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.

/pdf/expert-committee-recommendations-regarding-the-prevention-38kyxmdgpa.pdf

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.

/pdf/systematic-review-of-sedentary-behaviour-and-health-21hbd6lb0m.pdf

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

The Adolescent Medicine Rotation: Should It Stay or Should It Go?

Preface. Children, adolescents, and the media.

Sex, drugs, and adolescent medicine.

To the Editor.— Ravitch9s article1 is elegantly written but, unfortunately, ill-conceived. Ravitch would have us send to surgery any child with abdominal pain and right-lower-quadrant (RLQ) tenderness in whom no other diagnosis can be found. Why? Because the incidence of mortality for appendectomies is less than 1% and because the risk of missing a perforation is unacceptably high. Not so—if Ravitch had chosen to cite the recent surgical literature instead of reveling in McBurney9s original observations, he would have found an important study from Johns Hopkins2 in which children with abdominal pain were all admitted to the hospital for intensive observation.

RLQ pain = surgery?

* Abbreviations:
 AAP — : American Academy of Pediatrics

In 2012, schools increasingly have to compete with the media for the attention and time of children and adolescents. Young people currently spend more time with media (>7 hours/day) than they do in school.1 Far more research is now available about the impact of media on school-aged children and teenagers2,3 and the efficacy of teaching media literacy in the classroom.4 Since the development of Sesame Street 40 years ago, teachers have felt increasing pressure to entertain their students as well as to teach them.5 New technology in the classroom offers nearly limitless educational possibilities but potential problems as well (eg, students may be physically present in the classroom but downloading videos online or texting classmates). A recent longitudinal Canadian study of >1300 children at 29 months and in fourth grade found that for every additional hour of television viewed per day at 29 months of age, there was a 6% to 7% decrease in classroom participation, a 10% increase in victimization by classmates, a 9% decrease in physical activity, and a 5% increase in BMI by the fourth grade.6 Now that the American Academy of Pediatrics (AAP) has made Children and Media one of its new strategic priorities, pediatricians may want to familiarize themselves with this issue and how they can play a key role.

A century ago, to be “literate” meant that you could read and write; in 2012, literacy may need to be redefined to include reading, writing, texting, downloading, surfing the Internet, and tweeting. Now more than ever, children and teenagers … 

Address correspondence to Victor C. Strasburger, MD, Department of Pediatrics, MSC10 5590, 1 University of New Mexico School of Medicine, Albuquerque, NM 87131. E-mail: vstrasburger{at}salud.unm.edu

https://pediatrics.aappublications.org/content/pediatrics/129/6/1161.full.pdf

Victor C. Strasburger

Papers

The Adolescent Medicine Rotation: Should It Stay or Should It Go?

Preface. Children, adolescents, and the media.

Sex, drugs, and adolescent medicine.

RLQ pain = surgery?

Pediatricians, Schools, and Media