Interventions in Health Care Settings to Promote Healthful Eating and Physical Activity in Children and Adolescents

Background. Physical activity and nutrition are related to multiple health problems during youth and to chronic diseases in adulthood. Health care providers have many opportunities to counsel young people about health behaviors. Method. Policy documents and descriptive data on nutrition and physical activity interventions for youth in primary care were reviewed. Results. U.S. children and adolescents made 29.5 million office visits in 1995, and 6.5 million were for well visits. About 80% of young people have seen a physician during the past year. Many organizations recommend that health care providers counsel children and adolescents about nutrition and physical activity. Many pediatricians counsel patients about physical activity and nutrition, but they have low confidence in the success of these efforts. Bright Futures and Guidelines for Adolescent Preventive Services are two national programs with specific guidelines for counseling. No studies could be located that evaluated youth physical activity or nutrition interventions in primary care. Programs for adults in primary care are sometimes effective, but they must target behavior change and be of sufficient intensity and duration. School programs can be effective, but they are much more intensive than is feasible for primary care. It is likely that effective programs for youth in primary care will require interactions with patients and families beyond the clinic encounter. Barriers to effective counseling include lack of financial incentives, provider knowledge and skills, and tested interventions. Conclusion. There is sufficient promise of public health benefit to justify development and evaluation of youth nutrition and physical activity interventions in primary care. The design of programs should be in formed by behavior change theories, knowledge of opportunities within health care settings, research on determinants of health behaviors, and lessons learned from research on similar types of interventions.