American Journal of Lifestyle Medicine recent issues

From the Publisher

Epstein, R. — 2008-07-17

The Risk in Exercise Training

Foster, C., Porcari, J. P., Battista, R. A., Udermann, B., Wright, G., Lucia, A. — 2008-07-17

Although exercise training is unequivocally of benefit relative to the risk of cardiovascular disease, there is a definable risk of complications during exercise training. In younger individuals, the risk is almost exclusively related to the presence of congenital abnormalities, whereas in older (~40 years) individuals, the risk is largely related to atherosclerotic disease. In both groups, the risk of the underlying pathology leading to clinical presentation is increased by higher intensity exercise. In older individuals, preexercise screening is of potential benefit but is not generally well done. Exercise prescription should favor lower intensity exercise during the early weeks of an exercise program. Subjective methods, which do not rely on the results of an exercise test, including the Rating of Perceived Exertion and the Talk Test, are to be recommended because preliminary exercise testing is performed inconsistently. There are inadequate data regarding the spontaneous exercise training intensity in both healthy individuals and patients.

Exercise Nutrition for Adults Older Than 40 Years

Melanson, K. J. — 2008-07-17

In general, nutrient needs do not change much for older individuals who exercise regularly yet moderately for the purposes of chronic disease risk reduction. Overall diets should reflect those recommended by such authorities as the American Dietetic, Heart, and Diabetes Associations, with special attention to ensuring ample protein and antioxidant intakes. Proper timing and amounts of nutrients consumed before physical activity should be practiced, to ensure adequate fueling while minimizing gastrointestinal discomfort. Consuming energy during activities lasting less than 90 minutes is unnecessary if the individual is well fueled before starting. After exercise, consuming a blend of carbohydrate and protein is often advocated for glycogen resynthesis and muscle protein repair, but the importance of this for those not engaging in regular vigorous activity remains to be clarified. Adequate hydration is critical to physical performance and health during exercise, particularly in the heat. Because thirst might not sufficiently reflect fluid needs of older individuals, this matter deserves special attention. Sports drinks are generally not necessary for events lasting less than 60 minutes and may provide unwanted calories, sugars, and sodium for older exercisers. Naturally occurring sources of electrolytes may be preferable.

Exercise for Primary Care

Terre, L. — 2008-07-17

This review discusses physical activity counseling in primary care, including evidence-based perspectives on optimizing the risk-benefit ratio for the majority of patients who are not physically fit.

Do Supplements Benefit Exercise?

Kuczmarski, K. — 2008-07-17

It is a known fact that exercise will have beneficial effects on one's health. Nutritional supplementation is on the rise, resulting in a billion-dollar industry. However, because these medications are not regulated by the Food and Drug Administration, it is difficult for the public to determine what is safe and effective. Health care providers have to be aware of this lack of knowledge and educate their patients on which supplements are beneficial and which may be harmful to their health.

Treatment of Overweight and Obesity in Primary Care Practice: Current Evidence and Future Directions

Simkin-Silverman, L. R., Conroy, M. B., King, W. C. — 2008-07-17

Obesity is commonly encountered in primary care practice. Yet many patients who are overweight or obese are not identified, and those who are do not receive adequate treatment or referral. For many primary care providers, barriers to addressing weight control with patients include lack of time, limited training and resources, patient readiness to change, and inadequate insurance reimbursement. Studies that have evaluated weight control interventions in primary care vary tremendously in design and methodology. Most studies have focused on primary care provider training or practice-level interventions, or they have combined physician and nutrition counseling. Although results from these studies are encouraging, more randomized clinical trials are needed in this area. Future avenues for study include electronic health records, computer-tailored interventions, and translation of efficacious weight control interventions into primary care settings.

