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Childhood Obesity: More Than Just BMI Childhood Obesity: More Than Just BMI

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Childhood Obesity: More Than Just BMI - PPT Presentation

Presented by Erica Timmermann Dietetic Intern 2009 NTR 622 Case Study Seminar Julie Moreschi Spring 2009 Childhood Obesity Obesity among children and adolescents is on the rise today and is a major health concern ID: 813174

2009 obesity children food obesity 2009 food children http website overweight amp april diet childhood accessed weight www nutrition

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Slide1

Childhood Obesity: More Than Just BMI

Presented by: Erica Timmermann

Dietetic Intern 2009

NTR 622

Case Study

Seminar

Julie

Moreschi

Spring 2009

Slide2

Childhood Obesity

Obesity among children and adolescents is on the rise today and is a major health concern.

According to the NHANES survey from 1976-1980 and 2003-2006 showed that obesity has increased by:

5.0 % to 12.4 % among children aged 2 to 5 years of age.

And a 6.5 % to 17 % increase among children aged 6 to 11 years old.

[1] Centers for Disease Control and Prevention. Overweight prevalence. Available at website:

http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/prevalence.htm

.

Assessed April 3

rd

2009, 2009.

Slide3

Illinois and Chicago Childhood Obesity Rates

In 2007 the state percentage of children obese in Illinois was 12.9% of children, while 15.7% of children were considered overweight in Illinois.

Rates among children living in the Chicago area in 2007 was 15.9% of children were obese, while 18.7% were considered overweight.

[2] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results Illinois 2007 dietary behaviors percentage of students who were obese. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=507&loc=IL&year=2007

. Assessed April 3

rd

2009, 2009.

[3] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results Illinois 2007 dietary behaviors percentage of students who were overweight. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=506&loc=IL&yeay=2007

. Assessed April 3

rd

2009, 2009.

[4] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results

chicago

,

il

2007 percentages of student who were obese. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=507&loc=CH&yeye=2007

. Assessed April 3

rd

2009, 2009.

[5] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results

chicago

,

il

2007 percentages of students who were overweight. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=506&loc=CH&yeye=2007

. Assessed April 3

rd

2009, 2009.

Slide4

Childhood obesity is defined for children and adolescents aged 2 through 19 years of age as:

Overweight being defined as a BMI at or above the 85th percentile and lower than the 95th percentile.

Obesity being defined as a BMI at or above the 95th percentile for children of the same age and sex.

[6] Centers for Disease Control and Prevention. Defining childhood overweight and obesity. Available at website:

http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/defining.htm

. Accessed April 5th 2009

Slide5

Pathophysiology

of Childhood Obesity

Excess fat accumulates

in

children and adolescents when there is an increase in energy consumption and a decrease in energy expenditure due to a secondary lifestyle such as watching television or computer and video game use.

[7] Schwarz SM.

Emedicine

from WebMD. Obesity. Available at

http://emedicine.medscape.com/article/985333-overview

Accessed April 5th 2009.

Slide6

In those children and adolescents who are obese, there is a dysfunction in the gut-brain-hypothalamic axis by means of the

ghrelin/leptin

pathway.

This has been known to play a role in abnormal appetite control, which leads to an increase in energy intake.

[7] Schwarz SM.

Emedicine

from WebMD. Obesity. Available at

http://emedicine.medscape.com/article/985333-overview

Accessed April 5th 2009.

Slide7

Ghrelin and

Leptin

Ghrelin

is a hormone that stimulates hunger (appetite stimulate) while

leptin

plays a key role in regulating energy intake and energy expenditure (appetite depressor).

Ghrelin

levels increase before meals and decrease after meals. It is considered the counterpart of the hormone

leptin

, which is the overall satiety signal. Leptin is produced by fat cells and most obese people have higher

leptin

levels than normal because of a higher number of fat cells.

[8] Wikipedia: the free encyclopedia:

Ghrelin

. Available at website:

http://en.wikipedia.org/wiki/Ghrelin

. Accessed May 2nd.

[9] Wikipedia; the free encyclopedia:

Leptin. Available at website: http://en.wikipedia.org/wiki/Leptin. Accessed May 2nd 2009.Adopted from Deepa Handu. Professors at BenU. Obesity Theory and Practice Application. Lecture 5: Childhood Obesity.

Slide8

Ghrelin and

Leptin

Leptin

does not have the same satiety affect in obese individuals as it does in leaner individuals.

