NHD clinical - nutrition support
I took diet histories from both Mum and Amy. I was able to give advice, paying attention to overall intake of energy, pro- tein, total fat and saturated fat, fibre, calcium and iron. Mum was surprised and happy that I was helping her as well as her daughter and Amy was very keen to help ‘keep Mum on track’!
Goals during this session and the following two ses- sions included: reduce crisps to one standard bag per week, change to semi-skimmed milk instead of whole milk, have breakfast everyday, avoid eating supper. Appropriate infor- mation sheets were given, such as Change4Life top tips, rec- ipes sheets and handwritten sheets as a reminder of goals and items discussed.
The family were not present during the club session when reading food labels was covered. Food labelling was intro- duced in my third visit, as the family were doing well with their healthy eating goals. I encouraged Amy and her Mum to visit the supermarket rather than doing an internet shop so that they could read labels. The walk home with the shopping bags also increased their exercise.
Amy was tasked with looking for foods that were low in fat and sugar using the following rules: a low fat food is three percent or less total fat, a high fat food is 20 percent or more total fat, a low sugar food is five percent or less total sugar and a high sugar food is 15 percent or more total sugar. I also gave Mum advice on healthier alternatives and buying healthy foods on a budget, i.e. frozen/tinned fruit and vegeta- bles or those in season, bulk buying and freezing, choosing supermarket brands, avoiding impulse buys, picking products with a long sell-by-date, look out for BOGOF offers etc. At the fourth session I took Amy’s measurements after praising their continued good work. Amy was 10 years one month, weight 69.1kg, height 150.5cm, BMI 30.5kg/m2. This was a great outcome, Amy was happy with her decreasing BMI, but Mum seemed disheartened with the small weight loss despite my explanation of ‘growing into weight’. I left this visit wondering if Mum would revert back to her previous life- style and reinstate her barriers to change.
Social marketing Week 5. I decided to work with Mum’s difficulty to change using the principles of social marketing. Mum reported that she felt alone with these new changes and many of her friends did not seem to be changing. Social marketing is about under- standing people’s starting point in relation to obesity. The key questions are:
• What in their behaviour places them at risk? • What drives their current behaviours? • How might they be motivated to change? • Who might be able to influence them? • What might act as a barrier to change?
Mum seemed to use food as a reward for both herself and her daughter. She felt this was the only way she could re- ward the family, due to being a lone parent and having limited funds. I gave the family a Change4Life pack during the ses- sion, Amy recognised the Change4Life campaign from the television and billboards. From this the family saw that others have the same problem and Change4Life is helping others to change too. Change4Life can help with physical activity, non- exercise activity, portion size, reducing sugar and fat intake, balancing meal times and snacks and promoting five a day. Amy had been used to extra treats from Mum, so work- ing with her to promote Change4Life was useful also. Snack
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swaps and sticker charts and rewards such as a trip to the park were used help to reduce reward eating. Mum felt that all activities were expensive, so Amy didn’t take part in structured activities. Mum didn’t realise what was available and, for example, didn’t have a discount card for herself and her daughter. I organised two discount cards, which would enable Amy to attend some clubs for free or 25p at the local sports centre. Activities included sports such as non-contact boxing, dance, trampolining, football, cheerlead- ing, swimming etc and non-exercise activities, such as arts and crafts and health walks. The facility of the ‘free swims for all’ was also open to Amy, which the family were not using. With the discount card, Mum was able to use the gym facili- ties, exercise classes and all other facilities at a discounted rate. As Mum could not get childcare, she was able to do activities at the same time as Amy. During my sixth visit to the family, Mum decided that she wanted to attend club again. She felt that she didn’t have the confidence to use club properly on the first occasion and wanted to make friends with other families in the same situa- tion as them. Amy’s measurements at this stage were weight 68.7kg, BMI 30.3kg/m2.
Conclusion
Weight Aware UK. Nutritional Health & Dietetics Magazine. Portrait 131mm H x 93mm W. August 2010. Version 1.
Amy and her Mum are currently involved with the club and its exit strategy. They have continued motivation and Amy’s BMI is decreasing further.
Obesity is a complex condition and a one-size fits all ap- proach will not be successful. The family must be involved for the improvement of a child’s health and wellbeing. Profession- als must endeavour to maintain a positive attitude and help mo- tivate the child and family through weight control.
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www.weightawareuk.co.uk NHDmag.com Aug/Sept '10 - issue 57
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