Appetite-Related Gut Peptides in Obesity and Binge Eating Disorder

Geliebter, A., Ochner, C. N., Aviram-Friedman, R. — 2008-07-17

The worldwide increase in obesity prevalence is a result of positive energy balance, with energy intake exceeding expenditure. The eating behavior in obesity ranges from mild passive overconsumption to excessive overeating with loss of control observed in binge eating disorder (BED). The signaling systems that underlie appetite control in BED are complex and, at this point, not well understood. The present review highlights the current knowledge of key components of the gut peptide system and examines evidence of defects in signaling that differentiate obese binge eaters from obese non—binge eaters. The signaling network underlying hunger, satiety, and metabolic status includes leptin and insulin from energy stores and cholecystokinin, glucagon-like peptide-1, peptide YY(3-36), and ghrelin from the gastrointestinal tract. Of the many gastrointestinal peptides, ghrelin is the only established appetite-stimulating one, whereas cholecystokinin, glucagon-like peptide-1, and peptide YY(3-36) promote satiety. Adipose tissue provides hormonal signals via leptin and insulin to the brain about energy stores and likely from adiponectin and resistin. Binge eating has been related to a dysfunction in the ghrelin signaling system. Moreover, the larger gastric capacity observed in BED may further reduce satiety signals and contribute to overeating.

A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents

O'Neil, C. E., Nicklas, T. A. — 2008-07-17

Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.

Cardiovascular Risk: Exercise Good Judgment

McInnis, K. — 2008-07-17

Calendar

2008-07-17

Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence

Bassuk, S. S., Manson, J. E. — 2008-05-08

Cardiovascular disease is the leading cause of death among both women and men in the United States, accounting for nearly half of all deaths and considerable morbidity. Type 2 diabetes is a major risk factor for cardiovascular disease and one that is particularly potent in women; its prevalence has increased dramatically in recent years. Epidemiologic data indicate that cardiovascular disease and type 2 diabetes share common risk factors and are largely preventable; indeed, findings from the Nurses' Health Study suggest that 74% of cardiovascular disease cases, 82% of coronary heart disease cases, and 91% of diabetes cases in women could be prevented by not smoking, engaging in regular physical activity, maintaining a healthy weight, eating healthier food, and drinking moderate amounts of alcohol. This article reviews lifestyle risk factors and preventive strategies for cardiovascular disease and type 2 diabetes among women.

Nutrition for Women in the Prevention and Treatment of Type 2 Diabetes and Cardiovascular Diseases

Melanson, K. J. — 2008-05-08

Awareness of women's risks for type 2 diabetes and cardiovascular diseases must be promoted by health care professionals. For overweight and obese women, weight reduction is critical for reducing risks; prevention of excess weight gain must be encouraged for women of healthy body weight. Vulnerable times for weight gain during a woman's life cycle include early adulthood, the childbearing years, and menopause. Thus, healthy diet and exercise behaviors must be particularly emphasized during these years. Polycystic ovary syndrome is also associated with obesity, insulin resistance, and cardiovascular disease risk, and weight loss can lower these risks. Foods comprising diets associated with reduced cardiovascular disease and type 2 diabetes risks tend to be unrefined plant foods (vegetables, legumes, fruits, whole grains, nuts, seeds), low-fat dairy products, fish rich in omega-3 fatty acids, and lean sources of protein. Artificial trans fatty acids should be avoided and saturated fats cholesterol, sodium, and added sugars minimized. A balance of micro-nutrients and fiber should be obtained from wholesome food sources rather than supplements. Dietary counseling for women should consider the context in which they live, cultural aspects, socioeconomic factors, menstrual cycle influences on food intake, and warning signs for eating disorders. Continued gender-specific research will be helpful in discerning the most effective lifestyle interventions for women.

Lifestyle and the Risk of Cardiovascular Disease in Women: Is Physical Activity an Equal Opportunity Benefactor?

