A Hemophilia is a heritable genetic disorder, and is a recessive sex-linked trait carried on the X chromosome. Thus hemophilia is more common in males (XY) than in females (XX) since males only need one copy of the faulty gene to show the trait. In actuality, female carriers of the defective gene are almost exclusively asymptomatic carriers. Regardless, it is still a rare disease amongst boys.

In this current time of advanced technology in medicine, hemophilia can be divided into three different forms (A,B,C) based on the deficiency of a particular blood clotting protein. The most common version of the rare genetic disease is Hemophilia A. 1 in every 5,000-10,000 boys represents approximately 80% of hemophilia cases in which there is a deficiency in clotting Factor VIII (Hemophilia KidsHealth). Due to the hemophiliac’s faulty coagulant factors, the disorder results in problems regarding blood coagulation (or blood clotting) for the individual with the defective gene.

Therefore, the individual male diagnosed with hemophilia suffers from some or all of the following symptoms: excessive bleeding episodes known as ‘bleeds’, bruising easily, re-bleeding scabs, chronic anemia due to multiple episodes of excessive blood loss, and in some occasions hematuria. Childhood Obesity Obesity, in general, is a growing health concern in developed countries. Just like with adults, childhood obesity is diagnosed by a health care practitioner, usually a pediatrician, based on the child’s body mass index.

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BMI is a calculated value which represents human body fat based on an person’s height and body weight. However, childhood obesity is categorized a bit differently than adult obesity. The reason for this is because children are still growing as they age, especially during puberty. Therefore, BMI growth charts for children and teens are both age and sex sensitive, justified by the differences in body fat between sexes and among different age groups of children. When it comes to children, overweight and obesity labels are medically diagnosed to a child based on their BMI percentile, as ell as by a calculated BMI value. According to the growth charts, a BMI greater than the 85th percentile but less than the 95th percentile is considered overweight, and a BMI of greater than or equal to the 95th percentile is considered obese (Centers for Disease Control and Prevention). Childhood obesity can lead to both short-term as well as long-term physical, social, and psychological problems. Physical health effects include higher risk for cardiovascular disease, higher risk for diabetes, and higher risk for bone and joint related problems.

Obesity also can make it more difficult for a child to fit in peer social groups which can result in low self-esteem and possible depression. Being overweight and having hemophilia are particularly risky, since the extra weight can cause stress to the joints and lead to bleeding within a joint. Depression Depression amongst children can sometimes be difficult to diagnose especially when a child is going through puberty. It is normal for kids to be sad from time to time, especially after such events as moving from one town to another, a pet dying, or feeling sad over not achieving a particular goal they had planned.

However, certain signs can help diagnose a child as being clinically depressed such as the child no longer enjoys their favorite things or activities. In some occasions, children may take part in more risky and dangerous behavior which can cause harm to them and others. A child may also lose or gain significant weight due to change in eating habits. Depression can hamper a child socially and academically because the child may have trouble concentrating or making decisions due to lack of care or motivation.

Children with rare diseases that inhibit them from partaking in activities in which average healthy children partake can lead a child to having feelings of worthlessness, hopelessness, and even shame. Case Study The client, Brady Michael Beckham, who is 13 years old, and has come to my office with his parents for a physical before entering into the local public high school. Brady has always struggled with his weight management, but has always just been slightly overweight. Furthermore, Brady is a hemophiliac.

As Brady’s primary care pediatrician since his birth, I was the one who diagnosed Brady with hemophilia after the boy was bleeding excessively during his circumcision at 3 months old. I did a blood test the next day, and the test results revealed that Brady in fact had hemophilia A. Brady’s mother was unknowingly a carrier of the faulty gene and had passed it on to Brady. Due to Brady’s early diagnoses, his parents prevented him from participating in sports or other physical activities in which he could get cut and bruised. Thus Brady does not participate in much outdoor activity or exercise.

During his physical, Brady’s height is measured to be 5’2″ and his weight is 164 lbs. Thus Brady’s BMI is 30. 1 which is over the 95th percentile. As a result, I diagnosed Brady with childhood obesity. Brady’s parents were upset with the news, and began to lecture their child and blame themselves. Therefore I asked Brady’s parents to leave so I could speak to Brady alone. Brady informed me that he had been feeling depressed because of his weight, and how he has constantly been made fun of growing up because of his weight. He says he has never liked being teased, but he ignored it.

