Varsha Mullangi

Mrs. McMennamy
Capstone Period 5
17 October 2016
Track Hours 17-24 Reflection
For my first four track hours, I shadowed Dr. Mona Eissa. Dr. Eissa is a professor of
pediatrics and adolescent medicine at the University of Texas McGovern Medical School, as
well as the director of the adolescent medicine division and pediatric weight management
program. Two of my hours were spent shadowing her on August 12 at the pediatric weight
management clinic in the UT Professional Building, while the other two were on August 16 at
the UT Physicians Dashwood Clinic. Although this experience did not allow for much patient
interaction, as opposed to when working with a private pediatrician, I still learned a lot about
obesity and its correlates that I did not know before. Dr. Eissa went over BMI charts with me in
between patient visits, and explained to me some of the differences between BMI classifications
for children versus adults. In adults, a healthy BMI is 25 and under, 25-30 for overweight, and
above 30 and you are considered obese. For boys on the other hand, up till 85 and you are
healthy, 85-95 you are overweight, and above 95 qualifies you for obesity. One interesting
correlate I found was between obesity and sleep disorders. After asking Dr. Eissa, I learned that
obese patients often have narrow airways due to their enlarged tongues or fat in the chest area.
This excess weight can make it hard for the lungs to expand, causing snoring, and in some cases,
sleep disorders. In terms of treatment, there are unfortunately not many options. The most
obvious, weight loss, can be hard for patients to attain right away, so other methods include
removing the tonsils if they are enlarged or treating the patients allergies in order to reduce
swelling in the area. If removal of enlarged tonsils is not an option, a breathing machine is used
to pump oxygen near the patients nose in order to stimulate the lungs while asleep.
My next four hours were done through independent study, and consisted of me reading
and analyzing three articles. The first source was a publication that looked into various
evaluation methods for child and adolescent obesity, and the prevalence of these methods among
different types of health care professionals, and took me an hour and thirty minutes to read.
Source A was 9 pages long, and included the results of the study, data in tables, and conclusions
drawn from the data. Because I am dealing with pediatricians, in terms of analyzing health care, I
focused on looking into the most used methods by this group of professionals, which included
clinical impression, hypertension, and family history assessments.

Source B was also took me an hour and thirty minutes to read, and was a 9 page long
publication looking into the psychological and emotional side of evaluation and management of
obese children/adolescents. Like the first source, this one also provided tables summarizing the
results of the study. In addition to describing the results of the study, the publication also touched
on a barrier to treatment and suggested treatment methods, such as patient groups, involvement
of parents, and referral to mental health specialists.
My last source was a 4 page long article from the American Heart Association, which I
read and analyzed for about an hour. Although my research for this upcoming timed writing is
looking into and addressing current gaps in health care, it was interesting to see where we were
at medically in 1996. This source also touched on treatment and future directions for care, and I
was helpful to see what has changed and what areas have remained the same and still need more
research.

Source Analysis A
Source A
MLA Citation:
Barlow, Sarah E., William H. Dietz, William J. Klish, and Frederick L.
Trowbridge. "Medical Evaluation of Overweight Children and Adolescents:
Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered

Dietitians." Pediatrics 110 (2002): 222-28. American Academy of Pediatrics.

Web. 17 Oct. 2016.
Source Validation:
This source is valid because it was published in a reputable journal, Pediatrics,
which is the official journal of the American Academy of Pediatrics. This journal
is peer-reviewed and publishes observations and research relating to a multitude
of fields in pediatrics.
How I found this source:
I found this publication by searching through a volume of the journal Pediatrics.
Intended Audience:
The intended audience for this source is an educated audience interested in
learning about the varying medical evaluation methods between several types of
healthcare providers.
Arguments/topics:
The purpose of this publication was to examine the differing methods used by
pediatricians, pediatric nurse practitioners, and registered dietitians when
evaluating and diagnosing obese children and adolescents. The piece was split
into three parts, with the first half discussing how the study was carried out. The
second part looked over various assessment tools, such as medical history,
physical examination, laboratory evaluation, and family history. Accompanying
each assessment method was also tables listing their usage by the different
healthcare providers. Finally, the publication ended by summarizing the results,
listing a few barriers, and proposing improvements to the system.
Quotes, paraphrases, and summaries:
Improved knowledge of these problems is only the first step. Clinicians also
reported many barriers to treatment of these children, including lack of time and
inadequate reimbursement.

