Physician counseling, at-home follow-up may improve teen health behaviors

A program that combines advice from a primary care physician with computer assessment, mailings and phone calls may help teens improve some aspects of their diets and physical activity levels, according to a study in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Obesity is an increasing problem among American adolescents, according to background information in the article. In the past 30 years, the percentage of teens aged 12 to 19 years who are obese has increased from 6 percent to more than 16 percent in 2002. The average child aged 6 to 11 also ate 133 more calories per day in 2000 than in 1990, and less than 40 percent of teens get the government-recommended hour of daily physical activity.

Kevin Patrick, M.D., M.S., of the University of California, San Diego, and colleagues assessed the effectiveness of one intervention designed to improve diet and physical activity habits among teens, the Patient-centered Assessment and Counseling for Exercise + Nutrition (PACE+) . From May 2001 through June 2002, the researchers recruited 819 adolescents between the ages of 11 and 15 years. They assigned 424 participants (222 girls and 202 boys) to a group receiving PACE+, which begins with a computer screening and goal-setting tool completed in a primary care physician's office. After a three- to five-minute counseling session with the doctor, the teen and his or her parents took home educational materials. They then received one year of personalized mailings and brief follow-up phone calls from trained research staff. A control group of 395 teens (216 girls and 179 boys) did not participate in the PACE+ program. Each group was assessed at six months and one year.

After one year, adolescents in the PACE+ program reduced their sedentary behaviors by one hour per day, while those in the other group did not. "This is important given that sedentary behaviors can decrease energy intake in nonoverweight adolescents and has been suggested as an important component of interventions to prevent obesity and regulate body weight," the authors write. Boys in the PACE+ group also increased their number of active days per week and were more likely to meet the hour daily exercise requirement, and more girls in that group met the government's guidelines for maximum percentage of daily calories from saturated fat. Since 64 percent of the teens in the PACE+ group completed at least nine of the 11 scheduled follow-up calls, the intervention is feasible, the authors report.

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(Arch Pediatr Adolesc Med. 2006;160:128-136. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Drs. Patrick, Calfas and Sallis are co-owners of, and receive income from, the Center for Health Interventions, LLC, which is developing products related to the research described in this paper. This project was supported by grants from the National Institutes of Health National Cancer Institute, Bethesda, Md.

Editorial: Physicians Can Help Childhood Obesity Epidemic
Though primary care physicians have been advised to provide counseling on diet and exercise to their young patients, little information is available on effective strategies, writes Thomas N. Robinson, M.D., M.P.H., Stanford University School of Medicine in an accompanying editorial.

"This study provides a hopeful message that a primary care–based intervention can result in some beneficial changes in adolescents' obesity-related behaviors," Dr. Robinson writes.

Physicians and other child health professionals can also obtain further training in behavior-change counseling, become role models of healthful eating and physical activity and show leadership in reducing risk factors for obesity. "To maximize our impact on child and adolescent health may require stepping beyond traditional, office-based patient care roles to actively participate in building more healthful communities," he concludes. "I can't think of any group with more credibility for leading this effort than child health professionals."

(Arch Pediatr Adolesc Med. 2006;160:217-218. Available pre-embargo to the media at www.jamamedia.org.)

To contact editorialist Thomas N. Robinson, M.D., M.P.H., call Robert Dicks at 650-497-8364.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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