He explained how he is sad over his lack of good friends, but concealed his feelings in reading, playing video games, and sadly in eating snacks. He mentioned he does not have thoughts of harming himself, but he is very embarrassed and ashamed of his weight. He tells me that now that he is entering high school he would like my help in aiding him to lose weight in a way that is safe for him due to his condition. As his pediatrician, he says he trusts me. Brady lives in a household with his parents and his older sister Kristen, 17 years old, who has no genetic defects and participates in numerous sports and is a high school soccer star.

Brady’s parents give a large amount of their attention to Kristen, and tend towards ignoring his needs. Brady reports that he sometimes feels as if his parents don’t love him as much, and it is clear this has a very detrimental effect on his self-esteem and confidence. Brady states that he is afraid to participate in sports or physical activities at school or outside due to his hemophilia. Brady’s genetic disorder cannot be cured, but I plan on showing him how he can change his lifestyle from sedentary to active in order to lose weight. I mentioned to Brady and his parents that by maintaining a healthy active lifestyle, Brady will be able o lose weight to achieve a healthy BMI. By losing weight, Brady may gain more self-confidence and will have better self-esteem. Most importantly, Brady will learn that even with hemophilia he can participate in sports and be active like his peers. I will need to discuss with Brady’s parents how they need to be more supportive of Brady, and pay more attention to his personal needs. Overall though, Brady’s parents and I must develop a healthy eating plan and exercise regiment for Brady so that Brady can feel a higher level of social acceptance, and have a better quality of life. Problem Based Questions Brady’s Questions ) What does it mean to be obese? Well Brady, obesity is defined differently for children than for adults. For children like you, it means that your body mass index, or BMI, is above the 95th percentile for what the standard BMI of a boy your age and height should approximately be at (Barlow 2007). In simpler terms, it means that your body weight is significantly heavier than what a boy with a healthy body weight your age and height should be around. It’s okay though Brady. I know you’ve always had a bit of a hard time with your weight, but with a few lifestyle changes and trust in one another, we can lower your BMI to a healthier number. ) What is a BMI? How do doctors like you come up with that number? A body mass index (BMI) measurement is a special measurement that we health professionals use to help us determine if people have a healthy body weight for their sex and height. Age is also a factor that we doctors calculate when it comes to children because as kids our body structure changes as we age, and it varies between boys and girls. A child’s body changes especially during puberty which is what you are beginning to go through now Brady. If you recall your BMI is 30. , and that number was calculated using your age (13 years), your weight (164 lbs), and your gender (male). 3) Just because I am obese now, does it mean I am going to be obese when I am an adult? No which is why I am going to work with you to help you not only lose weight, but to maintain a healthy weight. However Brady, I must tell you that there is some research out there that suggests that children who are obese are more likely to become obese adults than children who have a healthier weight (Biro 2010) (Serdula 1993). 4) Are there any health problems for me now while I’m a kid?

Or do health problems just occur for obese people when they are adults? Brady there are health risks for you both now and later on when you reach adulthood. Regardless of age, obese people are more likely to have high blood pressure and higher cholesterol levels which are both big risk factors for cardiovascular disease. Obese people have an increased risk of developing type II diabetes and for having health problems with their liver. Joint pains and complications, musculoskeletal discomfort, and breathing troubles are all more associated with individual who are obese.

Still, as you know Brady, overweight and obese children have a greater risk of social and psychological problems, such as being on the receiving end of bullying, social discrimination, and poor self-esteem. Sadly these social problems can and tend to continue into adulthood. 5) I know a lot about hemophilia since I’ve had it my entire life, but how does my being overweight and now obese affect my condition? Being overweight and having hemophilia can be dangerous. The reason being is that your extra weight can cause an increased amount of stress on your joints and lead to bleeding within your joints. ) Do all I have to do is become more active to lower my weight? No. Participating in higher levels of physical activity will help you to lose weight, but it will become even more effective if complemented with a more proper and healthier diet. Therefore Brady, you need to work on avoiding your usual high in fats, sugars, or salty snacks that you enjoy so much. Instead try to have foods such as vegetables and fruits for snacks instead of chips, candy, or desserts. 7) I have never liked being picked on or taunted.

What do I do if people make fun of me while I am participating in more physical based activity and sports? Brady this isn’t an easy question to answer, but I understand why you are asking this question. It is tough to keep motivated especially when your aren’t receiving the support of your peers. However, Brady you must look at the end goal. By living a more active life, you will not only lose weight, but you will be proving to yourself and your peers that you can be just as active as any average healthy boy your age. You will show them how you have learned to live and be active with your condition.

