Question

Michael is a 12 year old boy that you are seeing for the first time at a well-child visit. The mother reports his birth weight as 2.3 kg. (5.06#). He had diarrhea during the first year of life and gained slowly to 8.0 kg. (17.6 #) at one year. After that, she reports "He ate really well." Michael has no chronic medical conditions and has never had to be on medication for anything. His mother, age 35, is a single parent who works full time in a grocery store and was diagnosed several years ago with hypertension and type 2 diabetes mellitus. Additionally, she has hyperlipidemia with an LDL of 260. His father is not with the family but the mother is able to inform you that he is 42 years old and has hypertension and had a heart attack at age 39. Michael has three siblings bya different father, two younger sisters, ages 11 and 9, and a younger brother, age 4; they are all healthy. Michael is currently in the sixth grade at a local public school and has a B average. He receives both free breakfast and lunch at school. Most days after school he and his sisters take the bus (even though they could walk) to a neighbors house where they will usually eat some type of snack like chips or convenience foods, watch TV for a couple of hours, and occasionally eat dinner. Michael's mother reports that he has a good appetite and eats meat, cereals and grains, but refuses to eat vegetables. He will occasionally drink orange juice in the morning but usually has soda with his meals. On physical exam you find that Michael is 58" tall and weighs 130#. His BP was 12882 mmHg at this visit. At this visit, the physician also ordered a lipid profile and blood glucose tests for. Below are the results of non-fasting lab work. Result Reference Range 80-120 3.9-5.2 112 5.0 165 34 Glucose (mg/dL) HbA1c (%) Cholesterol (mg/dL) HDL (mg/dL) LDL (mg/dL) Triglycerides (mg/dL) 55 F, 45 M <110 s150 114

Answer 1

5. The given data shows that Michael BMI percentile is 97.7. His blood reports also near the borderline. According to the American Academy of Pediatrics(AAP), he has been started with prevention plus stage for 3-6 months. In this stage, he has been served with more fruits and vegetables. Avoid sitting in front of the TV for a long hour and minimize of sweetened beverages and skipping of meals. Lifestyle modification included in this stage. Michael has been treated with the goal of reducing the weight percentile to less than 85. Michael should be targeted with loss of weight of 21bs per week.

If he has not shown any improvement then He has been referred to the dietician for the structured weight management program for 3 - 6 months. The diet plan should include of macronutrients and less amount of carbohydrate food. High protein diet should be included to maintain the muscle mass. The meals should be given in smaller portions and in frequent times to get enough energy. He has been motivated to the behavioral changes with proper counseling and education. His time with TV should be reduced and made him to be involved in physical activity. His mother should screen of his physical activity and dietary practices. He has been measured with assessment tools, screening, BMI curve, and laboratory screenings.

6. Environmental factors for childhood obesity:

• Lack of physical activity

Potential changes: After schooling, make him do physical activity with the siblings. Suggest spending time in parks instead of sitting in front of the TV. Advice him to concentrate on a healthy snack in the neighborhood houses.

• Social environment

Potential changes: Lack of family support, and lack of mother presence in the evening, low-income all these contributes to obesity. Make the mother spend time with the children, screening of his dietary practices, motivate for physical activity result in positive changes.

• Hereditary

Has both parents have suffered from hypertension, he also been in the risk factor of hypertension. Further obesity increases the risk of hypertension. Measures have been taken to modify the lifestyle changes for the prevention of hereditary diseases.

7. Stage 1 hypertension:

In stage 1 hypertension, the systolic pressure ranges between 140 to 159mmHg and diastolic pressure ranges between 90 - 99mmHg. The dietary and lifestyle changes include weight loss, physical activity, low sodium diet. In addition, if required thiazide diuretic medication is added to reduce the blood pressure.