Leptin

Resistance!

Ghrelin

levels in the plasma of obese individuals are higher than those in leaner individuals.

Ghrelin

does not decrease after a meal, it still very high which means it still stimulates appetite.[8] Wikipedia: the free encyclopedia: Ghrelin. Available at website:

http://en.wikipedia.org/wiki/Ghrelin

. Accessed May 2nd.

[9] Wikipedia; the free encyclopedia: Leptin. Available at website:

http://en.wikipedia.org/wiki/Leptin

. Accessed May 2nd 2009

.

Adopted

from

Deepa Handu. Professors at BenU. Obesity Theory and Practice Application. Lecture 5: Childhood Obesity.

Slide9

However, excess intake, decrease energy expenditure, and hormonal disorders do not completely explain excess weight gain.

Most overweight children and adolescents have a family history of overweight and obesity with at least one or two parents, whom are overweight.

Nevertheless, it is both genetics, environmental and behavioral factors that play a

role,which

will be

discussed later

.

[7] Schwarz SM.

Emedicine

from WebMD. Obesity. Available at http://emedicine.medscape.com/article/985333-overview

Accessed April 5th 2009.

Slide10

Contributing Factors to Childhood Obesity

Such factors include:Genetics

Behavioral factors such as:

Energy intake, physical activity, and sedentary behavior.

Environmental factors such as:

Home, school, and even childcare.

Slide11

American Dietetic Association

Evidence Based Library

Based on the American Dietetics Associations evidence based library, they have made a “map” outlining some of the plausible causes of childhood obesity and overweight status.

ADA- Factors Associated with Childhood Obesity

https://www.adaevidencelibrary.com/topic.cfm?cat=2792

[10] American Dietetic Association: Evidenced based library. Factors associated with childhood overweight. Available at website:

https://www.adaevidencelibrary.com/topic.cfm?cat=2792

. Accessed April 5

th

2009

Slide12

C.W

.

Slide13

Patient Profile: CW

CW is an eight-year-old Hispanic male that was born on August 17th, 2000.

CW speaks fluent English, as this is his primary language.

He is attending school full time and is enrolled in the 3

rd

grade.

He has two older female siblings and two parents that have been divorced for four years now.

Slide14

Living Arrangements

CW spends his afternoons at his mother’s house until 7 pm where the father will pick them up at this

time.

The children then

stay with

their

father until school the next day.

Weekends

can vary as to which parent has the children. CW’s mother is remarried and lives with her husband and her mother.

Father

lives by himself.

Slide15

Patient Profile: CW

Past Medical History:

Attention

Deficient Disorder (

ADD

)

D

iagnosed

two years ago. Current Symptoms: Excessive thirst Excessive hunger Inability to pay attentionTirednessS

leep apnea

He

has been tested for Diabetes since his symptoms indicate this, but the test came back negative after his fasting blood glucose was 93 mg/

dL

.

Slide16

Diabetes and Childhood Obesity

Rates for childhood obesity and type two diabetes are higher than ever. The accumulation of excess body fat, particularly in the visceral area, has the potential to reduce the sensitivity to insulin in skeletal muscle, liver tissues, and adipose tissues also known as insulin resistance.

[7] Schwarz SM.

Emedicine

from WebMD. Obesity. Available at

http://emedicine.medscape.com/article/985333-overview

Accessed April 5th 2009.

Slide17

Risk Factors for Type 2 Diabetes in Youth

Obesity: Risk for diabetes increase two times for every 20% of excess body weight.

Puberty: Insulin Resistance falls by 30% in early puberty.

Family History: T2DM is associated strongly with family history.

Ethnicity: More prevalent in some ethnicities/minorities.

Adopted from

Deepa

Handu

. Professors at BenU. Obesity Theory and Practice Application. Lecture 5: Childhood Obesity.

Slide18

Weight History

CW has been overweight since birth tipping the charts at the 90th

to

95

th

percentile.

Since

his parents divorce when he was 4, his eating habits have only gone down hill and have become increasing worse.

Slide19

Parent to Child Relationships

For CW, his underlying problem on his unhealthy eating habits and obese lifestyle has a great deal to do with his parents who have been divorced since he was four years of age.

A study that investigated the characteristics of the social environment and their potential risk on childhood obesity, found that lower social class status, lower expressive social support, and unmarried status of the caretaker were associated with a higher calorie intake and a higher weight for height score in the children being studied.

