DEFINITION OF NUTRITIONAL CARE PLAN AND CASE MANAGEMENT

Once the nutritional assessment has been completed, the practitioner can refer to the recommendations
of Barlow and Dietz for weight goals. Depending on the age, BMI, and comorbidities
present, weight-maintenance or weight-loss goals have been recommended for children ages 2 to
7 years and 7 years and older (see Figures 8.1 and 8.2). It is important to note that a weight loss
goal of 1 pound per month is recommended with an appropriate weight goal below the 85% for
BMI for age and sex. Before their pubertal growth spurt, children usually grow 2 inches per year.
Each inch in growth without subsequent weight gain represents approximately a 5-pound weight
loss, as demonstrated by a reduction in BMI. A child who loses 1 pound per month for a year and
gains 2 inches in height during that year, even though he or she only loses 12 lb, actually exhibits
almost a 22-lb weight loss, resulting in a significant reduction in BMI and BMI percentile. Explaining
the rationale of the recommended weight goals to children, adolescents, and their families can
help clarify unrealistic weight loss expectations and lead to more attainable weight goals.
The practitioner can adapt the intensity of lifestyle interventions to the severity of the overweight
condition, the findings of nutritional assessment, the readiness of the child or adolescent and family
to make lifestyle modifications, and the clinical resources available in the community. In other
chapters of this book, several nutrition, physical activity, and behavioral interventions and their
appropriateness will be discussed. A common aspect of all these interventions/programs is frequent
visits with the staff, such as weekly, biweekly, or monthly for an extended period of time greater
than 1 year. Each practitioner should communicate with other disciplines (medical, nutrition,
psychology, exercise) involved in the care of the child or adolescent to coordinate and provide
optimum care. Weight management for the at risk for overweight or the overweight pediatric patient
and his or her family should include an interdisciplinary approach to modify the families’ nutritional
and physical activity patterns to enable them to attain the needed skills for a lifetime of weight
management.