Nora is a 14-year-old female referred to you for medical nutrition therapy by her primary care provider (PCP). Nora has gained over 20 pounds this past year. Her PCP is concerned that with continuous weight gain and high low-density lipoprotein (LDL)/triglyceride levels, Nora will develop type 2 diabetes and chronic cardiac disease. Nora came to her initial appointment with her mother, who is morbidly obese. At the initial meeting, Nora explained that her favorite foods include fast-food options and processed desserts such as Yodels and cinnamon buns. Nora does very little physical activity during the week and claims that she does not find any enjoyment from exercise.
Anthropometric Data:
Height: 165 cm (64”) Weight: 85 kg (187 lb) BMI: 31 kg/m2 Waist circumference: 101.6 cm (40”)
Biochemical Data:
Total cholesterol 275 mg/dL (Desirable:<200mg><100mg><150mg>
Clinical Data:
Past Medical History: Asthma, prehypertension, prediabetes Medications: Sertraline (anxiety), corticosteroids (asthma) Vital Signs: Blood pressure 140/90 mm Hg; Temperature 97.5ºF; Heart rate 80 beats/min Nutrition-focused Physical Exam: Appears well nourished. Adiposity consistent with android body type. Oral exam, hair, and nails appear normal. Skin is warm and intact. No evidence of acanthosis nigricans. Abdominal exam unremarkable. No evidence of lower or upper extremity edema.
Dietary Data: 24-hour Diet Recall:
Breakfast (7 am): 2 bowls of Cocoa Puffs, whole milk, 1 cup of orange juice, 1 Pop-Tart Snack (10 am): 1 bag of Chex Mix, 8 to 10 mini Oreos, 8 oz of chocolate milk Lunch (12:30 pm): 1 hamburger with bun with ketchup and mayonnaise, French fries, steamed peas and carrots, 1 bag of potato chips, 1 medium soda (Nora receives school lunch) Snack (4 pm): 2 Eggo chocolate chip waffles, 1 mini bag of Cheez-it crackers Dinner: 2 bowls of boxed macaroni and cheese, 1 Italian roll, steamed green beans, 1 can of Dr. Pepper, 1 brownie for dessert Pre-bedtime snack: 1 bowl of vanilla ice cream with whipped cream and Hershey’s chocolate chips
1. Plot Nora’s data on the Centers for Disease Control and Prevention (CDC) growth chart. In what percentile is her weight-for-age? Height-for-age? BMI-for age? sex?
2. Does this information classify Nora as underweight, normal weight, overweight, or obese?
3. What risk factors does Nora have for diabetes and cardiovascular disease (CVD)?
4. Access Nora’s diet recall. What recommendations can be made to improve her diet?
5. Identify a nutrition intervention to help improve Nora’s lipid panels.
6. Would you recommend scheduling a follow-up with Nora? What are the benefits of a follow-up session?