There is no doubt in my mind Brady that once your peers will begin to respect you more and more as they see you trying to participate more and more often. Plus you will definitely lose the extra weight and feel better about yourself. You will feel more comfortable with your body, and will realize that you’ll have much more energy and your friends will no doubt want to hang out and play with you more. If you chose to keep up with the plan that you and I develop for your success, then I guarantee that you will ultimately feel like a brand new person full of confidence and a much healthier outlook. Brady’s Parents Questions ) Is it necessary for Brady to participate in more physical based activities? We preferred while he was growing up that he didn’t due to his condition (hemophilia). Well Mr. and Mrs. Beckham, it is necessary that Brady start participating more in physical activity instead of just reading, playing video games, or watching TV. In fact, a 2004 study from the Centers for Disease Control and Prevention (CDC) demonstrated that rates of obesity among children with hemophilia are generally higher when compared with those in the general population because they tend to live more sedentary lives than their peers.

I completely understand why you preferred Brady to have a more safe lifestyle in terms of activities, but now he needs us to encourage him to become increasingly more active. By becoming more physically active, Brady will be able to lose and maintain a healthier weight. Thus he will become an overall healthier individual. 2) What can we do as parents to help Brady through this weight management process? As Brady’s parents, it is essential that your son knows he has your support.

Brady is preparing to enter into his first year at the local high school, and is at an age where how his physical appearance is important to him and his peers. As you are aware, Brady is now an adolescent and is still developing as he continues to go through puberty. He is going to change both physically and emotionally. It is crucial for you to continue to remember that as you help your son. You must encourage him to spend more time being engaged in physical activity. It is understandable that you are concerned that he may injure himself.

Therefore it may be helpful if you teach Brady some simple first aid and teach him about safety in sports. If your son chooses to participate in extra school activities or sports, then you should inform the instructors or coaches of his condition. You shouldn’t ask the coaches to pity him or treat him specially, but you should just ask them to be aware. In that same sense, you as his parents should be aware and not be ‘babying’ your son. By treating Brady with special privileges or handicaps, you may be in fact causing your son to feel more insecure about himself.

Last, but most importantly, Brady must start eating a healthier diet. Therefore, Brady should not be consuming foods high in fat such as his usual snacks. Critical Issues Positive Points (Strengths) * Brady is highly motivated to work towards acquiring a healthy weight, and to begin being more active. He is also very determined in making friends and to build his self-esteem. * Brady and his family have an overall firm grasp on the complications and risks of Hemophilia. They understand how to handle Brady’s condition, and are always trying to further their understanding of the genetic disorder and how to live with it. Brady is aware of his depression and has sought out help. He understands that his depression is mild, and wishes for it not to escalate. * Brady is not fully aware of it, but both of his parents want to support him through his weight management regiment. Brady’s sister Kristen also wishes to support her brother Brady as he works to become more active and move away from his sedentary lifestyle. * Brady will be entering into a new school (high school) with new peers. The new school environment will allow Brady to feel as if he has a fresh start. It will give him an opportunity to make new friends and build his self-esteem. Brady has many opportunities at home and through his school (gym class ;amp; extracurricular activities) to engage in physical activity. Challenging Issues (Weaknesses) * Brady’s genetic disorder puts him at a higher level of health risk while participating in physical activity compared to his peers who do not have the condition. * Brady’s current lifestyle is very sedentary. It may be hard at first for him to begin a more physically engaged lifestyle. * Brady’s current depression puts him at a vulnerable state. Struggles in the beginning phases/steps of his weight management may further develop his depression. Brady’s parents have had a history of neglecting some of Brady’s needs, and not giving him the same fair amount of attention as his sister. Theoretical Issues Transtheoretical Model The Transtheoretical Model, or Stages of Change Model, suggests that people go through a sequence of five steps when it comes to making behavioral changes. However the Transtheoretical Model is not a linear model as the sound of five steps may suggest. Instead, it is more of a circular process. In fact, it is normal for people to find themselves skipping stages, stuck at certain stages, or regressing backwards through the five stages.

Therefore an individual’s or client’s stage must be reassessed periodically by a health care professional in order for the professional to better understand the patient’s readiness to progress to the next stage. The Precontemplation stage is the first stage of the Transtheoretical Model. During it, the individual has no intention of making any kind of behavioral change. They tend to resist, and occasionally reject, the idea or need for change even though the suggested change is needed for a healthier lifestyle.

