Question

Timothy is a seven year old boy, his mother takes him to the pediatrician for review. Its weight is 31 kg and corresponds to the 95th percentile; their height is 127 cm and they are between the 75th and 90th percentiles for their age. His body mass index is 19.25 kg / m2, which is just above the 95th percentile for his age. Their growth percentiles have increased in recent years. Timothy's mother expresses her concern to the pediatrician about the weight of her son; his brothers, one older and one younger than him, are slimmer. Timothy's mother is obese, but her father is a normal weight for height. Timothy is in his second year of elementary school and takes the school bus both to go to school and to return. She participates in her school's school breakfast program, but her parents give her extra money to buy, if she wants, some of the food sold in the cafeteria or the vending machines. After school, Timothy and his siblings stay at home with a babysitter until one of their parents returns from work. Timothy usually watches television or entertains himself with video games after school; Their parents leave treats (chips, cookies, and soft drinks) at home for their children to eat after school. The mother usually prepares the evening meal, which consists of meat, starch, vegetables and a dessert. After dinner, Timothy does his homework and then watches more television with his parents. He often has ice cream before going to the cabin.

Apply nutritional assessment,

nutritional diagnosis,

nutritional intervention

and nutritional surveillance

Answer 1

Nutritional assessment - More weight according to the height and age of the child .

Nutritional diagnosis - imbalanced nutrition more than body requirements related to food intake that exceeds body needs , socioeconomic status.

Nutritional interventions :-

Review individual cause for obesity (organic or nonorganic).Identifies and influences choice of some interventions.

Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits).Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring change or a base on which to tailor the dietary program.

Explore and discuss emotions and events associated with eating. Helps identify when patient is eating to satisfy an emotional need, rather than physiological hunger.

Formulate an eating plan with the patient, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, energy, and nutrient requirements. Determine which diets and strategies have been used, results, individual frustrations and factors interfering with success.Although there is no basis for recommending one diet over another, a good reducing diet should contain foods from all basic food groups with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to patient’s usual eating pattern as possible. A plan developed with and agreed to by the patient is more likely to be successful.

Emphasize the importance of avoiding fad diets.Elimination of needed components can lead to metabolic imbalances like excessive reduction of carbohydrates can lead to fatigue, headache, instability and weakness, and metabolic acidosis (ketosis), interfering with effectiveness of weight loss program.

Discuss need to give self permission to include desired or craved food items in dietary plan.Denying self by excluding desired or favorite foods results in a sense of deprivation and feelings of guilt and failure when individual “succumbs to temptation.” These feelings can sabotage weight loss.

Be alert to binge eating and develop strategies for dealing with these episodes (substituting other actions for eating).The patient who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts.

Identify realistic increment goals for weekly weight loss.Reasonable weight loss (1–2 lb per wk) results in more lasting effects. Excessive and rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting “stair-step” goals.

Weigh periodically as individually indicated, and obtain appropriate body measurements.Provides information about effectiveness of therapeutic regimen and visual evidence of success of patient’s efforts. (During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.)

Determine current activity levels and plan progressive exercise program (walking) tailored to the individual’s goals and choice. Exercise furthers weight loss by reducing appetite; increasing energy; toning muscles; and enhancing cardiac fitness, sense of well-being, and accomplishment. Commitment on the part of the patient enables the setting of more realistic goals and adherence to the plan.

Develop an appetite reducation plan with patient.