adolescent weight loss help

[Guest guest]

Looking for a little help from any experts (or very experienced) in adolescent

weight loss. I am working with a 14 y.o. girl. She currently has a BMI of

31. Her body fat is probably well represented by her BMI. She is very active

(dances 1-4 hours per day- sometimes low key but often very intense). She has

been keeping food journals for me and tracking calories diligently (her idea)

and it appears that if she stays under 1700 calories per day she can lose about

0.5-1# in a week, if she averages 2300 calories she gains 1# or more in a week.

She started menses within the last year so there are still body changes going on

and she has grown an inch in the 6 months I have worked with her. I feel like

her calorie intake shouldn't need to be that low for her to lose a small amount

of weight (because of her activity level) but even more so I feel that she

shouldn't be gaining so much with an average of 2300 calories. I am beginning

to feel that I am failing her (she has gained 15# since we have been working

together, I know some of the weight gain is from her going way overboard with

sweets and portions with friends). So maybe I just need a little reassurance or

maybe I need to see if I am missing something with her....should I be having her

thyroid checked? Is there some reason she seems to need to have such a low

calorie intake? Or does it not seem too low for her? Any feedback would be

appreciated.

Thank you

Laschkewitsch RD LD

Dietitian, Legacy Obesity Institute

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[Guest guest]

You may want to check labs for POCS. I am also working with a girl the same age

(less active)who continues to gain weight. We don't count kcal, but work on

mindful eating, etc Anyways- we checked labs annd her 2 hr GTT was 142 and her

free testosterone was high. Her mom is thin, but has a hx of PCOS.

Judy Simon MS,RD,CD,CHES

On Thu, 24 Jan 2008, Laschkwitsch, :LPH Obes Inst wrote:

> Looking for a little help from any experts (or very experienced) in adolescent

weight loss. I am working with a 14 y.o. girl. She currently has a BMI of

31. Her body fat is probably well represented by her BMI. She is very active

(dances 1-4 hours per day- sometimes low key but often very intense). She has

been keeping food journals for me and tracking calories diligently (her idea)

and it appears that if she stays under 1700 calories per day she can lose about

0.5-1# in a week, if she averages 2300 calories she gains 1# or more in a week.

She started menses within the last year so there are still body changes going on

and she has grown an inch in the 6 months I have worked with her. I feel like

her calorie intake shouldn't need to be that low for her to lose a small amount

of weight (because of her activity level) but even more so I feel that she

shouldn't be gaining so much with an average of 2300 calories. I am beginning

to feel that I am failing her (sh!

e!

> has gained 15# since we have been working together, I know some of the weight

gain is from her going way overboard with sweets and portions with friends). So

maybe I just need a little reassurance or maybe I need to see if I am missing

something with her....should I be having her thyroid checked? Is there some

reason she seems to need to have such a low calorie intake? Or does it not seem

too low for her? Any feedback would be appreciated.

> Thank you

>

> Laschkewitsch RD LD

> Dietitian, Legacy Obesity Institute

>

>

> IMPORTANT NOTICE:

> This communication, including any attachment, contains information that may be

confidential or privileged, and is intended solely for the entity or individual

to whom it is addressed. If you are not the intended recipient, you should

contact the sender and delete the message. Any unauthorized disclosure,

copying, or distribution of this message is strictly prohibited. Nothing in

this email, including any attachment, is intended to be a legally binding

signature.

>

>

[Guest guest]

Can anyone provide lab indicators and/or visual indicators for girls that

haven't started menses to possibly have PCOS?

S. Nodvin, MS., RD., LD.

Web-RD, LLC

8343 Roswell Road, No. 323

Atlanta, GA 30350

Office

Fax

melissa.nodvin@...

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From: rd-usa [mailto:rd-usa ] On Behalf Of

JUDY D. SIMON

Sent: Thursday, January 24, 2008 9:23 PM

To: rd-usa

Subject: Re: adolescent weight loss help

You may want to check labs for POCS. I am also working with a girl the same

age (less active)who continues to gain weight. We don't count kcal, but work

on mindful eating, etc Anyways- we checked labs annd her 2 hr GTT was 142

and her free testosterone was high. Her mom is thin, but has a hx of PCOS.

Judy Simon MS,RD,CD,CHES

On Thu, 24 Jan 2008, Laschkwitsch, :LPH Obes Inst wrote:

> Looking for a little help from any experts (or very experienced) in

adolescent weight loss. I am working with a 14 y.o. girl. She currently has

a BMI of 31. Her body fat is probably well represented by her BMI. She is

very active (dances 1-4 hours per day- sometimes low key but often very

intense). She has been keeping food journals for me and tracking calories

diligently (her idea) and it appears that if she stays under 1700 calories

per day she can lose about 0.5-1# in a week, if she averages 2300 calories

she gains 1# or more in a week. She started menses within the last year so

there are still body changes going on and she has grown an inch in the 6

months I have worked with her. I feel like her calorie intake shouldn't need

to be that low for her to lose a small amount of weight (because of her

activity level) but even more so I feel that she shouldn't be gaining so

much with an average of 2300 calories. I am beginning to feel that I am

failing her (sh!

e!

