or severe NASH)
Or a BMI of 40 kg/m2 with other co-morbidities (e.g.,
hypertension, insulin resistance, glucose intolerance,
substantially impaired quality of life or activities of daily
living, dyslipidemia, sleep apnea with apnea-hypopnea
Missy does not have any of these problems and so as for
right now, it would be completely unnecessary for her to
have bariatric surgery.
(ASMBS, 2015)
25.
26.
16
References
American Academy of Pediatrics: Overweight and Obesity.
http://www.aap.org/obesity/
American Diabetes Association. (n.d.). Retrieved October 7, 2015.
Centers for Disease Control and Prevention (CDC). Defining Childhood
Obesity. (2015, June 19). Retrieved October 11, 2015.
International dietetics and nutrition terminology (IDNT) reference
manual:
Standardized language for the nutrition care process. (3rd ed.).
(2011).
Chicago, IL: American Dietetic Association.
Mayo Clinic: Childhood Obesity (2015, May 10). Retrieved from
http://www.mayoclinic.org/diseases-conditions/childhoodobesity/basics/definition/con-20027428
National Institutes of Health (NIH). (2013, August 12). Retrieved
October 5, 2015
from http://www.cdc.gov/obesity/childhood/defining.html
Nelms, M., & Roth, S. (2004). Medical nutrition therapy: A case study
approach (2nd
ed.). Belmont, CA: Wadsworth/Thomson Learning.
Nelms, M. (2011). Nutrition therapy and pathophysiology (2nd ed.).
Belmont, CA:
Wadsworth, Cengage Learning.
Pediatric Best Practice Guidelines - American Society for Metabolic and
Bariatric Surgery. (2015, December 5). Retrieved October 6, 2015.
17
18