Zoeller, R. F. — 2008-05-08

Cardiovascular disease is the number one killer of women in the United States. It is estimated that 36.6% of women older than age 20 have some form of cardiovascular disease. In 2004, an estimated 459 100 women died from cardiovascular disease, more than 10 times the number of women who died from breast cancer that same year. Regular physical activity of moderate intensity, such as brisk walking, reduces the risk of cardiovascular disease and mortality in women. The benefits of more vigorous exercise are not clear, but the apparent lack of a dose-response relationship between exercise intensity and cardiovascular benefit may be the result of the design of many epidemiologic and interventional studies. Studies examining the benefits of greater cardiorespiratory fitness for women are limited, but the data suggest that they are similar to that of men. Women may require greater caloric expenditure than men for weight reduction, but this issue may be confounded by other variables such as caloric intake and spontaneous physical activity. The risk of cardiovascular disease associated with type 2 diabetes is much greater in women than in men. Regular physical activity and greater cardiorespiratory fitness are associated with a lower incidence and prevalence of type 2 diabetes in women. Greater cardiorespiratory fitness has also been found to be protective of the metabolic syndrome, but the benefit of physical activity is unclear. Limited evidence suggests that moderate-intensity activities can lower systolic blood pressure in women. There is a pressing need for more research into the health benefits of regular physical activity in women.

Health Risk Reduction in Women

Terre, L. — 2008-05-08

This review discusses evidence-based perspectives on health risk reduction in women and the implications for gender-informed research, clinical best practices, and public policy.

Encouraging Healthy Lifestyles in Women: Are Pharmacists Doing Enough?

Prevost, R. R. — 2008-05-08

There is evidence that weight reduction, increased physical activity, improved nutritional choices, smoking cessation, and moderate alcohol ingestion can decrease the risk of cardiovascular disease and diabetes mellitus in women. Pharmacists must increase their incorporation of lifestyle interventions while performing medication counseling. To prepare, pharmacists need increased didactic training during pharmacy school, and practicing pharmacists need focused continuing education. Pharmacists must also look for simple but creative ways to engage patients while performing medication counseling. As heath care costs continue to rise, pharmacists must be willing to participate in research that may demonstrate a reduction in prescription burden due to the combination of healthy lifestyle counseling with medication counseling.

Dietary Fiber and the Relationship to Chronic Diseases

Timm, D. A., Slavin, J. L. — 2008-05-08

Preventative medicine is targeting chronic diseases such as heart disease, cancer, diabetes, and obesity. Populations that consume more dietary fiber have less chronic disease. Intake of dietary fiber has beneficial effects on the risk factors for developing several chronic diseases. Dietary reference intakes recommend the consumption of 14 g of dietary fiber per 1000 kcal, or 25 g for women and 38 g for men, based on the goal of protection against cardiovascular disease. Usual intake of dietary fiber is only 16 g per day. Viscous fibers decrease the glycemic response and may assist in diabetes care. High-fiber diets provide bulk, are more satiating, and have been linked to lower body weights. Evidence that fiber decreases cancer is mixed, and further research is needed. Dietary messages to increase consumption of high-fiber foods such as whole grains, legumes, fruits, and vegetables should be broadly supported by the medical profession. Consumers are also turning to fiber supplements and bulk laxatives as additional fiber sources. As many fiber supplements have not been studied for physiological effectiveness, the best advice is to consume fiber in foods.

Translating Cancer Control Research Into Primary Care Practice: A Conceptual Framework

Graham, A. L., Kerner, J. F., Quinlan, K. M., Vinson, C., Best, A. — 2008-05-08

Effective dissemination, implementation, and adoption of research-tested lifestyle risk factor interventions within primary care are critical to reduce cancer morbidity and mortality. The objective of this study is to identify short- and long-term action steps within primary care research and practice to bridge the discovery-to-delivery gap in cancer prevention and control. Experts in primary care research and practice from the United States and Canada participated in this qualitative project. Concept mapping was used to synthesize expert input on actions to improve research-practice integration in cancer prevention and control. Results were used to facilitate an action-planning meeting among primary care researchers and practitioners. Five areas were identified as critical to improving the integration of research and practice in cancer prevention and control: (1) stakeholder collaborations, (2) organizational culture and structure, (3) learning infrastructure, (4) incentives and funding, and (5) data and accountability systems. Addressing the discovery-to-delivery gap in primary care requires collaboration among researchers and practitioners throughout the knowledge production cycle. The model developed in this project can be used to stimulate actions at the individual, organizational, and systems level to reduce the burden of cancer related to lifestyle risk factors.

