Showing posts with label obesity. Show all posts
Showing posts with label obesity. Show all posts

Tuesday, May 26, 2015

You Can Dance If You Want To: Dance Class and Continued Physically Activity


By: Lewis First, MD, MS; Editor-in-Chief       
  
     We publish many studies stressing the importance of physical activity as a means of maintaining general health and fitness, not to mention prevention or treatment of conditions like being overweight or obese.  Dance is certainly an option for many children—but just how good is an organized after-school dance class or program in generating the CDC recommended 30 minutes of of moderate to vigorous physical activity?  
      Cain et al (doi: 10.1542/peds.2014-2415)  collected data from 17 private dance studios and 4 community centers in San Diego involving more than 250 girls ranging from children to teens and used accelerometers and activity levels to measure the degree of physical activity demonstrated in 7 dance types—ballet, hip-hop, jazz, Latin-flamenco, Latin-salsa/Ballet Folklorico, partnered and tap.  So which dance types provided good amounts of physical activity in dance classes? Not as many as you might think—and by adolescence, not one of the dances studied is more effective than any other at increasing physical activity.  
      Perhaps you should foxtrot over to your local dance instructors and see if they agree with the findings in this article relative to their own dance programs.  That would certainly be a step in the right direction when it comes to making dance a better activity for improving the physical fitness of our pediatric patients.

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Monday, May 11, 2015

Why Would an Article on Alzheimer Disease Appear in Pediatrics?


By: Lewis First, MD, MS; Editor-in-Chief   

          Hopefully the headline for today’s blog caught your attention.  What’s our interest in Alzheimer Disease in a pediatric journal? Believe it or not, two markers of insulin resistance have been associated in adults with an increased risk of developing Alzheimer Disease and dementia, and Luciano et al. (doi:10.1542/peds.2014-2391) opted to look for these markers early by measuring them in normal, overweight, and obese preschoolers and adolescents.  
      Correlations of the Alzheimer biomarkers were significantly associated with elevated body mass index (BMI) in conjunction with insulin resistance suggesting that perhaps seeing these markers early on may signal a later risk of developing the cognitive abnormalities associated with Alzheimer Disease and dementia.  How these markers in childhood might result in the brain changes that cause this disease of adults and what we might do about this while our patients are still young raises perhaps more questions than answers—but that’s what reading our journal is all about.  
     Hopefully an article like this will raise awareness enough to trigger other studies to confirm these findings, follow the cohort of overweight and obese children with insulin resistance and see if reducing the level of resistance also improves mentation as these children age.  Read this study and you’ll see yet another example of how the prevention work we strive to do as pediatricians pays off not just in childhood but throughout our patients’ lives.

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Tuesday, March 31, 2015

Being PROS at Motivational Interviewing to Combat Being Overweight in Childhood

By: Lewis First, MD, MS; Editor-in-Chief  
  
      Motivational interviewing (MI) is a patient-centered counseling style by which you work with a patient to facilitate behavioral change through their recognizing their internal desire to change.  It is used for a variety of behavioral disorders by psychologists. 
      This week we publish a fascinating study by Resnicow et al. ( doi: 10.1542/peds.2014-1880) involving a randomized controlled trial performed by pediatric providers and registered dieticians of children in 42 practices enrolled in the AAP’s Pediatric Research in Office Settings (PROS) Network. Overweight children ages 2-8 were randomized to get (1) usual care, (2) four provider trained MI sessions to parents of an index child and (3), four provider trained MI sessions  plus 6 more MI sessions with a registered dietician with outcome being BMI measured at a two-year follow-up. 
     Without spoiling the richness of the data contained in this study, suffice it say that the groups that received MI showed much more impressive reductions in BMI than the group who got routine care.  Before everyone cheers (and cheering is well deserved here), one still needs to ponder whether this study can be generalized to all of us. Fortunately obesity researcher Dr. Cara Ebbeling (doi: 10.1542/peds.2015-0495) offers a commentary on this study that provides further insight as to what we can learn from it. 
     One thing is certain—before your patients can benefit from an MI approach to losing weight, you would need to learn MI, and perhaps hire dieticians if you don’t have some available to you also facile in MI, —which might not be affordable despite the reduction in up-the-road health care costs due to the weight reduction achieved. 
      Would you or registered dieticians in your community or practice be willing to learn motivational interviewing if it can lead to weight reduction in your overweight patients? Why or why not?  Share your thoughts with us as a response to this blog, via an e-letter or via our Facebook or Twitter sites.

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Friday, January 30, 2015

Fast Foods that List the Amount of Exercise Needed to Burn Off the Calories: A Strategy for Healthier Eating?


By: Lewis First, MD, MS; Editor-in-Chief 

    More and more we find foods in restaurants and especially fast food restaurants listing the calories for the various items we wish to order. But what if the listing also included how much exercise is needed to burn off those calories?  Would it make a parent order even healthier options for their child? 
     Drs. Viera and Antonelli (doi: 10.1542/peds.2014-2902) conducted an intriguing national survey of 1000 parents who were randomized to receive one of four theoretical fast food menus that included a menu group with (1) no labels, (2) only calories, (3) calories plus minutes of exercise to burn off those calories and (4) calories plus miles needed to walk to burn off the calories.  
      Knowing the information on the menu, parents were then asked to order for their child as well as comment on whether putting nutritional as well as exercise information on the posted food item would promote their child to exercise more?The results do show caloric and exercise labels do make a difference—but as to which type of label works best, they all are better than just listing the food without labels but substantive differences of one type of label versus another do not seem to show statistically significant differences.  
      As to how many parents felt the label would help them promote exercise in their children, you’ll have to exercise your eyes and read the full study to glean the take-home lessons learned from this fast-food study and then digest the findings with your patients.

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Friday, January 23, 2015

Pizza Intake Over 8 Years in Children and Adolescents: Slicing Up the Nutritional Risks


By: Lewis First, MD, MS; Editor-in-Chief 
     If you ask children and teens what one of their favorite foods might be, a safe bet would likely be pizza.  So how does a child or adolescent’s pizza consumption affect their caloric and nutrient intake—and better yet, has the consumption pattern changed over the past decade or so?  
     Powell et al. (doi:10.1542/peds.2014-1844) looked at four different annual sets of dietary recall data from 2003 to 2010 for children and teens from the National Health and Nutrition Examination Survey and while controlling for various confounders, estimated the role that pizza consumption played on total caloric intake and amount of salt, saturated fat and sodium taken in daily.  Although caloric intake from pizza decreased over the study period, the prevalence of having pizza in the diet  was unchanged and in turn was associated with overall higher net total energy intake in terms of calories as well as with increased intake of saturated fat and sodium and sadly—this was seen across all sociodemographic categories studied.  
      The authors cook up even tastier pieces of information about the associated nutritional risks of eating pizza that await your perusal. Does this mean an end to pizza as a favorite meal for many of us?   No----but perhaps we could go with less “portion distortion” (i.e. smaller slices) and some healthier ingredients than currently occur with this popular dish.   
     Any ideas for a healthier pizza?  Share them with us by responding to this blog, sending an e-letter or commenting on our Facebook or Twitter sites.

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