Case 9911: Karen
The nurse has referred Karen to you from the clinic at the local high school. She went to the clinic two weeks ago (February 1993) because she had not had her period for five months and she was afraid she was pregnant. Karen is in the ninth grade at Memorial High school. She was 15 years old in January 1993. Her first menses was in January 1991 when she was 13 years old. She had regular periods until October 1992. She had unprotected intercourse once in September 1992. The clinic did a pregnancy test and ruled out pregnancy as well as other venereal diseases.

Karen is quite relieved over the results of the pregnancy test and thinks that her missed periods may have been due to stress, since she had a period about a week ago. She describes this period as being 'light" and lasting only three days. She says that the nurse at the clinic was concerned about her weight and suggested that this might be the reason for her missed periods.

Karen is 5 feet 7 and 1/4 inches tall and weighs 118 pounds. Karen has an older sister (17 years) and a younger brother (12 years). She does quite well in school although she admits a certain amount of anxiety associated with being in high school. She has been taking ballet lessons since she was four. She takes five two-hour classes a week, immediately following school. In November, the ballet teacher commented about the size of her hips so she began to watch what she ate and she started attending an aerobics’ class three times a week. She is happy to report that she has lost ten pounds since November. (Energy expenditure)

Karen typically has bran cereal and skim milk for breakfast and an apple and a diet soda for lunch. She eats some carrot and celery sticks before her class. For dinner, she eats three ounces of fish or chicken, a tossed salad with lemon juice and some rice. She often drinks a cup of coffee before her aerobics class because she says it gives her extra energy. She says she has been feeling more tired lately. (Diet Analysis). About once or twice a week she admits that she cheats on her diet by eating a couple of bags of chips and a bag of cookies or some other snack food on the way home from aerobics class.

Her grandmother died recently following a hip fracture. She had been suffering from the effects of osteoporosis for some time prior to the fracture. Karen's parents are healthy and she says that they are very supportive of her interest in ballet but are concerned about her new eating habits.