The individual may feel this way due to one or a multitude of reasons such as the client is unaware of their unhealthy behaviors, lack of understanding of the health topic, or the person is feeling helpless after a previous failed attempt at change. Although it may take time, the client may eventually begin to recognize a need for change. It is then that the client has made progress to the Contemplation stage. During this stage the individual struggles as they weigh the pros and cons of beginning or committing to such a behavioral change.

The client is concerned that the long term benefits may not compensate for the short term costs. It is these perceived barriers that prevent the patient from taking action towards change. Once the client has reduced the perceived cons and is comfortable with making a commitment towards making a healthier change, the client is labeled as progressing to the Preparation stage. In the Preparation stage, the person has confirmed to themselves that the benefits of change outweigh the disadvantage. Thus they commit to taking action within 30 days, and eventually begin taking initial steps to prepare for change.

The fourth stage in which the actual behavior change occurs is known as the Action stage. As the name of the stage suggests, the individual participates in making actual health behavior changes. It is important to note however that these new behaviors should not be view as permanent until the client has sustained this altered behavior for over a period of 6 months. Lastly comes the Maintenance stage, in which one reinforces their behaviors over the 6 month period of time, leading to health behavior change that can truly be considered permanent.

The Transtheoretical Model can be applied to all individuals looking to or needing to make a healthier lifestyle change. Thus it applies to young Brady who is in need of changing his sedentary lifestyle of reading and videogames to a more active one complimented by a healthier diet. Brady has shown a strong level of awareness of his health over the years, but has always struggled with his weight management. Yet due to recently being diagnosed as an obese child, Brady has realized the importance of lowering his weight to a healthier number. Brady is now quite determined to have his weight under control.

He has shown that he understands that there will be some hardships associated with change, but he knows that the long-term benefits will outweigh all of the short term cons. It is this determination that would suggest that Brady is in the Preparation stage. As his primary care pediatrician, it will be my task to support Brady as he progresses through the stages of change on his way to engaging full time in a healthier lifestyle. Maslow’s Needs Hierarchy Maslow’s Hierarchy of Needs states that people have different levels of prioritized needs.

Maslow’s theory, which is usually depicted as a pyramid, illustrates the motivation or need for people to satisfy their more basic and fundamental needs before they work towards satisfying other needs higher up on the pyramid. Maslow stated that a person’s behavior at a particular time in their life is dictated by the stage of the hierarchy that they are in. However, Maslow added that many different motivations and needs from different levels of prioritized needs usually occur at the same time. In total, Maslow’s Hierarchy of Needs is made up of five different levels of need.

The first level, and therefore the most fundamental, is the Physiological needs level. Basic needs for human survival such as water, food, shelter, and sleep are the needs found in this level. The next level is the Safety needs level in which the individual behaves according to need for safety from personal harm, safety in the sense of health and well-being, financial security, and safety in family. The third level is the Love and Belonging needs level where the individual’s behavior reflects the need for friendship, romantic love and intimacy, and even family love and bonds.

The level above that on the pyramid is the Esteem needs level. On this level, a person’s behavior reflects a need to be respected and to have self-esteem and self-respect. People want to feel accepted by their peers, and want to be valued accordingly. The final level of Maslow’s Hierarchy of Needs is the Self-Actualization level. On the top level of the hypothetical pyramid, this level signifies that when all the other levels of needs are completed, a person then works towards understanding one’s self better and the potentials that one has.

In this way, understanding where the client is on the hierarchy can allow me as the family’s pediatric physician to make appropriate suggestions that will be more likely to help Brady in making healthier behavioral changes. Brady comes from a economically stable family and thus his physiological and safety needs are all met with his normal day to day living in a provided for home with food, water, and more. However, it is necessary to focus on Brady’s Love and Belonging needs and his Esteem needs for these levels have been primary needs for concern for Brady.

Brady’s feelings of being neglected by his parents appear to be a factor in his poor weight management and slight depression. Due to his heavier weight, Brady has been teased and feels a need to find belonging with not only his family, but with his friends and peers as well. Brady’s obesity and depression can also be explained by his Esteem needs as well. Brady is suffering from depression due his lack of self-esteem, self-respect, and his general feeling of not being accepted and underappreciated. Brady’s depression, which is sadly an ultimate result of his being overweight, further prevents him from obtaining self-esteem on multiple levels.

