increasing fruit and vegetable consumption (Pignone et al., 2003). The best evidence was for patients with known risk factors for cardiovascular and other chronic diseases, but there was also fair evidence that brief counseling in primary care can produce some improvements in diet among unselected patients as well.

Similar reviews of studies that focused on physical activity counseling of adults in primary care found mixed results, although most of the studies showed a trend toward increased physical activity in the intervention groups (Sallis et al., 2000b; Eden et al., 2002). For example, a nonrandomized controlled trial in healthy sedentary adults found short-term increases in moderate physical activity, particularly walking, among those who had received three to five minutes of physical activity counseling by their physician (Calfas et al., 1996).

Although research on the effectiveness of counseling children and their caregivers about obesity prevention is limited to date, and much remains to be learned, the seriousness of the problem and the emergence of tested strategies argue for routine counseling. The evidence that routine smoking-cessation counseling is effective, at least in changing adult behaviors, is another precedent for this kind of guidance (DHHS, 2000a).

Additionally, as visible and influential members of their communities, health-care professionals can serve as role models for good nutrition, for being physically active, and for maintaining a healthy weight. Health-care professionals can also have influential voices in increasing community awareness and advocating for actions to prevent childhood obesity. By giving speeches or conducting workshops at schools, testifying before legislative bodies, working in community organizations, or speaking out in any number of other ways, health-care professionals can press for changes to make the community one that supports and facilitates healthful eating and physical activity. A notable precedent is that physicians and other healthcare professionals have played crucial roles in changing tobacco-related behaviors; they have been advocates both at the local and national levels, and they have served as personal role models by quitting smoking or by not starting in the first place.

Pediatricians, family physicians, nurses, and other clinicians should take active roles in the prevention of obesity in children and youth. As discussed above, this includes routinely measuring height and weight; tracking BMI; and providing feedback, interpretation, counseling, and guidance on obesity prevention to children, parents, and other caregivers. This assumes that clinicians will have learned the appropriate skills to deliver these preventive services, which has implications for training at all levels (see below). They should also serve as role models for healthful eating and regular physical activity and take leadership roles in advocating for childhood obesity prevention in local schools and communities.



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