A Review of TV Viewing and Its Association With Health Outcomes in Adults

Williams, D. M., Raynor, H. A., Ciccolo, J. T. — 2008-05-08

Observational studies of the relationship between TV viewing and health outcomes (overweight/obesity, cholesterol/lipids, blood pressure/hypertension, type 2 diabetes, and metabolic syndrome) in adults are reviewed. Studies indicate that in adults, greater amounts of TV viewing are consistently associated with increased overweight risk, both cross-sectionally and longitudinally, but that results are mixed regarding the relationship between adult TV viewing and other health outcomes. It is theorized that greater TV viewing is related to increased weight status and poorer health outcomes by reducing energy expenditure, predominantly through reducing time spent in physical activity, and increasing energy intake. No randomized trials that manipulated TV viewing time measured the effects of this manipulation on diet and physical activity and then measured future health outcomes in adults. However, experimental studies, predominantly conducted in children, show relationships between TV viewing, energy intake, physical activity, and weight status, which follow the hypothesized mechanisms. Interventions targeting TV viewing in adults appear to be justified, and proposed methods for conducting these interventions, as well as potential barriers to implementing these interventions, are discussed.

Prevention Research and Reality: Narrowing the Quality Chasm

Zapka, J. G. — 2008-05-08

Ending the Food Fight by David Ludwig, MD, PhD, Boston: Houghton Mifflin * 2007 * $26 * ISBN:0-618-68326-0

Troxler, R. G. — 2008-05-08

New Breakfast Calculator: Online Tool Helps Encourage a Healthy Breakfast

2008-05-08

Calendar: 2008 Conferences

2008-05-08

Themed Review: Lifestyle Treatment of the Metabolic Syndrome

Janiszewski, P. M., Saunders, T. J., Ross, R. — 2008-02-26

The metabolic syndrome is a clustering of metabolic risk factors including abdominal obesity, dysfunctional glucose metabolism, dyslipidemia, and elevated blood pressure. Approximately 1 in 4 Americans currently has the metabolic syndrome and are thus at an elevated risk of cardiovascular disease, type 2 diabetes, and mortality. Leading health authorities recommend lifestyle modification consisting of exercise and caloric restriction for treatment and prevention of the metabolic syndrome. The purpose of this report is to review the evidence that considers lifestyle modification as a treatment strategy for the metabolic syndrome. The influence of lifestyle modification on abdominal obesity, dysfunctional glucose metabolism, dyslipidemia, and elevated blood pressure is considered. Findings suggest that interventions consisting of exercise and/or caloric restriction are associated with improvement in all components of the metabolic syndrome, although the magnitude of this effect varies according to the specific component studied and additional factors such as baseline values. The evidence presented supports the promotion of lifestyle modification as an efficacious strategy for the treatment of the metabolic syndrome.

Clinician's Corner: The Metabolic Syndrome: A Lifestyle Medicine Foe Worthy of a Seek and Destroy Mission

Greenstone, C. L. — 2008-02-26

The Metabolic syndrome (MetS) is comprised of dyslipidemia, elevated blood pressure, elevated plasma glucose, abdominal obesity and associated prothrombotic and proinflammatory states. It is accompanied by a life long twofold increased risk of cardiovascular disease and a fivefold increase risk for diabetes. Since cardiovascular disease and diabetes are predictable by modifiable risk factors, metabolic syndrome is a prime candidate for lifestyle modification utilizing the tools of Lifestyle Medicine (LM), (exercise, nutritional therapy and behavior modification). Such approaches can prevent the development of full blown Type II diabetes (5) and dramatically modify all of the components of the metabolic syndrome. This article discusses the definition and importance of MetS and how to screen for it and manage it using LM principles.

Nutrition Review: Diet and Metabolic Syndrome

Melanson, K. J. — 2008-02-26

Since most components of metabolic syndrome are related to lifestyle, exercise and diet are critical aspects of treatment. Most patients will need to reduce body weight. Some flexibility in dietary macronutrients is allowed, depending on the patient's metabolic profile and responsiveness. Types of fats and carbohydrates are particularly important. Artificial trans fats should be eliminated as much as possible and saturated fats minimized. Carbohydrates should be mainly unrefined and unprocessed, emphasizing fiber and low glycemic index, while keeping added sugars low. Monounsaturated fats are the best replacements for saturated fats and refined carbohydrates within energy and total fat limits. Micronutrients that may be beneficial for metabolic syndrome include vitamin D, calcium, magnesium, and potassium from whole food sources. Excess sodium chloride, as well as meal skipping, should be avoided.

