To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

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Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/216320/ira30040_2433_2445.pdf

Depression and pain comorbidity: a literature review.

Our future: a Lancet commission on adolescent health and wellbeing

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

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Systematic review of sedentary behaviour and health indicators in school-aged children and youth

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60149-4.pdf

Adolescence and the social determinants of health

.This statement describes the possible negative health effects of television viewing on children and adolescents, such as violent or aggressive behavior, substance use, sexual activity, obesity, poor body image, and decreased school performance. In addition to the television ratings system a

Children, Adolescents, and Television

Media, from television to the “new media” (including cell phones, iPads, and social media), are a dominant force in children’s lives. Although television is still the predominant medium for children and adolescents, new technologies are increasingly popular. The American Academy of Pediatrics continues to be concerned by evidence about the potential harmful effects of media messages and images; however, important positive and prosocial effects of media use should also be recognized. Pediatricians are encouraged to take a media history and ask 2 media questions at every well-child visit: How much recreational screen time does your child or teenager consume daily? Is there a television set or Internet-connected device in the child’s bedroom? Parents are encouraged to establish a family home use plan for all media. Media influences on children and teenagers should be recognized by schools, policymakers, product advertisers, and entertainment producers.

/pdf/children-adolescents-and-the-media-1jatic3w6e.pdf

Children, Adolescents, and the Media

Children, adolescents, and television.

Youth spend an average of >7 hours/day using media, and the vast majority of them have access to a bedroom television, computer, the Internet, a video-game console, and a cell phone. In this article we review the most recent research on the effects of media on the health and well-being of children and adolescents. Studies have shown that media can provide information about safe health practices and can foster social connectedness. However, recent evidence raises concerns about media's effects on aggression, sexual behavior, substance use, disordered eating, and academic difficulties. We provide recommendations for parents, practitioners, the media, and policy makers, among others, for ways to increase the benefits and reduce the harm that media can have for the developing child and for adolescents.

Health effects of media on children and adolescents.

In the light of the increase in teenage sexual activity over the past decade, the authors review current social, psychological, and educational attitudes. Together with a summary of the legal ramifications, they provide recommendations for treatment of this patient group.

Victor C. Strasburger

Papers

Children, Adolescents, and Television

Children, Adolescents, and the Media

Children, adolescents, and television.

Health effects of media on children and adolescents.

Adolescent contraception. Review and recommendations.