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Defining the terms OBESITY & ANOREXIA Describing the potential causes Describing the health consequences related to obesity & anorexia

Therapeutic management for both of these disorders

School-age children, between the ages of 6 and 12 years are experiencing a time of slow progressive physical growth, and their needed calories decrease while their appetite increases. Our role as healthcare professionals include: Promoting healthy growth and development Addressing common developmental concerns Identifying the need for intervention, or referral.

In this age group, decreased exercise levels, and poor nutritional choices can lead to the rising problem of obesity

School-age children with an average body weight of 20 to 35 kilograms needs approximately: x 70 calories/kg daily The average water requirement is: x 1,800 to 2,200 ml/day. The child needs 28 grams of protein, which is found best in: x Meats, poultry, fish, and eggs 800 mg of calcium are needed for maintenance of growth, nutrition, and the development of strong bones and teeth.

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High quality protein with every meal Milk with added vitamin D and other low-fat dairy products Vegetables high in vitamin A Fruits high in vitamin C Whole-grain or enriched breads or cereals Vegetable oils high in polyunsaturated fats Meats (4 servings/week 4oz. each) Fish (12 times per week) Poultry (12 times per week) Dark green, leafy, or deep yellow vegetables (at least 4 times per week) Eggs (4 times per week)

OBESITY: is defined as a BMI at

or above the 95th percentile for children of the same age and sex.

FACTS:
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The CDC and National Health and Nutrition Examination Survey find that more and more children are over-weight. Over the past two decades the number of obese children, and adolescents has nearly doubled.

Obesity is one of the most common diseases in childhood and adolescence.

Interview conducted at METRO on 10/13/2011 Pediatric Clinical Dietitian: Susan M. Akers, R.D., L.D.
1.) Within the last 10 years, have you noticed an increase in

school-age obesity? Answer: ` When I started my career 17 years ago there were many failure to thrive cases, however the last 10 years is when I started noticing the increase with obesity, and each year the numbers keep getting larger. 2.) With school-age obesity, what are the common health problems that you see? Answer: ` Increase with type II diabetes ` Fatty livers ` Sleep apnea seems to be under diagnosed, and it causes decreased activity, tiredness, resulting in poor grades. 3.) What suggestions, treatment options, or programs do you see to work the best? Answer: ` Eating a healthy diet with exercise is the best Requires family compliance. Activities/exercise as a family ` No caloric beverages in the house, water and low-fat milk only ` Must have family structure, decrease TV, computer, and video games ` Thursdays with Theo is FREE program held 2 days a week at METRO that consists of exercise & strength training for the whole family.

Some factors linked to causing obesity include: Lack of exercise Unstructured meals Cultural, genetic, and environmental factors. Sedentary activities such as watching TV, or video games Low metabolic rates When parents do not have the knowledge of nutrition

Genetics Environment Unhealthy Diet Sedentary Lifestyle Lack of Physical Activity

Signs:
Increased weight Thickness around the midsection Obvious areas of fat deposits Sleep apnea

Symptoms:
Type 2 diabetes HTN Cardiovascular diseases Headaches Joint pain Low self-esteem Depression Being bullied

Advise parents to: Avoid using food as a reward. Emphasize physical activity. Ensure that a balanced diet is consumed. As future nurses, we can help by: Teaching them to make healthy food selections for meals & snacks. Encourage the child to choose fruits and vegetables that appeal to him or her. Drink water, not pop when they are thirsty

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Provide accurate diet counseling Encourage daily physical activity. Counsel parents to limit television & computer time. Encourage parents to praise their childs good food choices, and to role model appropriate eating and exercise.

NUTRITIONAL REQUIREMENTS FOR THE ADOLESCENT

Stephanie Cochran

Nutritional needs are increased during adolescence due to accelerated growth and sexual maturation. According to the CDC and Prevention data:
67% of children between 6 and 19 years of age exceed the dietary guidelines recommended for fat intake; 72% exceed recommendations for saturated fat 21% of high school students eat the ve recommended daily servings of fruits and vegetables.

Teenagers have a need for increased calories, zinc, calcium, and iron for growth.