Physical Activity: Physical Activity and the Metabolic Syndrome: A Review of the Evidence

Churilla, J. R., Zoeller, R. F. — 2008-02-26

Metabolic syndrome is a global public health problem identified as a seminal cause of cardiovascular disease and type 2 diabetes. The syndrome is characterized by the clustering of cardiovascular risk factors, including insulin resistance, central obesity, hypertension, and atherogenic dyslipidemia. Currently there are 5 working medical society definitions of metabolic syndrome. However, the majority of recent research focusing on metabolic syndrome has relied on the National Cholesterol Education Program (NCEP) definition because of its clinical utility. Studies of the association between physical activity and prevalence of metabolic syndrome using National Health And Nutrition Examination Survey (NHANES) data generally found the association to be reduced or attenuated by other lifestyle factors and is generally weaker in females. Other studies tracking physical activity over longer periods have generally found a stronger association between regular physical activity and lower prevalence or incidence of metabolic syndrome. Interventional studies are limited but suggest that regular exercise reduces the incidence of metabolic syndrome. The amount and intensity of physical activity required to prevent or reverse metabolic syndrome has yet to be definitely determined. Evidence suggests that regular, moderate-intensity physical activity may be preventive of metabolic syndrome and that activity of greater intensity may carry greater benefit. Greater cardiorespiratory fitness has demonstrated an even stronger negative association with metabolic syndrome. Strength training is recommended as an adjunct to regular aerobic exercise but is not the primary form of activity to prevent or manage metabolic syndrome.

Behavioral Medicine Review: Psychological Risks for Metabolic Syndrome

Terre, L. — 2008-02-26

Despite their ubiquity in primary care, psychological disorders often are overlooked as cues to heightened risk for metabolic syndrome (MetS), potentially leading to the suboptimal management of patients with these comorbid conditions. Accordingly, this review discusses psychological dysfunction as an under-appreciated MetS hazard and the strategic implications for cardiometabolic risk reduction in primary care.

Patient Education: The Art of Waist Management

Miner, M. — 2008-02-26

Although given an ICD9 code for diagnosis, variability exists for the definition of metabolic syndrome. In fact, these definitions do not always define the same patient population. The author discusses the various definitions, their applicability to clinical practice, and the teachings of a national best-seller: You: On a Diet: The Owner's Manual for Waist Management by Roizen and Oz. He shares basic tenets and humor for clinical guidance of patients suffering from metabolic syndrome.

State of the Art Reviews: Male Menopause: Fact or Fiction?

Wald, M., Miner, M., Seftel, A. D. — 2008-02-26

The possible existence of a menopause-like process in aging men has been speculated, given certain age-related hormonal and other biological changes noted to occur. Specifically, a slow decline in serum testosterone levels has been reported to occur with normal male aging. Androgen deficiency, which may result from this process, could have an effect on various systems and physiologic parameters, including bone density, body composition, sexual function, and the cardiovascular system, thus significantly affecting health and quality-of-life issues in older men. There has been an increasing interest in evaluating the possible use of testosterone replacement in preventing some detrimental aspects of aging and age-related hypogonadism, as well as in the investigation of the potential adverse effects of this therapy on different target organs. It is the purpose of this review to summarize currently available information with regard to the changes in testosterone and other hormones in older men, discuss their possible clinical manifestations and relationship with other age-related changes, and provide an updated description of testosterone replacement therapy for older men, including its indications, formulations, and safety considerations.

