Question

Andrew is 16 years old and sedentary. He is 5 ft 8 in tall, weighs 218 pounds, and has a BMI of 33. He has been overweight for most of his life, as is most of his extended paternal family. His mother has tried "everything" over the years to get him to lose weight, from putting him on her own weight loss diet to hiding foods he shouldn't have, such as soft drinks and chips, to limit his access. He has a part-time job in a fast-food restaurant and is able to leave the school property at lunchtime to have lunch where he works. He is not good at sports but loves to play video games and watch movies. He hates that he's so big but feels hopeless about changing. His normal day's intake is shown below:

Breakfast: Two doughnuts and a large glass of apple juice

Lunch: A double cheeseburger, large fries, and a large shake Snacks: Frozen mini pizzas, a large soft drink, and a handful of cookies

Dinner: The same as lunch on nights he works; if he's home, he eats whatever is available, often pizza or sandwiches and chips, ice cream, and a soft drink Snacks: Chips and salsa and a soft drink

• Using the BMI-for-age percentile for boys, what is Andrew's weight status?

Is it an appropriate approach to limit Andrew's calories to outgrow his current weight status?

• How many calories should Andrew consume daily? Based on the MyPlate intake levels, which food groups is he consuming the appropriate amounts of? Which groups is he overeating? Which groups is he not eating enough of? What are the sources of empty calories in his diet?

• What specific goals would you encourage Andrew to set regarding his intake, activity, and weight?

• What would you suggest his mother do to support better eating habits and a healthier weight?

Answer 1

BMI -for - age percentile shows that Andrew's weight is greater than the 95th percentile. It shows that he is obese for his age. Only limiting the caloric intake of Andrew is not enough. Andrew's excess weight should be reduced by reducing caloric intake, and increase of physical activity, and increases the caloric expenditure.

Andrew should decrease the daily caloric intake to 1200Kcal/day. His daily intake is reduced to 3 meals and 2 snacks per day. Based on my plate, he consumes more amount of carbohydrate, fat, sodium, and sugar-sweetened beverages. He consuming more amounts of calorie dense food and less intake of fruits and vegetables. Cake, cookies, chips, soft drinks are the empty calories in his diet.

Specific Goals:

• Limit the outside foods especially at the restaurants.
• Limit the intake of caloric foods.
• Encourage the physical activity of at least 60 minutes per day.
• Motivate him to reduce his weight of 1 - 2 lb per week.
• Motivate him to change his eating habits.

Suggestion for Andrew's mother:

• Encourage the mother to give 3 frequent meals with 2 snacks per day.
• Advice her to give more amount of fruits and vegetables.
• Minimize the sodium and fat content in the diet.
• Advice her to motivate her son to do daily physical activity.
• Reduce beverages and increase fluid intake.