[11] Gerald LB, Anderson A, Johnson GD, Hoff C,

Trimm

RF. Social class, social support and obesity risk in children.

Pediatrics.

2006; 20(3):145-163.

Slide20

Parent to Child Relationships

Another study done by Strauss, investigated whether the association between the home environment and socioeconomic factors lead to the development of obesity and found that children who lived

with single mothers were significantly (

P

< .05) more likely

to develop obesity by the 6-year follow-up.

[12] Strauss RS, Knight J. Influence of the home environment on the development of obesity in

children.
Pediatrics. 1999 Jun;103(6):85.  

Slide21

Parents Medical History

The parent’s have no past medical issues; however, his mother used to be overweight until having gastric bypass surgery a few years back and the father is within normal weight status.

Mother states that one of his siblings is reported to be within normal weight limits while the other is reported to be underweight.

Slide22

Nutritional Data

Height: 5’0 feet

Above the 97

th

percentile for stature-for-age

Weight:

158

pounds

Above the 97th percentile for weight-for-ageTaken at doctors office at the end of FebruaryBMI: 30.8Above the 97th percentile for BMI-for-ageUBW:

Varies since he is a child.

Gaining 1-2 pounds/month

Slide23

Medications

Drug

Name

Instructions

Diet

Nutritional

Oral/GI

Other

Ritalin

5 mg tab

Take with food, no later than 6 pm.

Food helps increase extent, but not rate of absorption.

Insure adequate calorie

intake.

Limit Caffeine.

May cause:

-Anorexia

- Decrease weight

- Decrease Growth

Dry Throat

Nausea

Abdominal Pain

Nervousness

Insomnia

Tachycardia

Hypertension

Hypotension

Rash

Joint Pain

Drowsiness

Headache

[13]

Pronsky

ZM.

Food Medication Interactions

, 14

th

ed.

Birchrunville

, PA: Food-Medications Interactions; 2006.

 

Slide24

Lab Results

Lab Test

Normal Values

Date Taken/Values

Results

Triglycerides

< 150 mg/

dL

2/20/09

135 mg/dL

Normal

Fasting

Blood Glucose

< 100 mg/

dL

2/20/09

93 mg/

dL

NormalTotal Cholesterol< 120-199 mg/dL2/20/09156 mg/dLNormalLDL

< 100

2/20/09

80 mg/

dL

Normal

HDL

> 40

2/20/09

43 mg/

dL

Normal

Slide25

Typical Day for C.W.

Breakfast

2 cups of cereal, which is either Cookie Crisp or a peanut butter chocolate cereal with one cup of 2% milk

Some days he may have waffles or French toast sticks with syrup and butter.

Occasionally scrabbled eggs

Drinks about 2 cups of juice a day such as apple or orange juice with breakfast

Lunch

Lunch consists of the hot lunch at school, which may be:

2 slices Pizza with fries

6 Chicken nuggets with fries

Macaroni and cheese

1 Salisbury steak

1 cup mashed potatoes

He only drinks chocolate milk at school.

 

- Mother will sometimes pack him fruit and cheese to eat with his lunch but she is not sure if he eats it.

Dinner

Usual at mother house:

1 Chicken breast

1 cup

Rice

½ cup Vegetables

2 slices of bread with 4 tbsp of butter.

May drink some water at dinner ~ 1 cup

Snack

After School Snack:

Animal crackers

Graham crackers

Yogurt with soda.

Evening Snack:

When father picks children up around 7 pm every night, he likes to “treat” them with an ice cream sundae.

Slide26

Nutrient Analysis of a Typical Day

Based on the nutrient analysis:

Total caloric intake: 3400

kcals

Protein: 97.91 grams

Fat: 140 grams of fat

Sodium: 4,520 mg.

Vitamin and Minerals: most vitamins and minerals meet 100% of the recommended intake except Vitamin E.

Carbohydrates: 50%

12.9 servings9 from simple carbohydratesProtein: 11%. 5.0 servings of lean protein sourcesFat: 38% 23 servings Fruit: 3.5 servings

Vegetables: 3 servings

Milk: 1 servings

Slide27

Personnel Food Habits

CW eats breakfast and dinner at his mother’s house and lunch at school.

When the father comes to pick up the kids in the evening, he likes to “treat” the kids to a snack which is usually around 7:00 pm.

Ice cream

Slide28

Personnel Food Habits

Mother states: CW rarely skips a meal and will often eat late at night.

