Discussion 1.
José's growth charts demonstrate a steep slope in weight gain, with no
increase in stature over two years. The rate of weight gain is concerning
because, if it continues at this rate, he will be at increased risk for
various health related problems associated with obesity.
Now that he is in
a school-based health clinic, there is an opportunity to monitor his growth
in weight and stature, using the CDC charts, and to interpret these findings
in ways that might motivate him to change some of his lifestyle habits. 2.
Assuming that all of the measurements on the growth charts were accurate,
José has had a rapid increase in BMI over the past two years. The
new CDC growth charts allow plotting of BMI-for-age, similar to plotting
the curves for stature-for-age and weight-for-age. BMI values are positively
correlated with total
body fat, fat as a proportion of body weight (% body fat), as well
as the total of all lean tissue (fat-free
body mass).
Since José's BMI
has increased at least three-times the normal rate (from 18.5 to 25 over
2 years), he deserves a more in-depth medical assessment. In addition
to the screening factors noted above, this should include evaluation of
exogenous causes of obesity, the complications of obesity, as well as
a diet and activity history. 3.
Medications used to treat asthma, especially corticosteroids, may increase
appetite and retard growth in stature. In addition, breathing difficulties
associated with asthma may make exercising difficult. Thus, José may be
experiencing a troublesome combination of increased energy intake and
reduced physical activity, similar to that reported in the general population
of adolescents over the last 20 years. If at all possible, medications
that might increase his appetite or decrease his growth in stature should
be avoided, and every effort should be made to improve his exercise-induced
symptoms, with the goal of facilitating increased physical activity.
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