Patient Information: Tom: 4 years old, gained 10 lbs. over past year and now classified as overweight per BMI. Family: Mom: Susan, Telemarketer Dad: Gary, Janitor Baby: Grace, 8 months old, has reflux and is a fussy baby Grandma: Susan, lives with family, helps with children Your Information: Counselor (nutrition professional). Work at a busy pediatrics clinic. Have patients scheduled ahead of time but will also see patients referred on the same day. Sessions are short, typically 15‐20 minutes. Follow‐up with patient happens every week or as needed. Use Motivational Interviewing tools. Typically set only one goal at a time with patients. Questionnaire mom filled out in waiting room (with help from grandma, who watches the children while mom works). Answers highlighted: 1. How many times a day does your child eat vegetables? None, One, Two or more 2. How many times a day does your child eat fruit that is fresh, canned or dry (not counting juice)? None, One, Two or more 3. How many times a day does your child drink juice, soda, Kool aide, Lemonade, sweet tea, or any other sweet drink? None, One, Two or more 4. How many glasses of milk does your child drink in a day? None, One, Two or more 5. What type of milk does your child drink? No milk, skim, 1%, 2%, Whole 6. How many times a week does your child eat food from a fast food restaurant or pizza delivery? None, One to Two, Three or more 7. How many times a week does the family eat dinner together? None, One to Two, Three to Five, Every night 8. Is the television switched ON during meals? Yes, No 9. Does your child have a TV in his/her bedroom? Yes, No 10. How many hours a day does your child spend watching television or playing computer games? None, One to Two, Three to Four, Five or more 11. How active would you say your child is? Not Active, Only a little active (prefers to be still but will run around for about 30 minutes total in a day), Active (plays actively at least 1 hour a day), Very Active (never stops) Tom’s 24 hour recall (completed with grandma’s help in the waiting room): 7:00am – Milk in a sippy cup, ~ 8 oz, whole milk (got milk when he first got up, then went to watch TV and took the cup with him. He sipped while watching TV). 9:30am – Breakfast: 1 egg with 1/2 sausage pattie and an English muffin (with butter and jam). Got orange juice in his cup, about 4 ounces, he sipped on it and took it with him to watch TV. 10:30am – About 3 ounces more juice. 11:00‐ Snack: a small ziplock bag (snack bag size) with Teddy Graham crackers and apple juice, about 4 ounces, in a sippy cup. He ate all the crackers while watching TV, finished his juice within an hour. Still watching TV. 12:30pm – Lunch: Peanut butter and jelly sandwich (whole sandwich) and a handful or potato chips. Didn’t want anything to drink but took a sip or two of grandma’s Coca Cola. 1:30pm – Snack: a chocolate chip cookie with about 4 ounces of whole milk. 3:00 pm – Snack: 2 more chocolate chip cookies with about 4 ounces of whole milk. 5:00 pm – 2 fruit snack packets and milk in his sippy cup (about 4 ounces). 6:30pm – Dinner: 1 hot dog (no bun), macaroni and cheese (small portion, maybe 1/3 cup). Didn’t want anything to drink but took sips of dad’s Coca Cola, probably ended up drinking about 4 ounces of it. 8:00 pm – Snack – A Little Debbie cupcake, about 3 ounces of milk. Tom’s BMI at age 3 years Tom’s BMI at age 4 years