State of the Art Reviews: Glycemic Index, Obesity, and Chronic Disease

Marsh, K., Brand-Miller, J. — 2008-02-26

There is increasing evidence that both the amount and type of carbohydrate play an important role in weight management and risk of chronic disease. Classifying carbohydrates according to their post-prandial glycemic effect (ie, the glycemic index of foods) has yielded more useful insights than the historical distinctions of simple versus complex chemical structure. Diets based on carbohydrate foods that are more slowly digested and absorbed (ie, low glycemic index diets) have been independently linked to reduced risk of type 2 diabetes, cardiovascular disease, and some types of cancer. In individuals with diabetes, intervention studies have shown improvements in insulin sensitivity and glycated hemoglobin concentration with low glycemic index diets. Research also suggests that low glycemic index diets may assist with weight management through effects on satiety and fuel partitioning. Although ongoing research is needed, the current findings, together with the fact that there are no demonstrated negative effects of a low glycemic index diet, suggest that the glycemic index should be an important consideration in the dietary management and prevention of obesity and chronic disease.

State of the Art Reviews: Nutrition and Lifestyle for a Healthy Pregnancy

Ricciotti, H. A. — 2008-02-26

Nutrition and lifestyle factors can maximize health in pregnancy and lower future risk of disease for both mother and fetus. Education can make a big difference for patients in pregnancy outcomes, anxiety, and future health. Pregnancy is a time when attention to proper weight gain can reduce the risk of future obesity, diabetes, hyperlipidemia, and cardiovascular disease. There is mounting evidence that fetal "programming" for future risk of disease begins in utero and varies with nutritional exposures during different times of pregnancy, although the exact mechanisms remain to be elucidated. It is clear that a few simple precautions and enhancements of diet and lifestyle can prevent birth defects and perinatal infections and may reduce future health risks. Exercise in pregnancy is safe and should be encouraged for healthy women.

State of the Art Reviews: Using the Internet to Promote Physical Activity and Healthy Eating in Youth

Whiteley, J. A., Bailey, B. W., McInnis, K. J. — 2008-02-26

The prevalence of overweight children and adolescents is increasing at alarming rates. Since 1980, the prevalence of overweight among children aged 6 to 11 years has more than doubled and more than tripled among adolescents aged 12 to 19. Innovative, effective weight loss strategies that effectively promote healthy eating and physical activity are needed to address this obesity epidemic. The Internet may prove to be an effective means of reaching youth to reduce overweight and, ideally, prevent weight gain. This article reviews the available literature of Internet-based interventions promoting healthy eating, physical activity, and/ or weight loss in school, home, camp, and medical settings. Findings show that few examples of well-designed trials exist in the youth literature. However, several studies show promise for the use of the Internet. It is recommended that future trials use adequate sample sizes, randomized designs, objective measures, boys and girls, health disparity youth, longer intervention periods (at least 16 weeks), long-term follow-up, theory-based skill building (eg, tracking of behavior, goal setting, feedback, increasing social support), the involvement of parents or caretakers, and improved means for sustaining interest and use in the site over time.

Book Review: Weight Loss Confidential: How Teens Lose Weight and Keep It Off--and What They Wish Parents Knew by Anne M. Fletcher, MS, RD Houghton Mifflin * 2007 * 272 pages * $26.00 * ISBN: 061843366X

Hermann, M. — 2008-02-26

2008 Conferences

2008-02-26

Themed Review: Clinical Interventions to Promote Physical Activity in Youth

Meriwether, R. A., Lobelo, F., Pate, R. R. — 2008-01-07

National recommendations call for children and adolescents to accumulate at least 60 minutes of moderate to vigorous physical activity on most days of the week and for physicians to counsel their patients about physical activity. Physical inactivity tracks from childhood into adulthood, and among youth, it is associated with unfavorable risk factor profiles that promote the development of cardiovascular and metabolic chronic diseases. Few studies of clinical interventions to promote physical activity in children and youth have been published, and the paucity of evidence describing effective interventions and significant barriers limit delivery of counseling. However, existing studies provide evidence about elements of counseling most likely to be effective to guide clinical interventions and inform future research. Based on a literature review, this article offers guidance for incorporating physical activity promotion into clinical care, identifies gaps in current evidence, and suggests methodologic considerations for future research.