Teenage girls who are active require about 2,200 calories per day. Teenage boys who are active require between 2,500 and3,000 calories per day. Adolescents require about 1,200to 1,500 milligrams of calcium each day. Adolescent males require 12 milligrams of iron each day and females require 15 milligrams each day. Advise adolescents about foods high in iron (see Box 8.3 and Healthy People 2010). Protein requirements for adolescent girls are 46 grams per day, and 45 to 59 grams for boys. Some foods high in protein are meats, sh, poultry, beans, and dairy products

ANOREXIA NERVOSA: is characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise. Anorexia nervosa occurs in about 1 of 200 adolescent females

Anorexia is a complex condition that arises from a combination of many social, emotional, and biological factors. Although our cultures idealization of thinness plays a powerful role, there are many other contributing factors, including your family environment, emotional difficulties, low self-esteem, and traumatic experiences you may have gone through in the past.
Activity that demands slenderness such as: Ballet Gymnastics modeling. It also includes having parents who are: Overly controlling, and put a lot of emphasis on looks, diet themselves, or criticize their childrens bodies and appearance. Stressful life events such as: The onset of puberty, a breakup, or going away to schoolcan also trigger anorexia.

If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

Common physical signs of malnutrition from anorexia include:

A low body weight. Constipation and slow emptying of the stomach. Thinning hair, dry skin, and brittle nails. Shrunken breasts. Stopping or never getting a monthly menstrual period. Feeling cold, with a lower-than-normal body temperature. Low blood pressure BMI usually less than 17

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Death Anemia Heart problems such as: Mitral valve prolapse Abnormal heart rhythms Heart failure Bone loss, increasing risk of fractures later in life In females, absence of a period In males, decreased testosterone Gastrointestinal problems such as: Constipation Bloating Nausea Electrolyte abnormalities such as: Low blood potassium Sodium Chloride Kidney problems

Magazines, television, and other media have created an unrealistic image of the perfect, successful person Professions and sports that require a certain body type may also indirectly encourage eating disorders. Ballet, gymnastics, modeling, acting, running, figure skating, swimming, jockeying, and wrestling often emphasize or require a thin, lean body. Certain family attitudes or dynamics may contribute to the risk of a child or teen developing an eating disorder. The risk for eating disorders may be higher in families that: Focus on high achievement. Emphasize being perfect. Are concerned about appearance. Worry about being socially accepted. Are concerned about physical fitness, including parents' own body weight and that of the child (or children). Are overprotective or too involved in their teen's life.

For the teen with anorexia, family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically. It also supports parents in creating a normal eating pattern for their child Ideally, you can take charge of anorexia with the help of a team that includes a mental health professional (such as a psychologist or licensed counselor), a medical health professional (such as a doctor or nurse), and a registered dietitian

Most adolescents with eating disorders can be treated successfully on an outpatient basis. Those with anorexia who display severe weight loss, unstable vital signs, food refusal, or arrested pubertal development or who require enteral nutrition will need to be hospitalized. Re-feeding syndrome (cardiovascular, hematologic, and neurologic complications) may occur in the severely malnourished patient if rapid nutritional replacement is given, so slow re-feeding is essential to avoid complications.

Assist the adolescent and family to plan a suitably structured routine for the child that includes meals, snacks, and appropriate physical activity. Use the physical ndings associated with anorexia to educate the child about the consequences of malnutrition and how they can be remedied with adequate nutrient intake.

BMI is a number calculated from a child's weight and height. BMI is a reliable indicator of body fatness for most children and teens. The percentile indicates the relative position of the child's BMI number among children of the same sex and age. The growth charts show the weight status categories used with children and teens (underweight, healthy weight, overweight, and obese).

Weight Status Category

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Underweight Healthy weight Overweight Obese

Less than the 5th percentile 5th percentile to less than the 85th percentile 85th to less than the 95th percentile Equal to or greater than the 95th percentile

1.) Which of the following will promote weight loss in an obese school-age child? (Choose all that apply) a. Unlimited computer and TV time b. Role modeling by family. c. Becoming active in sports. d. Eating unstructured meals e. Involving child in meal planning and grocery shopping. f. Drinking three glasses of water per day 2.) What are some signs and symptoms of anorexia? 3.) What can a parent do to prevent obesity, or anorexia in their child?