Food dominates his life and she worries that he has lost all control over eating.

Does not chew his food but simply swallow’s food whole.

Eats 3 solid meals a day with snacks but has seen him sneaking food into his bedroom or other areas of the house in order to eat more food.

Slide29

Personnel Food Habits

CW has no known food allergies or cultural restrictions.

He will eat out at least 2 times a week at fast food restaurants.

Mother prepares most meals

and

occasional he will eat ethnic Hispanic foods at fathers house over the weekends.

Eating together rarely occurs as the mother prepares the food and lets the children eat for themselves.

Mother and father do all grocery shopping for CW.

Slide30

Personnel Food Habits

When meeting with parents together at the second visit without CW, RD determined that child will eat one thing at mom’s house and then tell father that he does not like that food when served at fathers house.

Slide31

Current Diet Order

After meeting with the RD on March 2nd

2009, she prescribed the follow diet:

1800-2000 kcal meal plan

50% from complex carbohydrates

25% lean protein

25% from monounsaturated and polyunsaturated fat

Saturated fats: < 7-8% of fat calories

20 grams of fiber per day.

Slide32

Diet Recommendations

Education: Family Based counseling techniques

Role of six food groups for growth, development as well as disease prevention.

Sources of energy dense foods and beverages.

Appropriate portions for children.

Role of Physical activity in health and weight management.

Nutrition Goals:

Aim for daily consistency in intake

Decreasing portion sizes

Screen time: 1 Hour per dayPhysical activity: 60 minutes per day

Slide33

1800 Kcal Diet

50% from carbohydrates = 900 calories/4 = 225 grams/15 = 15 servings.

Diet Recall = 13 servings (9 from simple carbohydrates)

25% from fat = 450 calories/9 = 50 grams/5 = 10 servings.

Diet Recall = 23 servings

25% from protein = 450 calories/4 = 112.5 grams /7= 16 servings

5 servings from lean meats

Slide34

Diet Rationale

The diet rationale is appropriate based on current recommendations for treating pediatric obesity.

Based on the American Dietetic Association Evidence Based Library, they recommend the use of a

1)Treatment Focus Plan

Dietary interventions

Physical activity interventions

Behavioral interventions

Adjunct therapies

2)Treatment Format Plan

Educating children and parents together versus child alone

Prescribed diet plan and nutrition education

Group versus individuals counseling

Peer counseling

https://www.adaevidencelibrary.com/topic.cfm?cat=2795

[14] American Dietetic Associations Nutrition Care Manual. Treating childhood overweight. Available at website:

https://www.adaevidencelibrary.com/topic.cfm?cat=2795

. Accessed April 4

th

2009 

Slide35

Dietary Interventions

Dietary Interventions include the use of:

1) Balanced macronutrient diets

1)By age Groups

2)Selected Diets

2) Altered macronutrient diets

Slide36

Balanced Macronutrient Diets

Balance macronutrient diets are based on the child’s age group or selected diet approaches.

Based on

CW’s

age, the ADA evidence based library states:

“A prescribed diet was considered to be macronutrient "balanced" if the macronutrient composition fell within DRI ranges: ‘Adults should get 45 percent to 65 percent of their calories from carbohydrates, 20 percent to 35 percent from fat, and 10 to 35 percent from protein. Acceptable ranges for children are similar to those for adults, except that infants and younger children need a slightly higher proportion of fat (25 %-40%).’ “

[15] American Dietetic Associations Nutrition Care Manual. Pediatric weight management: dietary interventions: Available at website:

http://www.adaevidencelibrary.com/topic.cfm?cat=2939

.

Accessed April 4

th

2009.

 

Slide37

Selected Diet Approaches

Stop Light Diet

2) Food Guide Pyramid

Slide38

Stop

Light

Diet

The Stoplight Diet is ideal for those age 6 to 12 years of age as a dietary component commonly used in behavioral interventions.

The diet classifies food as green, yellow, and red; much like a stoplight.

The energy goals for this diet is around 900 to 1,300 kcal/day with daily recording of all food and drinks consumed.

According to the evidence library, they grade this with a 1, which is good.

[16] Kirk S, Scott B, Daniels S. Pediatric obesity epidemic: treatment options.

J Am Diet Assoc

. 2005;105:44-51.

 

Slide39

Stop

Light

Diet

Green-light foods are low calorie, high fiber foods with no restrictions placed on how much to eat.