Person-Centered Existential Theory Carl Rodger’s person centered approach to behavioral change focuses on the idea that people have an internal drive towards self direction. In other words, the client has an inherent tendency to want to succeed, grow, and change for the better. As a result, the client realizes his or her potential for growth in an environment of unconditional self-regard. Health practitioners then further develop this environment by completely accepting the client without passing any kinds of judgment. Total acceptance on behalf of the counselor is key in Rodger’s theory.

The reason being that it is important for clients to build and develop a high level of trust with their clinician. In a judgment free setting, clients will be able to speak more freely about their feelings and current circumstances. As a result, health care professionals must not form judgments regardless of clients opinions or previously failed attempts. They must listen to the client, and allow the client to help cooperate in building their plan to behavioral change is preferred over accusatory strict advice-giving. It is important to make the client feel as involved as possible in their care and behavioral change process.

Being Brady’s and his sister’s pediatrician since they were born, I have developed a trusting professional relationship with Brady and his family. Still I want Brady to know that he is my primary concern, and that I will give him my undivided attention. Knowing that Brady’s going through some slight depression, I will need to avoid passing judgment of any kind; verbal and non-verbal. Even though I have known that Brady has had difficulty with managing a healthy weight for most of his life, I cannot judge him or his parents for their past failures in Brady’s weight management.

As an alternative, I must build up Brady’s confidence, support him and his determination in change, and guide him in a comforting and supporting manner. Thus my counseling approaches would focus on his courage to approach me about his depression, and his determination to lose weight to better his self-esteem and earn the respect of his peers for his efforts. Rational Emotive Behavior Theory (Cognitive Theory) Albert Ellis’ Rational Emotive Behavior Theory argues that learned behaviors are the most frequent source of people’s emotional problems, and that negative self talk and irrational ideas are self defeating.

It overall focuses on resolving emotional and behavioral problems by influencing a person’s pattern of thinking from negative, self-harming thoughts to more positive self-motivating ones. As a result of this theory, health care professionals teach clients that harmful self-monologues should be identified, eliminated and replaced with productive self talk. The Rational Emotive Behavior Theory applies to Brady especially in his negative thoughts about himself. Therefore, I must teach Brady how to identify the negative feelings that he has towards himself and why he is creating those self-harming attitudes towards himself.

I must teach him that his depression stems from his negative thoughts about himself, and that he must rid himself of those feelings. I must then assist Brady in learning how to replace those harmful thoughts with more positive ones. For example, Brady must identify a particular negative feeling that he has towards himself. He must ask himself if that is how he truly feels about himself, or if he is just telling himself that because others have said such hurtful things. Once recognizing which thoughts are self defeating, Brady must learn to replace those thoughts with uplifting feelings.

I will assist Brady in realizing his strengths and positive qualities such as his maturity, courage, determination, and his other positive characteristics. Counseling Goals and Objectives Goal #1: Increase Brady’s personal education and understanding of how to participate in regular physical activity and be safe with Hemophilia * Objective: Aid Brady and his family to identify three Hemophilia organizations and/or support groups. They will then look into any possible programs held by these organizations geared for families with members who have the genetic disorder.

After finding a local program fit for their needs, Brady and family members will all take an active part in the program. * Objective: Brady and family will learn about WE CAN! program (http://www. nhlbi. nih. gov/health/public/heart/obesity/wecan/) and begin implementing program’s recommended “eat right, get active, and reduce screen time” plans. * Objective: Teach Brady basic first aid skills, and how to treat himself (or how to inform others of how to treat him) in case bleeding episode or injury should occur while client participates in physical activities.

This skill should be developed as immediately as possible due to safety concerns. Goal #2: Increase Brady’s amount of routine physical activity * Objective: Have Brady participate in physical activity for at least 30 minutes each day. Doing something moderately aerobic for a minimal of 30 minutes every day will give Brady better long-term results. It could be as simple as going for a walk after dinner, taking a bike ride or playing in the pool (not necessarily swimming laps), or participating in group or team physical activities such as sports.

