Directions: Read the follow scenario and answer the questions below. The assignment should be typed and submitted along with the necessary attachments (growth charts, Supertracker printouts, and abstracts) in class on Wednesday, April 15.
Scenario
Zach is a 5-year old boy who was referred to you following his annual pediatric evaluation. His mom states that he was referred to the dietitian due to excessive weight, but his mom is not concerned since “he has always been solid.” Zach is currently 48.5 inches tall and weighs 73 pounds. He has been healthy throughout his life with no known food allergies. No labs were taken at his recent pediatrician’s visit.
Zach’s parents have recently separated. He lives with his mom during the week and spends every other weekend with his dad. Zach has an older brother who is 7, but currently does not have any weight related issues. Zach’s teacher has reported some behavior problems that have recently began at school. He is having more difficulty concentrating and has been acting out more. As part of his punishment for misbehavior he loses part of recess.
He started school last fall and attends full-day kindergarten two days a week. Zach typically wakes up around 7:30 am. On days that he attends school, he gets on the bus at 7:50 am. After school is released at 2:30 pm, Zach attends an after school program until 5 pm when his mom picks him up. On non- school days he attends daycare from 8 am to 5 pm. Upon arriving home, his family typically eats. He is then allowed to spend his evening as he chooses until his bedtime at 9:00. During the evening, he usually watches TV or plays video games with his older brother. Zach has two 30 minute recess periods each school day. He loses half of one recess due to misbehavior about 1-2 times per week. His daycare has a 30 minute morning recess and afternoon outside playtime from 3:30-5, weather permitting. Zach also participates in a youth soccer team. He has practice for 30 minutes two days a week and one match a week that lasts about 30 minutes.
Due to a lack of time in the morning, breakfast is usually something that is quick to grab or as is the case on many days, Zack does not eat breakfast. On school days, Zach’s mom packs him a lunch, but due to lack of time is often convenience items. On non-school days, Zach eats lunch provided by the daycare. An afternoon snack is provided by the after school program or daycare. Dinner is often takeout or quick to prepare foods since his mom works and does not always have time to cook.
A 24-hour recall found a typical day’s food intake to include:
Breakfast: 1 breakfast tart (Pop Tart) 6 oz Sunny Delight
Lunch: 1 Tbsp peanut butter, creamy 1 Tbsp jelly
2 slice white bread (regular size) 1 single serving bag Cheetos
2 oreo cookies
6 oz Capri Sun
Snack: 2 oz cheddar cheese 4 Triscuit crackers
Dinner: 4 chicken nuggets
2 tbsp honey mustard dressing
1 small fast food order of French fries (fried from frozen) 1 Tbsp ketchup
8 oz chocolate milk, low fat (1%)
Answer the following questions:
1. Using the ABCD method of nutritional assessment, categorize the information from the above scenario into the appropriate categories: anthropometric, biochemical, clinical, and dietary (4 pts)
2. Calculate Zach’s current BMI. (2 pt)
3. Using the CDC growth chart, plot Zach’s measurements. Describe his current height, weight,
and BMI using percentiles from the growth charts. (3 pts)
4. Calculate Zach’s calorie needs.
a. Calculate his needs using TWO of formulas discussed in class. Be sure to identify the formulas that you use. (4 pts)
b. Which formula do you believe is more accurate and why? (2 pts)
In order to answer questions 5 and 6, you will need to enter Zach’s 24-hour recall into SuperTracker found at: https://www.supertracker.usda.gov/. Click on the blue Create Your Profile tab on the right hand side and enter Zach’s information into the profile page. If you wish to save your information, you will need to register. If you do not wish to save your information, click submit. Select the Food Tracker box and begin entering in his foods. Once all the foods have been entered in, go to the My Reports tab at the top of the page to select reports. Reports may be exported to PDF, Excel, or Word and saved or printed. Print the following reports and hand them in with the rest of your case study:
Menu Summary report
Food Groups & Calories Report
Nutrients Report
5. Make a table to compare Zach’s actual intake to the recommended intake for the following: total calories, empty calories (found on the Food Groups & Calories report), total fiber, total fat, saturated fat, cholesterol, vitamin A, vitamin C, vitamin D, thiamin, riboflavin, niacin, folate, calcium, iron, zinc, and sodium. (8 pts)
6. Referring to the table created in question 5, for any nutrient that Zach has not met the recommendation for or exceeded the recommendation, provide TWO dietary modifications per nutrient that could be made to improve her diet and help her to meet the recommended intakes. Be specific, don’t just say “increase vegetables”, provide a vegetable that is high in that nutrient. (15 pts)
7. Zach’s mom has heard a lot of negative things about the school breakfast and lunch programs. Even though she really doesn’t have time to pack appropriate lunches for her kids, she has elected to do so because of the poor reputation of the school meal programs. What evidence is

there to support that kids eat the revised school foods? How does the nutritional value of meals brought from home compare to the nutritional value of meals purchased at school? Go to the Obler Library Idaho Health Sciences Library website: http://www.isu.edu/library/ihslindex.shtml. Click on PubMed located on the left hand side toward the bottom. Search “school lunch program.” Find two journal article abstracts that answer the above questions. Abstracts can be for the same question or one for each question. Abstracts must be published in the past 2 years (so 2013 or newer). To get abstracts, click on the Summary tab located at the top and bottom of the page and select abstract. Print off the two abstracts that you have found and briefly summarize their answers to the questions posed above. (6 pts)
8. Given Zach’s current weight, diet, and physical activity level, what, if any recommendations would you make regarding weight loss? Explain you rationale for making this decision. (3 pts)
9. If Zach’s weight and BMI continue in their current direction, what are some potential problems he may face as an adult? List at least three possible problems. (Hint: think about issues related to weight) (3 pts)
