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 pro viders have many opportunities to counsel young people about health behavio rs. Method. Policy documents and descriptive data on nutrition and physical act ivity interventions for youth in primary care were reviewed. Results. U.S. children and adolescents made 29.5 million office visits in 1 995, and 6.5 million were for well visits. About 80% of young people have s een a physician during the past year. Many organizations recommend that hea lth care providers counsel children and adolescents about nutrition and phy sical activity, Many pediatricians counsel patients about physical activity and nutrition, but they have low confidence in the success of these effort s. Bright Futures and Guidelines for Adolescent Preventive Services are two national programs with specific guidelines for counseling, No studies coul d be located that evaluated youth physical activity or nutrition interventi ons in primary care. Programs for adults in primary care are sometimes effe ctive, but they must target behavior change and be of sufficient intensity and duration. School programs can be effective, but they are much more inte nsive than is feasible for primary care. It is likely that effective progra ms for youth in primary care will require interactions with patients and fa milies beyond the clinic encounter, Barriers to effective counseling includ e lack of financial incentives, provider knowledge and skills, and tested i nterventions. Conclusion. There is sufficient promise of public health benefit to justify development and evaluation of youth nutrition and physical activity interv entions in primary care. The design of programs should be informed by behav ior change theories, knowledge of opportunities within health care settings , research on determinants of health behaviors, and lessons learned from re search on similar types of interventions. (C) 2000 American Health Foundati on and Academic Press.