Brady should learn to continue this plan of exercise for the rest of his life. * Objective: Get Brady to join a group or sport activity through either his high school or through a hemophilia support group with children around his age group. * Objective: Have Brady and his family participate in physical activities as a family. For example by becoming members at a local Y. M. C. A and participating in family group activities, weekly jogging or bike riding together, etc. Goal #3: Reduce Brady’s current BMI of 30. 1, which is in the obese level, to a healthy level between 18. 5 and 24. * Objective: Keep Brady to participating in 30 minutes or more of physical activity daily as planned. Brady will keep an activity journal and will go over it with me on a bi-weekly basis. * Objective: Encourage Brady and his family to eliminate candy, high in sugar sweets, fatty foods, fast food, soda, and other unhealthy food choices from his daily diet. Have Brady begin immediately in eating a healthier diet composed of more fruits, vegetables, leaner meats, and water over most high sugar drinks. Brady will keep a food journal and will go over it with me on a bi-weekly basis. Objective: Teach Brady about the difference between eating when hungry and eating for some other reason. To go further, to teach Brady the importance of eating only when he needs to, and how to control his hunger with smaller more filling portions. For example, teach him how children eat for reasons unrelated to hunger—because food is there and looks delicious, because parents or friends are, because children may be use to while watching television or while reading a book for leisure, and in his case because he is sad and is feeling sorry for himself.

Goal #4: Decrease Brady’s feelings of depression & increase Brady’s social well being * Objective: Have Brady join and participate in school and non-school sponsored groups or clubs that pertain to his likes and interests. * Objective: Further strengthen the bonds between Brady and his family. Have Brady and his family spend more time together as a whole family in group activities such as physical activities, family evenings, etc. Teach Brady how to not be jealous of his sister. Instead, Brady must learn to be proud of his sister, and to also be proud of his own accomplishments and for who he is. Objective: Hold bi-weekly meetings with Brady either after school when he is free or during the weekends to discuss: how he is feeling lately, to review physical activity and food journals, his overall progress, if he has any concerns, and possibly just to talk and further build our practitioner-client relationship. Ultimately it is my job to serve as a source of support for Brady. Patient Education Evaluation Losing Weight with Hemophilia and Positive Thinking Assessment Quiz Overall score on this assessment quiz will show overall understanding of the topics of Hemophilia, Weight Management, and Self-Esteem.

Multiple Choice: Read each question carefully, and select the answer that best answers each question. 1. Hemophilia is a genetic sex-linked recessive gene. Therefore males have a ____ risk of showing the genetic disorder than females? a. Higher b. Lower c. Equal d. None of the above. Hemophilia is like koodies, only girls can get it. 2. Obesity in Hemophiliacs is especially dangerous because…? e. Extra body fat stretches out the skin and can lead to unintended cuts f. Extra weight can cause increased amount of stress on joints and lead to bleeding within joints g.

Extra weight absorbs too much nutrients from blood and makes blood clotting even more difficult than it already is in hemophiliacs h. Obesity has no health risks…duh! 3. How does one identify which type of Hemophilia they have? i. By how long it takes for your blood to clot after an initial cut j. By which blood clotting factor you are deficient in k. There are no different types of Hemophilia, just different stages. l. Using really expensive hospital equipment such as fMRIs 4. Which of the following are reasons why there is a high level of obesity among children with hemophilia? . Parent’s are overcautious and do not let child participate in as much physical activity as is needed n. Child with hemophilia is frightened of having possible future bleeding episodes and lives a more sedentary and safe lifestyle o. Parents and children get too comfortable of being in the zone that doing very little is safest, and as a result becomes a habit for the child. p. All of the above 5. Which of the following are necessary in healthy weight management? I. Physical Activity/Exercise II. Proper Healthy Dieting III. Health & Fitness Education . I only r. I and II s. II only t. I, II, and III 6. Which of the following foods should you AVOID? u. All natural and Organic foods v. Vitamin supplements w. Foods high in calories, fats, and/or sugars x. Low-fat, No sugar alternative foods 7. At least (the minimal) ___ minutes a day of exercise every day, is a healthy amount of exercise? (Hint: Which time duration is the shortest, but still acceptable) y. 2-3 hours z. 1-2 hours {. 20-30 minutes |. 0-10 minutes 8. People with High Self Esteem are generally _____ than those with low-self esteem? }. Healthier . Overall happier with their lives and themselves . More Liked . More Attractive Short Answer Questions 9. Benefits of having High Self Esteem are, what? 10. How can having a good support system help to build someone’s self esteem? Plan of Action Diagnosis: As Brady’s primary care pediatrician since his birth, I was the one to diagnose him with Hemophilia Type A back when the boy was an infant. Therefore I have and will continue to be the health care professional supervising and coordinating his care. Due to my recent diagnosing of Brady as obese with a BMI of 30. , it has come to my attention that Brady’s usual weight management troubles have gotten significantly worse over the past year. It is important to note that during his recent physical exam, Brady approached me stating he has been feeling symptoms of depression and is concerned. Thus for Brady’s personal safety and for my notes, I have diagnosed Brady as being mildly depressed. Brady’s hemophilia is a genetic disease. Therefore it cannot be cured, but it can be managed in such a way to allow Brady to live as high a level of quality of life as any non-hemophiliac child. Instead, Brady’s main problem for concern is his obesity.

