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Ryan is a 6-year-old elementary school student. At his last well-child exam, his height was 46 inches and his weight was 56 pounds. His pediatrician is concerned that Ryan has gained an excessive amount of weight over the past year. His usual diet consists of sweetened cereal with whole milk and fruit juice for breakfast and a juice drink and crackers for his midmorning snack. During the week, Ryan buys his lunch at school; his favorite menu items are pizza and tacos. His parents give him money in case he wants to buy some additional à la carte food items from the cafeteria. His mother states that she started a new job this past year and is going to school 2 nights a week, which requires that Ryan attend an after-school program until 5:30 or 6 in the evening. He receives a snack there, usually an 8-ounce box of fruit juice and crackers. Ryan's parents report that Ryan is "always hungry" and that they will often stop for his favorite chicken nuggets, fries, and a soda on late evenings when the family is too tired to cook. Ryan likes to play video games and has a computer and television in his room. His father reports that Ryan spends more time in his room than playing outside. Ryan's mother is overweight and his father is of normal weight, although he states he was overweight as a child. The family has discussed getting more exercise on the weekends but are not sure how to add this to their busy schedules.
Childhood Obesity
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