Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity.

Many primary care physicians are not providing care that is consistent with recommendations to prevent, to identify, and to manage childhood obesity. This report presents modifications made to the electronic medical record system of a large pediatric health care system, using a quality improvement approach, to support these recommendations and office system changes. Although it is possible to make practice changes secondary to electronic medical record system enhancements, challenges to development and implementation exist.

Dietary recommendations for children and adolescents: a guide for practitioners.

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association.

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Public health and clinical recommendations for physical activity and physical fitness: special focus on overweight youth.

Numerous physical activity and physical fitness recommendations exist for youth. To date, however, no investigator has systematically reviewed these public health and clinical guidelines to determine whether the recommendations address overweight youth. This review examines youth-oriented physical activity and physical fitness recommendations for both the public health community and the clinical community, and assesses how overweight youth are specifically targeted by each of these two groups. Our review determined the extent to which the recommendations assessed four components of physical activity (i.e. frequency, intensity, duration and type) and four components of physical fitness (i.e. cardiorespiratory capacity, strength, flexibility and body composition). We further reviewed clinical recommendations to determine how they included two facets of the physician-patient encounter: assessment and counselling. After identifying all current physical activity and physical fitness recommendations for youth, we evaluated whether public health (n = 13) and clinical recommendations (n = 12) addressed physical activity and physical fitness for overweight youth. Findings revealed inconsistent, yet explicit, recommendations for the public health community where most organisations (12 of 13, 92%) included > or =3 physical activity components. In addition, organisations encouraged volumes of daily moderate- to vigorous-intensity physical activity for youth ranging from 30-60 or more minutes. Recommendations for the clinical community generally did not provide explicit physical activity and fitness recommendations to advise physicians on the assessment and counselling of patients and their families. Overweight youth were addressed within some recommendations (6 of 12, 50%) for the clinical community, but within few recommendations (2 of 13, 15%) for the public health community. To best inform public health and clinical communities, organisations developing future recommendations should include information fully documenting the decision-making processes used to develop the recommendations. In cases where mutual goals exist, public health and clinical communities should consider collaborating across agencies to develop joint recommendations.

Weight counseling patterns of U. S. Pediatricians.

OBJECTIVE: To estimate the proportion and characteristics of U.S. pediatricians who reportedly counsel their patients about maintaining a healthy weight. RESEARCH METHODS AND PROCEDURES: Beginning in October 1998, information was collected from 813 primary care pediatricians randomly selected from a nationally representative sample. Pediatricians were asked how frequently they counseled about maintaining a healthy weight during the well-care visits of patients in three age groups. Multivariable logistic regression determined which physician characteristics were associated with counseling. RESULTS: Approximately fifty percent of pediatricians reportedly always counseled about maintaining a healthy weight. Those who always counseled were more likely to be women, to spend more time with patients during well-care visits, and to conduct more well-care visits per week from patients in one particular age group. Most pediatricians who responded that they always counseled about healthy weight reported that they counseled about physical activity and nutrition, but not about balancing caloric intake with expenditure. DISCUSSION: Although many pediatricians report counseling about healthy weight, the frequency of counseling might be further increased by increasing the amount of time the patient spends during office visits with the pediatrician or with other professional staff, such as nurses or dietitians.