Academic journal article Childhood Obesity

Adolescent Report of Lifestyle Counseling

Academic journal article Childhood Obesity

Adolescent Report of Lifestyle Counseling

Article excerpt

[Author Affiliation]

Nicolas M. Oreskovic. 1 Center for Child & Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA. 2 Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. 3 Harvard Medical School, Boston, MA.

Elizabeth Goodman. 1 Center for Child & Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA. 2 Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. 3 Harvard Medical School, Boston, MA.

Alyssa I. Robinson. 1 Center for Child & Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA.

Eliana M. Perrin. 4 Department of Pediatrics, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC.

James M. Perrin. 1 Center for Child & Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA. 2 Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA. 3 Harvard Medical School, Boston, MA.

Address correspondence to: Nicolas M. Oreskovic, MD, MPH, Instructor in Pediatrics, Center for Child & Adolescent Health Research and Policy, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA 02114, E-mail: noreskovic@partners.org

Introduction

The prevalence of pediatric obesity remains a major public health problem in the United States.1 Obesity can lead to increases in blood pressure and blood lipids, two leading risk factors for cardiovascular disease (CVD).2 Several established risk factors for CVD, including obesity, elevated blood lipids, and diabetes, have been shown to start as early as adolescence.3-5 Adolescence therefore represents a pivotal and actionable time period during which risk factors for adult morbidity and mortality, including obesity, can be measured and addressed, yet studies have shown low rates of physician- and parent-reported lifestyle counseling among providers caring for adolescents.

Healthcare providers, including physicians and nurse practitioners, would seem well positioned to play a role in obesity prevention and treatment counseling, because most US youth interact with a healthcare provider at least once during the year.6 Moreover, lifestyle counseling on healthy eating and being physically active are part of well child care7 and are especially important for prevention of overweight and obesity. Despite recommendations from the American Academy of Pediatrics, the American Medical Association, the CDC, and the US Department of Health and Human Services that clinicians should screen and counsel youth at least annually for overweight and obesity,8,9 providers report that lifestyle counseling for obesity often occurs infrequently as a result of a host of reasons, including visit time constraints, poor reimbursement, and low provider self-efficacy.10

Previous studies have sought to identify patterns of physician counseling in the areas of diet and physical activity. Though these studies have tended to adjust for weight status,11-13 few studies have investigated the role of physical activity. Physical activity is known to have beneficial health effects independent of weight status.14 Adolescent physical activity levels may play an important role in determining which patients receive lifestyle counseling, even after adjusting for weight status. For example, adolescents who report participating in sports or frequent forms of daily physical activity (e.g., walking to school) during annual well child care visits may prompt providers to not counsel on physical activity in the belief that this topic has already been covered or that current physical activity recommendations are being met, regardless of weight status. …

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