Yellow-light foods are viewed as those essential to a healthy, well-balanced diet, but because they are considered to be a higher nutrient density they are to be eaten in moderation.

Red-light foods are those that are high in fat or simple in sugars and are limited to no more than four servings per week and have to be eaten away from home.

[16] Kirk S, Scott B, Daniels S. Pediatric obesity epidemic: treatment options.

J Am Diet Assoc

. 2005;105:44-51.

 

Slide40

Food Guide Pyramid

Research on the pre-2005 Food Guide Pyramid focuses primarily on the use of the pyramid as an assessment tool, not as an intervention tool to treat overweight in children.

There is not enough research to judge the effectiveness of using the pre-2005 Food Guide Pyramid as an intervention tool to treat overweight in children.

[17] American Dietetic Associations Nutrition Care Manual. What is the evidence to support the Food Guide Pyramid as an approach to limiting calorie/food intake in children? Available at website:

http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=250051

.

Accessed April 4

th

2009

 

Slide41

Altered Macronutrient Diets

Low FatAltered Carbohydrates

Altered Protein

[14] American Dietetic Associations Nutrition Care Manual. Treating childhood overweight. Available at website:

https://www.adaevidencelibrary.com/topic.cfm?cat=2795

. Accessed April 4

th

2009 

Slide42

Physical Activity

Receiving a grade score of one, the evidence based library indicates that “using a program to increase physical activity as part of a pediatric weight-management program results in significant improvements in weight status and adiposity in children and adolescents”

[18] American Dietetic Associations Nutrition Care Manual. What is the effectiveness of using a program to increase physical activity as a part of an intervention program to treat

childhood overweight? Available at website:

http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=105

.

Accessed April 5

th

2009 

Slide43

Treatment Focus-Behavioral

Behavioral interventions include the use of family-based counseling that includes parent training as part of a multi-component pediatric weight management program which results in significant reductions in weight status and adiposity in children 12 years and younger.

[19] American Dietetic Associations Nutrition Care Manual. What is the effectiveness of family-based counseling including parent training or modeling as part of a

multicomponent

pediatric weight management program to treat overweight in children (ages 6-12)? Available at website:

http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=99

Accessed April 5

th

2009.  

Slide44

Treatment Focus

Prescribed Diet and Nutrition Education

It has been shown that including a prescribed diet plan as part of a multi-component weight-management program results in improvements in adiposity in children in both the short-term and longer-term (more than one year).

 

[20] American Dietetic Associations Nutrition Care Manual. What is the effectiveness of using a prescribed dietary plan as part of an intervention program for child (ages 6-12) overweight? Available at website:

http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=97

. Accessed April 5

th

2009.

 

Slide45

Other Recommendations

Research has shown that eating dinner as a family has been associated with a more healthful diet; more fruits and vegetables, fewer fried foods, less soda, less fat and more micronutrients.

Furthermore, I would encourage the parents to be a role model in healthy eating behaviors as well as partaking in physical activities with the child.

Parental modeling for both healthy eating habits and physical activity has been shown to help shape children’s values, beliefs, and behaviors about healthy eating and engaging in physical activity.

[21]

Gillmann

MW,

Rifas-Shiman

SL, Frazier AL,

Rockett

HR,

Camargo

CA

Jr

, Field AE, Berkley CS,

Colditz

GA. Family dinner and diet quality among children and adolescents.

Arch

Fam Med. 2000; 9:235-240.  [22] Ritchie LD, Welk G,

Styne

D, Gerstein D, Crawford P. Family environment and pediatric overweight

Slide46

Other Recommendations

I would recommend the parents to write a list of meals together that the child can eat within their household in order to provide the same meals/foods at each house.

Educate the father on ways to provide “treats” that are not foods, such as going for a walk or a movie, taking them to the park or the pet shop, etc.