Nutrition Review: Lifestyle Approaches to Promoting Healthy Eating for Children

Melanson, K. J. — 2008-01-07

Healthy eating habits are vital to establish during childhood and sustain thereafter. Nourishing, well-balanced diets are essential for proper growth, immunity, physical and mental development, health and well-being, and reduced risk of chronic diseases later in life. Health care professionals, parents, and teachers should be aware of common nutrition-related concerns in children and teens, such as dental caries, allergies, anemia, growth retardation, eating disorders, and obesity, and watch for indicators that a child may be at risk for these. Foods that comprise a healthy diet for children include vegetables, fruits, whole grains, legumes, low-fat dairy products, and lean sources of protein. Foods and beverages with low nutrient density and high energy density should be consumed in moderation only, within a child's discretionary calorie allowance. Although children may need to eat more frequently than adults, they should be taught healthy snacking practices. Role modeling and nutrition education from adults in children's lives are critical in promoting lifelong healthy eating. Resources to facilitate these include Web sites from the American Academy of Pediatrics, American Dietetics Association, MyPyramid.gov/kids, and the US Dietary Guidelines.

Physical Activity: The Epidemic of Obesity and Overweight Among Youth: Trends, Consequences, and Interventions

LaFontaine, T. — 2008-01-07

Childhood and adolescent overweight and obesity are an epidemic problem in the United States. Studies show that approximately one third of youth are overweight or obese, representing a tripling since the 1960s and 1970s. The average male and female adult in the United States has gained 25 lbs and 24 lbs, respectively, since 1962. The body mass index of the average adult has increased from 25 to 28. Among youth, the average body mass index has increased from 21.3 to 24.1 since 1963. This increase in bodyweight among adults and youth is partially due to the decreased levels of physical activity. The economic and health consequences of this epidemic are enormous. Type 2 diabetes mellitus, a disease that was rare among youth 20 to 30 years ago, now represents as many as 45% of all cases of diabetes among youth. Cardiovascular risk factors are worsened in overweight and obese youth, and early evidence of atherosclerosis manifested by endothelial dysfunction and increased coronary artery calcium is present in a high percentage of overweight youth. Numerous psychosocial problems also are increased among overweight and obese youth. However, there are numerous examples in the scientific literature of successful approaches to the prevention and management of overweight and obesity in youth. This article summarizes statistics concerning the prevalence of overweight, obesity, and physical inactivity among youth; discusses the numerous physical and psychosocial consequences of overweight and obesity among youth; and presents information regarding interventions that have been demonstrated to be effective in preventing childhood and adolescent overweight and obesity.

Behavioral Medicine Review: Promoting Healthy Lifestyles in Pediatric Populations

Terre, L. — 2008-01-07

The upsurge in lifestyle-related, pediatric health problems has become the focus of widespread concern. This review discusses developmental considerations in lifestyle risk reduction and their implications for research, evidence-based practice, and public policy.

Pharmacy Review: Promoting Physical Activity in Youth: A Pharmacist's Reflections

Prevost, R. R. — 2008-01-07

Pharmacists have the unique opportunity to promote physical activity as an obesity prevention lifestyle measure while providing medication counseling. Common childhood disorders treated with medications include asthma, type 1 and type 2 diabetes mellitus, attention-deficit hyperactivity disorder, juvenile arthritis, and mental disorders. Medications are always associated with benefits and risks; in some situations, the medication may allow a child to enjoy physical activity that otherwise might not be possible. In other situations, the medication may cause side effects that could result in physical limitations. Educational efforts on the benefits of physical activity to reduce the risk of chronic disease must be enhanced.

Patient Education: This Practitioner's Ignorance of Diet, Nutrition, and Exercise: A Call to Education

Miner, M. — 2008-01-07

The delivery of preventive health care services in the wellness visits of children and adolescents fails to adequately identify the child and adolescent overweight and at risk for obesity and its subsequent comorbidities. There are multiple competing issues and barriers addressed in this article. However, a brief inventory of exercise and dietary and nutritional guidance is presented for the primary care clinician. Included are the appropriate history, physical exam, and laboratory evaluation that should encompass any child or adolescent at risk for obesity.

