An Obese Teen: More Than Meets the Eye

Shannon Patrick, ARNP, MSN; Janet Silverstein, MD

Disclosures

June 18, 2013

1-Month Follow-up Visit: How Did Ashley Do?

At her 1-month follow-up visit, Ashley had an A1c level of 6.9%. Her height was unchanged, and weight had decreased to 99.2 kg (218.7 lb) from her previous weight of 101.2 kg (223.1 lb). Her BMI was now 37.3 kg/m2 (previously 37.8 kg/m2), still above the 99th percentile for age and sex. Blood pressure was 128/82 mm Hg (previously 140/86 mm Hg).

Review of Ashley's blood glucose values revealed that most fasting blood glucose levels were in her target range. She had had a single fasting glucose level of 142 mg/dL but states that she had gone to a sleepover the night before that reading and had eaten pizza for dinner and an ice cream sundae for dessert, and had snacked on junk food late at night with her friends. She has been walking 3 days a week with her mother. She thinks she might like to take hip-hop dance lessons. Ashley had had intermittent diarrhea during the first few days of metformin therapy but has had no further problems.

Ashley's mother states that her brother and sister complained at first about not having soda in the house. They have continued to eat out on soccer nights but have tried to make healthier choices, such as sandwiches or salads. Ashley states it has been hard to give up soda and she doesn't really like walking, but she is happy because her clothes fit better. You congratulate Ashley and her mother on their success and encourage them to continue to make healthier choices and increase the frequency and duration of exercise.

On the basis of Ashley's current A1c and blood glucose values, you decide to continue with metformin therapy and lifestyle modification. Referral to a dietitian is recommended for general nutrition education as well as modification of dietary salt and fat intake, weight control, and improvement of metabolic control. Ashley would also benefit from guidance on fitting treats and party foods into her diet so that she can socialize with her friends while maintaining metabolic control.

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