A 5-year-3-month-old Malay boy with underlying bronchial asthma and allergic rhinitis was referred for childhood obesity management during ward admission for bronchopneumonia. Anthropometry showed weight of 28 kg (>97th percentile) with excessive energy intake of 3010 kcal/day at baseline. Dietary assessment revealed frequent intake of fried foods, condensed milk-containing beverages, feeding frequency ≥6 times/day, low fruit and vegetable intake, prolonged screen time, and lack of physical activity. Stage of Change assessment demonstrated pre-contemplation stage for fat and fiber intake, while simple sugar and fruit intake were at preparation stage, indicating selective readiness toward dietary behaviour modification. Excessive oral intake (NI-2.2) related to food- and nutrition-related knowledge deficit and frequent consumption of energy-dense foods and sugar-sweetened beverages as evidenced by estimated energy intake of 3010 kcal/day, intake of condensed milk-containing beverages, feeding frequency ≥6 times/day, and obesity status with weight-for-age >97th percentile. Stage-based nutrition counselling was individualized according to readiness to change. Initial intervention targeted simple sugar intake, as caregiver was in preparation stage for sweetened beverage modification. Counselling focused on reducing condensed milk addition in Milo from 2 tablespoons to 1 tablespoon per serving, limiting sweetened beverages, and promoting plain water intake. During follow-up, caregiver progressed to action stage for simple sugar reduction and fruit intake, allowing further intervention on healthier fruit incorporation using affordable and practical options suitable for the family environment. Follow-up showed reduction in energy intake from 3010 kcal/day to 2060 kcal/day and simple sugar intake from 54 g/day to 17 g/day. Stage of Change progression was observed from preparation to action stage for simple sugar and fruit intake, with minimal weight increment from 28 kg to 28.5 kg over 3 months.

Muhammad Zaki Norhisham is a clinical dietitian currently serving at Hospital Tanah Merah, Kelantan, where he provides medical nutrition therapy for both outpatient and inpatient settings, conducts diet history assessments, and supports nutrition counselling and education. He holds a Bachelor of Science in Dietetics with Honours from Universiti Putra Malaysia. His professional background includes experience as a nutritional representative with Abbott, where he supported paediatric formula education, conducted continuing medical education sessions, and assisted hospital nutrition-related follow-up. He has also worked as a dietitian at BIG Pharmacy Damansara, providing nutrition education, supplement counselling, and health screening services

Zaki has been actively involved in professional and community programmes, including nutrition education, health screening, school and community outreach, and conference-related activities. His areas of interest include clinical nutrition, paediatric nutrition, nutrition education, and public health promotion. With a combination of clinical, community, and industry experience, he is committed to delivering evidence-based nutrition care and improving health outcomes through practical dietary interventions.