State of the Art Reviews: Methods of Evaluation: Issues and Implications for Physical Activity Referral Schemes

Gidlow, C., Johnston, L. H., Crone, D., James, D. V. B. — 2008-01-07

In the pursuit of evidence-based practice, the common focus on controlled research within physical activity and health promotion has created a restricted view of the acceptable type of evidence on which practice should be based. To improve our understanding of physical activity (and other behavioral) interventions, a more holistic approach to evaluation is required. In the context of physical activity referral schemes, this article considers the implications of adhering to this narrow definition of "acceptable" evidence and the importance of recognizing alternative evaluative approaches.

State of the Art Reviews: The Oatmeal-Cholesterol Connection: 10 Years Later

Andon, M. B., Anderson, J. W. — 2008-01-07

Ten years have passed since the Food and Drug Administration (FDA) completed their review of the literature pertaining to the consumption of whole-oat sources of soluble fiber and a reduction in blood cholesterol concentrations. Since that time, data have continued to accumulate regarding oat-soluble fiber consumption, cholesterol, and other physiologic vectors related to cardiovascular health. The objective of this review was to compare the findings of more contemporary analyses of the oat and cholesterol-reduction literature to determine if newer information is consistent with the original conclusion reached by the FDA. A number of formal assessments have been conducted subsequent to the FDA review, and virtually all have reached the same conclusion, namely, consumption of oats and oat-based products significantly reduces total cholesterol and low-density lipoprotein cholesterol concentrations without adverse effects on high-density lipoprotein cholesterol or triglyceride concentrations. In addition, a number of new insights about the potential benefits of oats have emerged over the past 10 years. These more recent data indicate that including oats and oat-based products as part of a lifestyle management program may confer health benefits that extend beyond total cholesterol and low-density lipoprotein cholesterol reduction.

State of the Art Reviews: Development of Fitness in Children: The Influence of Gender and Physical Activity

Keller, B. A. — 2008-01-07

The influences of gender and physical activity on the development of fitness are reviewed from early childhood to late adolescence. Changes in parameters of fitness prior to puberty are driven predominantly by neuroendocrine-mediated factors, although physical activity level may be influenced largely by sociocultural factors prior to and following puberty. Thus, it is still unclear to what extent environment versus genetics accounts for gender differences in fitness. Future studies need to account for all factors known to explain gender differences in fitness to better differentiate intrinsic versus environmental causes. Consequently, one must consider if and to what extent a gender comparison study actually reveals true, inherent gender differences compared with sociocultural and/or cultural influences. Nevertheless, differences in fitness between girls and boys that are influenced by sociocultural factors should be considered when devising programs to promote physical activity and enhance fitness in youth. Fundamentally, the role of parents and primary caregivers in modeling physical activity and influencing the fitness level of their child cannot be overestimated.

State of the Art Reviews: Patient and Physician Communication About Weight Management: Can We Close the Gap?

Beran, M. S., Fowles, J. B., Kind, E. A., Craft, C. E. — 2008-01-07

Purpose. To understand and gain insight into improving communication about weight management between patients and physicians and answer the question, "How should physicians communicate with obese patients about weight management?" Design. Three patient focus groups of 5 participants each and 2 physician focus groups of 6 participants each, segregated by gender, during July and August 2004. Participants. Patients with a body mass index of ≥ 30, English speaking, aged 25 to 75 years. Physicians trained in internal medicine or family medicine from a large multispecialty group. Methods. Focus group discussions were transcribed verbatim, a coding scheme developed, and 4 independent reviewers coded each transcript. Consensus among reviewers was obtained. Results. Patients perceive that physicians do not initiate weight discussions, whereas physicians feel that they initiate these conversations regularly. Patients expressed desire for individualized information and advice about weight loss, yet physicians used 1 or 2 messages with all their patients and felt the individualized plans that some patients want are outside the role of the physician. Conclusion. Our results indicate that a communication gap does exist between patients and physicians about weight management. Individualized weight management advice by physicians for patients may reduce this gap.

Book Review: An Evidence-Based Approach to Dietary Phytochemicals by Jane Higdon New York: Thieme Medical Publishers * 2007 * $59.95 * ISBN: 9781588904089

Bowen, P. E. — 2008-01-07

Letter to the Editor

Faust, J. A. — 2008-01-07