 Among all 3 professional groups, a majority (62%82%) frequently used clinical

impression, weight-for-age percentile, weight for-height percent, and
weight-for-height percentile.
Routine evaluation of hypertension was nearly universal (95%) among
pediatricians and PNPs (Table 3).
The justification for routine screening for obesity related health conditions lies in
their increasing prevalence rates.

Source Analysis B
Source B
MLA Citation:
Jonides, Linda, Virginia Buschbacher, and Sarah E. Barlow. "Management of
Child and Adolescent Obesity: Psychological, Emotional, and Behavioral
Assessment." Pediatrics 110 (2002): 215-21. American Academy of Pediatrics.
Web. 17 Oct. 2016.
Source Validation:
This source is valid because it was published in a reputable journal, Pediatrics,
which is the official journal of the American Academy of Pediatrics. This journal
is peer-reviewed and publishes observations and research relating to a multitude
of fields in pediatrics.
How I found this source:
I found this publication by searching through a volume of the journal Pediatrics.
Intended Audience:
The intended audience for this source is an educated audience interested in the
psychological and emotional side of evaluation and management of obese
children/adolescents.
Arguments/topics:
This publications aim was to look at the different psychological, emotional, and
behavioral evaluations various health care professionals use when diagnosing
obese youth, as well as if their practices met recommended evaluation standards.
Major psychological evaluators among pediatricians were poor self-esteem, eating
disorders, and depression. Other general diagnostic tools included diet and
physical activity history. Many professionals looked to patient groups,
involvement of parents, and referral to mental health specialists in order to bolster
treatment. The study also touched on the barrier of lack of motivation in patients,
and the difficulty this posed to professionals when trying to find treatment
options.
Quotes, paraphrases, and summaries:
However, most of these providers, especially RDs, did not initiate treatment in
patients who did not want to control their weight. This finding raises the question
of how to care for the unmotivated, overweight child.

 Studies have examined the relationship of obesity with such psychological issues
as self-esteem, depression, eating disorders, and family dynamics. These studies
have identified low self-esteem and significant depression in overweight children
as well as higher levels of emotional distress and psychiatric symptomatology.
The majority of providers frequently assessed all levels of physical activity
(Table 4). More than 95% of all providers asked about organized physical
activities, 90% asked about unstructured physical activity or free play and about
sedentary behavior, and 85% asked about routine activities.
The majority of practitioners (55%73%) involved parents and patients in the
treatment of obesity for both children and adolescents (Table 6).

Source Analysis C
Source C
MLA Citation:
Gidding, Samuel S., Rudolph L. Leibel, Stephen Daniels, Michael Rosenbaum,
Linda Van Horn, and Gerald R. Marx. "Understanding Obesity in Youth."
Circulation 94.12 (1996): 3383-387. American Heart Association Journals. Web.
17 Oct. 2016.
Source Validation:
This source is valid because it was published in a reputable journal, Circulation,
which is the official journal of the American Heart Association. This journals
publications are reviewed by an editorial board, and publishes articles,
manuscripts, and other content relating to cardiovascular health and disease.
How I found this source:
I found this publication by searching through Google Scholar.
Intended Audience:
The intended audience for this source is an educated audience wanting to learn
about differing aspects of obesity in youth, as well as its treatment.
Arguments/topics:
Because this source was published in 1996, it serves as a good comparison in
terms of advancements in obesity treatment over the past few years. The first half
of the publication discusses the epidemiology, morbidity, and etiology of obesity
among children. The second half of the article looks at prevention, treatment, and
future directions for care of obese individuals. The treatment section also includes
a table, which displays evaluation facets of children with obesity. Future
proposals for treatment included interventions, establishing genetic markers, and
developing public health measures.
Quotes, paraphrases, and summaries:
Conditions for which weight loss is recommended include hypertension, diabetes
mellitus, cor pulmonale, sleep apnea, orthopedic abnormalities, and severe
psychosocial stress secondary to obesity.
Further research on obesity in children should be directed toward understanding
the critical periods for its development, devising successful family-oriented
interventions, establishing clinical and genetic markers that identify individuals

and populations at risk, improving standards for the diagnosis of obesity, and
developing effective public health measures to increase participation in active
rather than sedentary lifestyles.
Current research leaves the hope that the trend toward increased obesity can be
reversed through a public health policy that encourages regular physical activity
and prudent diet combined with new insights into pathophysiology for specific
therapy of severely affected individuals.
Public health interventions for primary prevention should be directed toward the
promotion of healthful behaviors. These include accumulation of at least 30
minutes of endurance-type physical activity of at least moderate intensity on
mostpreferably alldays of the week and consumption of the prudent diet
recommended by the American Academy of Pediatrics and the American Heart
Association.