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Intervention steers teens away from obesity-related behaviors.

An integrative exercise and nutrition intervention initiated during primary care modestly improved the diet, physical activity, and sedentary behaviors of adolescents, reported Dr. Kevin Patrick of the University of California, San Diego, and his colleagues.

Childhood obesity is currently on the rise in the United States, fueled by increased calorie consumption, sedentary behavior, and a paucity of physical activity. Only 6% of adolescents aged 12-19 years were classified as obese 30 years ago, compared with more than 16% of adolescents in 2002, one study found. Moreover, this growing epidemic spans all age, sex, and ethnic groups, they said.

In a randomized controlled trial of 819 youths aged 11-15 years (381 boys and 438 girls), roughly half of the group was assigned to the 1-year Patient-Centered Assessment and Counseling for Exercise + Nutrition (PACE+) intervention. This involved a computer-assisted assessment of diet and physical activity and behavior-change goals followed by a short counseling session given by the health care provider and monthly mail- and telephone-based counseling sessions. The other half was assigned to a control intervention focusing on sun exposure protection.

The research sample was highly diverse in that 42% were from races other than non-Hispanic white, though the sample did not fully reflect the ethnic composition of the study community, the investigators noted (Arch. Pediatr. Adolesc. Med. 2006;160:128-36).

Participation rates were respectable, with 64% of the youths in the PACE+ arm completing at least 9 of the 11 telephone-based counseling sessions.

Both boys and girls in the PACE+ arm significantly reduced their sedentary behaviors by approximately 1 hour each day in comparison with control youths. Moreover, boys significantly increased their weekly activity levels and were more apt to achieve the activity guideline of 5 or more days of physical activity per week in comparison with control boys. Girls were more likely to consume less than 10% of their daily calories from saturated fat, compared with girls in the control arm.

More frequent contact with adolescent girls, but not boys, improved their likelihood of meeting various health and nutrition guidelines.

No differences between boys and girls in the PACE+ and control groups were observed for the number of minutes per week of moderate and vigorous physical activity (either self-reported or objectively measured), the probability of spending 2 or fewer hours in front of the television, the percentage of overall calories consumed from fat, the number of fruit and vegetable servings eaten daily, the likelihood of consuming the recommended daily amount of fiber, and body mass index.

"Taken as a whole, the bulk of null findings and lack of confirmation of the self-reports by the available objective measures suggest that PACE+ produced only modest effects. However ... this study provides a hopeful message that a primary care-based intervention can result in some beneficial changes in adolescents' obesity-related behaviors," Dr. Thomas N. Robinson of Stanford (Calif.) University commented in an accompanying editorial (Arch. Pediatr. Adolesc. Med. 2006;160:217-8).

To improve upon the intervention, the study investigators stated that "more intensive interventions, perhaps using a 'stepped-care' approach that varies the intensity of the intervention, are showing promise in adults and also may be appropriate in childhood."


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Title Annotation:Adolescent Health
Author:Nyberg, Kara A.
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Apr 1, 2006
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