Brian is a 7-year, 4-month-old male who gained 15 pounds during the past school year. His height is 50½ inches, and his weight is 75 pounds. Brian moved to a new home and began a new school a year ago after his parents’ divorce. After-school care has been provided by a retired neighbor, who loves to bake for Brian. He has few friends in the neighborhood, and his main leisure activities have been watching television and playing video games. When he gets bored, he often looks for a snack. His mother reports that they often rely on take-out and fast-food meals because of the time constraints of her full-time job, and she has gained weight herself. She recently started an aerobics class with a friend and is interested in developing healthier eating habits for herself and Brian. After joint sessions with Brian and his mother, the following goals were identified by the family: (1) explore after-school care at the local community center, which has a physical activity component; (2) alter grocery and menu selection to emphasize the MyPlate and low-fat choices while still meeting the family’s time and resource constraints; (3) begin to incorporate physical activities (Brian identified swimming and bicycling as things he would like to do) on the weekends; and (4) limit television and video games to no more than 2 hours daily. After 4 months, Brian has enrolled in the local community center’s afterschool program and participates in organized soccer and “pickup” basketball. Weekends are a challenge. Brian and his mother have not yet incorporated physical activity into their weekend routine, and Brian finds it tough to limit screen time to 2 hours on the weekends. Brian has lost 4 pounds and is taller; he is 51 inches tall and weighs 66 pounds.
Nutrition Diagnostic Statement
Overweight/obesity as evidenced by BMI-for-age above the 95th percentile or more related to infrequent physical inactivity, large amounts of sedentary activity, and estimated excessive energy intake.
Nutrition Care Questions
1. Calculate and plot Brian’s BMI over time. Discuss the changes.
2. What recommendations should be made to prevent Brian and his mother from resuming their old habits?
3. What other activities can Brian try to help him avoid or reduce the tendency to eat when he is not hungry?
4. What would you suggest to promote a positive feeding relationship between Brian and his mother, considering his age and level of development?
5. What recommendations can you make to decrease Brian’s energy intake and make it more consistent with MyPlate recommendations? Consider ideas to alter Brian’s favorite recipes (e.g., his favorite meal is fried chicken with gravy, mashed potatoes, and ice cream), select healthy options from take-out or fast-food options, and modifications to snack options.
6. Are there any nutrient-related concerns because Brian’s diet is being altered to help with weight management? Or because of his age? Or other factors?