Slide47

Sample Meal Plan-1800 kcal

Breakfast

:

1 egg or ¼ cup egg substitute

1 slice whole wheat bread, toasted

1 tsp margarine

6 ounces of low fat yogurt

1 medium orange

Lunch:

3 ounces of lean deli meat1 ounce of low fat cheese

2 slices of whole wheat bread

Lettuce, tomato, onion, etc

2 tsp mayonnaise 1 medium apple

1 ounce of light chips

Dinner

5 ounces of grilled, broiled or baked boneless skinless chicken

¾ cup cooked rice

1 dinner roll (whole wheat)Steamed assorted vegetables1 small salad with lettuce tomatoes, onions, and cucumbers2 tbsp of low fat salad dressing1 tsp margarineSnack 1 cup of skim milk3 graham cracker squares

½ cup of unsweetened applesauce

Slide48

Short Term Goals for C.W. and Parents

Aim for a healthy well rounded diet

Increase fruits and vegetables to three to five per day

Increase low fat milk consumption

Decrease fast food consumption by limiting to once per week

Decrease soda and sugary beverage consumption to once a week

Increase physical activity to one hour per day

Decrease TV viewing time to one hour per day

Have divorced parent’s work together in planning meals and grocery list in order to have the same foods at both homes.

Work on portion control

Work on having the parents pack the child’s lunch to school every day

Slide49

Long Term Goals for C.W. and Parents

Weight MaintenanceImproved diabetic symptoms

Ability for CW to plan his own healthy meals

Want CW to know the difference between healthy vs. not so healthy foods so he can continue to maintain his weight into adulthood.

Slide50

ADIME NOTE: Assessment

CW is considered to be at a moderate to high nutritional

risk due

to an excess of body weight for his height and age.

He

is

far

above the 97

th percentile when plotted on a growth chart for BMI for age. He consumes large amounts of food and eats all throughout the day. He has diabetic symptoms and although he tested negative for diabetes he could still develop diabetes if his eating patterns continue.

Slide51

ADIME: Diagnosis

P: Excessive Oral Food/Beverage Intake (NI-2.2)

E:

Related to food and nutrient knowledge deficit, lack of access to healthy food choices, inability to refuse or limit offered foods, lack of food planning, purchasing, and preparation skills, unaware of being full, and uninterested in reducing intake.

S:

Diabetic related symptoms

such as

polyphagia

, polydypsia, and lethargy. Patient is experiencing weight gain of 1-2 pounds per month and is considered obese as indicated by CDC growth charts. Intakes of large portions of food and beverages that are of high caloric density, in addition to episodes of binge eating, with frequent visits to fast food restaurants.

Slide52

ADIME: Intervention

Food and Nutrient Delivery: Modified distribution, type, or amount of food and nutrients within meals or at a specified time. Nutrition Education:

Recommended Modifications

Nutrition Counseling:

Stages of changes and Goal Setting

Slide53

ADIME: Monitoring/Evaluating

Total energy intake, social support within the home, portion control, planned meals and snacks, food selection and preparation, and monitor growth and development.

Slide54

Certificate Opportunity

June 15-17, 2009Certificate of Training in Childhood and Adolescent Weight Management program.

Hyatt Regency Crown Center, 2345 McGee Street, Kansas City, Missouri.

For registration information and to view the certificate requirements, timeline, registration deadlines and agenda go to:

http://www.cdrnet.org/wtmgmt/childhood.htm

For a list of Certificate of Training in Adult Weight Management programs along with registration information, certificate requirements, timeline, registration deadlines and agenda, go to:

http://www.cdrnet.org/wtmgmt/certificateoftraining.htm

Slide55

THANK YOU!

Sincerely,

Erica Timmermann

Slide56

References

[1] Centers for Disease Control and Prevention. Overweight prevalence. Available at website:

http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/prevalence.htm

.

Assessed April 3

rd

2009, 2009.

[2] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results Illinois 2007 dietary behaviors percentage of students who were obese. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=507&loc=IL&year=2007

. Assessed April 3rd 2009, 2009.

[3] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results Illinois 2007 dietary behaviors percentage of students who were overweight. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=506&loc=IL&yeay=2007

. Assessed April 3

rd

2009, 2009.

[4] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results

chicago

,

il 2007 percentages of student who were obese. Available at website: http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=507&loc=CH&yeye=2007. Assessed April 3rd 2009, 2009.[5] Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results chicago, il 2007 percentages of students who were overweight. Available at website:

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=506&loc=CH&yeye=2007

. Assessed April 3

rd

2009, 2009.

[6] Centers for Disease Control and Prevention. Defining childhood overweight and obesity. Available at website:

http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/defining.htm

. Accessed April 5th 2009

[7] Schwarz SM.

Emedicine

from WebMD. Obesity. Available at

http://emedicine.medscape.com/article/985333-overview

Accessed April 5th 2009.

Slide57

References

[8] Wikipedia: the free encyclopedia:

Ghrelin

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