> has gained 15# since we have been working together, I know some of the

weight gain is from her going way overboard with sweets and portions with

friends). So maybe I just need a little reassurance or maybe I need to see

if I am missing something with her....should I be having her thyroid

checked? Is there some reason she seems to need to have such a low calorie

intake? Or does it not seem too low for her? Any feedback would be

appreciated.

> Thank you

>

> Laschkewitsch RD LD

> Dietitian, Legacy Obesity Institute

>

>

> IMPORTANT NOTICE:

> This communication, including any attachment, contains information that

may be confidential or privileged, and is intended solely for the entity or

individual to whom it is addressed. If you are not the intended recipient,

you should contact the sender and delete the message. Any unauthorized

disclosure, copying, or distribution of this message is strictly prohibited.

Nothing in this email, including any attachment, is intended to be a legally

binding signature.

>

>

[Guest guest]

,

After medical assessment (as per Judy's suggestion) consider that this 14 y.o.

girl is not eating as low-calorie as she reports to you, or as she would like

to. Having walked this walk your explanation of the situation has me suspicious

(and the fact that counting calories was her idea). Without meaning to judge

her without knowing her, consider the possibility that she may be preoccupied,

perhaps obsessed, about her food intake which is fertile foundation for, or an

indication of, binging. I am especially wary of her explanation because she is

a dancer, and dances so much (I was a gymnast). They are often

motivated/obsessed by body image (after all, they are working to cultivate a

beautiful use of their body) which is also fertile ground for disordered eating.

After you gain her confidence and truly feel you have built a rapport with her,

I would gently and persistently pursue this possibilty with her (that she is

eating more than is recorded). If you do not feel you can gain her confidence

try to find someone who can. While I advocate the use of food journals in my

classes with much success, there is a certain percentage of people with

obsession with food/body image (I was one of them) for whom keeping a record of

food intake makes the preoccupation worse (thus the 15# weight gain? realizing

there is normal weight gain with puberty). For these individuals I recommend

keeping a journal of feelings related to eating (tell her she does not have to

show it to you)--if she is successfully guided through this process there will

be a time down the road she reaches freedom that a food journal is a tool she

can use to help her optimize her nutrition (as a tool for a time, not as a

lifestyle of bondage!) Of course this recommendation is presupposing you find

she is eating more than on her food diary.

Also, if she is " restricting " (inevitably leading to low carb intake) it can

exacerbating binging, especially if there is a disposition to hypoglycemia. I

would starve with the best of them, which set me up for overeating every night.

Perhaps some discussion of the difference between balanced discipline and

bondage, restriction, etc. Perhaps help her to begin the switch to a focus on

what to put IN instead of what to cut OUT? If she is binging, once she begins

to give her body what it needs she won't have the same drives to overfeed it.

Of course we know nothing of any emotional eating that may be going on for her

(at age 14 in this culture!) but it is always right to begin with good

nutritional support.

Respectfully,

Diane Preves, M.S., R.D.

N.E.W. LIFE (Nutrition, Exercise, Wellness for LIFE)

www.newlifeforhealth.com

e-mail: newlife4health@..., 4newlife@...

Re: adolescent weight loss help

You may want to check labs for POCS. I am also working with a girl the same

age (less active)who continues to gain weight. We don't count kcal, but work on

mindful eating, etc Anyways- we checked labs annd her 2 hr GTT was 142 and her

free testosterone was high. Her mom is thin, but has a hx of PCOS.

Judy Simon MS,RD,CD,CHES

On Thu, 24 Jan 2008, Laschkwitsch, :LPH Obes Inst wrote:

> Looking for a little help from any experts (or very experienced) in

adolescent weight loss. I am working with a 14 y.o. girl. She currently has a

BMI of 31. Her body fat is probably well represented by her BMI. She is very

active (dances 1-4 hours per day- sometimes low key but often very intense). She

has been keeping food journals for me and tracking calories diligently (her

idea) and it appears that if she stays under 1700 calories per day she can lose

about 0.5-1# in a week, if she averages 2300 calories she gains 1# or more in a

week. She started menses within the last year so there are still body changes

going on and she has grown an inch in the 6 months I have worked with her. I

feel like her calorie intake shouldn't need to be that low for her to lose a

small amount of weight (because of her activity level) but even more so I feel

that she shouldn't be gaining so much with an average of 2300 calories. I am

beginning to feel that I am failing her (sh!

e!

> has gained 15# since we have been working together, I know some of the

weight gain is from her going way overboard with sweets and portions with

friends). So maybe I just need a little reassurance or maybe I need to see if I

am missing something with her....should I be having her thyroid checked? Is

there some reason she seems to need to have such a low calorie intake? Or does

it not seem too low for her? Any feedback would be appreciated.

> Thank you

>

> Laschkewitsch RD LD

> Dietitian, Legacy Obesity Institute

>

>

> IMPORTANT NOTICE:

> This communication, including any attachment, contains information that may

be confidential or privileged, and is intended solely for the entity or

individual to whom it is addressed. If you are not the intended recipient, you

should contact the sender and delete the message. Any unauthorized disclosure,

copying, or distribution of this message is strictly prohibited. Nothing in this

email, including any attachment, is intended to be a legally binding signature.

>

>