Brady has always been slightly overweight. Brady’s recent bringing to my attention that his weight has been a cause for trouble in daily life on a social level is another problem that must be properly treated as well. It should be noted that his hemophilia is the primary factor for why he and his family have allowed Brady to avoid regular healthy physical activity. As a result of this learned sedentary lifestyle on top of poor eating habits, Brady has been constantly over a healthy weight and BMI which has led to his personal lack of self-esteem and feelings of depression.

However due to his recent diagnosis of obesity, Brady and his family have been given a sort of “wake-up” call that Brady needs to make some behavioral and lifestyle changes. Assessment: As the overseeing health professional of Brady’s treatment, I will be working with Bray and his immediate family to improve his current health predicament. During our first meeting I will explore Brady’s current health habits by using the “Typical Day” strategy in which I ask what Brady does on an average normal day.

In this way, I will be able to gather information him about his dieting and his physical activity regiment, or lack thereof. I will also interview Brady’s parents in the same fashion in order to reconfirm information about their son’s diet and exercise. In addition I will ask questions to determine if the Beckham’s know of any local hemophiliac support groups in which they could get in contact with. Regardless, I will have advise that they and their family take the time to further educate themselves about how hemophiliacs can stay physically active and still be safe.

Brady’s emotional health will be assessed through questioning, and based off what and if he chooses to disclose his personal feelings with me during scheduled meetings between us. These tasks and questions are part of the overall patient evaluation which will be used at future meetings as well to understand Brady’s progress, and to determine when and which of the goals are being met. Patient Education: Since Brady has had hemophilia his entire life, I am aware that he and his family have a high level of understanding about the genetic disorder.

However, it is necessary for Brady and his family to understand that hemophiliacs also must partake in regular physical activity in order to maintain a healthy level of fitness. Thus I recommended they receive further education in sports and activities that are interesting to Brady, and how he can participate while still keeping safety as a first priority. It will also be necessary that as a family they educate themselves on learning which exercises or activities would be most convenient for their family to begin partaking in together.

By doing this Brady will not only begin to become more comfortable with physical activity, but it will also give time to Brady and his family to connect and bond better with one another. I will also reiterate and further explain the facts behind how obesity is particularly dangerous in hemophiliacs. After, I will continue to answer any of their questions and explain the importance of regular physical activity and a healthy nutritional diet in weight management. As a pediatric physician, I have had much training and experience working with overweight children and children with specific conditions and disease.

However, it is important that I effectively communicate all information in an understandable manner so that the Beckham family can take in the information most efficiently. Throughout the education process, I will be meeting with Brady and both, or one of his parents, through bi-weekly meetings in order to evaluate their level of understanding of the topics mentioned earlier. Later in the process, I will be using the Patient Evaluation Tool and different variations of the tool to assess the progress that Brady has personally been making in educating himself about hemophilia, weight management, and positive thinking.

It will also be necessary for me to teach Brady’s parents and possibly Brady’s sister how to be a more engaging support system for Brady both during and after his counseling. Intervention: The end all goal of the plan Brady and I have designed is for him to adopt a healthy lifestyle in which his BMI is lowered to and maintained within the medically accepted healthy range. The secondary goal is that Brady’s self-esteem will be heightened accompanying his weight loss and further engagement in physical activities with friends and family.

I will work with Brady and his parents in order to create a plan with sets of objectives for the Beckham family to follow in providing and maintaining a healthy diet for Brady. Brady and I will then develop together a specific set of objectives to promote an increase in physical activity in his life. We will plan objectives for him in participating in family exercise with his parents and sister, at school, and possibly in out-of-school groups or programs. I will work together with Brady in order to ensure that he fully agrees to the objectives, in addition to their timeline for completion.

It is very important to me that Brady feel completely a part of his behavioral change plan, and that all of the goals and objectives are reasonable to him. If doubt, fear, or any other form of resistance to the program develops in Brady, then I will reassess the health importance of the plan and provide support and confidence in Brady and our developed plan. From there, I will reassess which stage of the Transtheoretical Model Brady is at and make the appropriate changes in order to not force him into any decision making that he is not yet ready for or uncomfortable with.

