Author: Sharon Wallace, RD, CSP, CNSD, LDN
Tracy was a twelve year-old girl with spina bifida. Because she could not walk, she used a wheelchair to get around. She was referred to the nutrition clinic for help with weight control and constipation.
Tracy reported that she loved fast food and usually stopped with her mom at McDonald?s or Burger Kind on the way home from school 2-3 days each week. She was one of 5 siblings, so her mom said that in order to save money, they ?supersized? everything, so she and her younger brother could share what they ordered. After talking more with the family, it was discovered that her brother was actually fairly picky, so he rarely ate much of what was purchased.
The nutritionist obtained a 24- hour diet recall so as to be able to zero in on problem areas.
Breakfast: A poptart or waffle sticks and 16 ounces Sunny Delight or Koolaid
Lunch: Pizza or french fries (or both sometimes) at school. Tracy noted that the school food was ?gross? and those were the only 2 items she would eat. She drank chocolate milk with lunch.
Snack: fast food or chips, cookies, occasionally some fruit as well
Dinner: Chicken, pasta and bread. She disliked most vegetables, but also admitted to not trying any in a very long time.
When asked about her fluid intake, Tracy reported she mostly drank soda, Sunny Delight and occasionally water.
The nutritionist obtained Tracy?s height using two methods: a segmental height (measuring from head-shoulder, shoulder to waist, waist to ankle) and also an arm span (where Tracy would extend her arms out sideways and a tape measure was used from one fingertip to the fingertip on the other hand). Her weight at the time of the consult was 120 pounds, and her growth chart showed she had gained about 12-15 pounds in the last year. Tracy?s goals were to be able to wear ?cuter clothes? at school and to become less constipated, as it made her uncomfortable and was embarrassing at times at school.
The nutritionist worked with Tracy and her parents over the next three months on making better meal and snack choices that were lower in calories and fat, and higher in fiber. She agreed to try 3 new vegetables each week and would eat salad and fresh fruit as well She began taking her lunch to school and fast food trips were decreased to one day per week. They no longer ?supersized? her food and over time she switched her food choices from a whole meal to a small order of fries or an ice cream cone. The importance of fluids was stressed and a goal of 60-70 ounces of fluid (about eight-8 ounce glasses) was set per day. Tracy began drinking more water, less soda, and selected juices that contained 100% fruit juice versus ?fruit drinks.? At the same time, a physical therapist worked with Tracy to set up an exercise program that she could perform in her chair. Tracy lost 7 pounds over the next 3 months, improved her symptoms of constipation, and felt much better about herself.
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