Still it will also be necessary that Brady’s family learn from me on how to serve as a better support system, and eventually take the responsibility of being his main support group in the future after Brady has completed his weight management counseling with me. With these steps in mind, I believe that Brady can make and maintain these new healthy behavioral and emotional changes, achieve a higher level of social acceptance, and ultimately have a better quality of life. Progress ;amp; Follow-up: Brady’s progress will be evaluated during bi-weekly meetings where we will also discuss the changes, address concerns, and re-evaluate goals.

As Brady’s primary care physician, I will schedule meetings to Brady’s schedule so that he can fully participate and feel comfortable with our lifestyle change plan. It will also be my responsibility to remind Brady of the progress that he will have made during his weight loss plan, and to continue to keep being active. Therefore I will continue to encourage Brady and his family to make sure he continues to be involved in school, community, family, and personal centered physical activities. In my opinion, it is also important to note of the skills that Brady will pick up during this process.

He will have learned first aid and other safety skills, skills to how effectively manage his weight, and most importantly skills to keep positive and maintain a healthy level of self-esteem and self-respect. I will continue meeting with Brady on a regular bi-weekly basis until I have determined that he and his family are fully capable of maintaining Brady’s weight, and that Brady’s depression no longer exists. Further counseling will be needed in the scenario that Brady has controlled his weight but in which his depression still lingers.

References Barlow, S. E. , & the Expert Committee (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120, Supplement December: S164—S192. Bennett, DS (1994). “Depression among children with chronic medical problems: a meta-analysis”. Journal of pediatric psychology (0146-8693), 19 (2), p. 149. Biro, F. M. , and Wien, M. (2010). Childhood obesity and adult morbidities. Am J Clin Nutr. 91(5):1499S-1505S. CDC | NPAO | Childhood Obesity Facts: Adolescents and School Health. ” Centers for Disease Control and Prevention. Web. 29 Jan. 2012. <http://www. cdc. gov/HealthyYouth/obesity/facts>. “Childhood and Adolescent Depression: Symptoms, Treatment, and More. ” WebMD. Web. 01 Feb. 2012. <http://www. webmd. com/depression/tc/depression-in-childhood-and-adolescence-topic-overview> Douma-Van Riet, D. C. M. , Engelbert, R. H. H. , Van Genderen, F. R. , Ter Horst-De Ronde, M. T. M. , De Goede-Bolder, A. and Hartman, A. 2009), Physical fitness in children with haemophilia and the effect of overweight. Haemophilia, 15: 519–527. doi: 10. 1111/j. 1365-2516. 2008. 01928. x “Hemophilia. ” KidsHealth. Web. 29 Jan. 2012. <http://kidshealth. org/parent/medical/heart/hemophilia> “Hemophilia in Children – Care Guide. ” Drugs. com. Web. 29 Jan. 2012. <http://www. drugs. com/cg/hemophilia-in-children> “Obesity and Overweight for Professionals: Childhood | DNPAO | CDC. ” Centers for Disease Control and Prevention. Web. 29 Jan. 2012. <http://www. cdc. ov/obesity/childhood/index>. Pierce, J. W. and Wardle, J. (1997), Cause and Effect Beliefs and Self-esteem of Overweight Children. Journal of Child Psychology and Psychiatry, 38: 645–650. doi: 10. 1111/j. 1469-7610. 1997. tb01691. x “Staying Fit with Hemophilia. ” Hemaware: The Bleeding Disorders Magazine. Web. 31 Jan. 2012. <http://www. hemaware. org/story/staying-fit-hemophilia>. Serdula, M. K. , Ivery, D. , Coates, R. J. , Freedman, D. S. , Williamson, D. F. , & Byers, T. (1993). Do obese children become obese adults?

A review of the literature. Prev Med. 22, 167—177. Soucie, JM (2004). “Joint range-of-motion limitations among young males with hemophilia: prevalence and risk factors”. Blood (0006-4971), 103 (7), p. 2467. “Understanding Depression. ” KidsHealth. Web. 01 Feb. 2012. <http://kidshealth. org/parent/emotions/feelings/understanding_depression> “We Can! Ways to Enhance Children’s Activity and Nutrition. ” National Heart Lung and Blood Institute. Web. 17 Feb. 2012. <http://www. nhlbi. nih. gov/health/public/heart/obesity/wecan/>


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