Review Article

Dietary and Nutrition Recommendations in Pediatric Primary Care: A Call to Action

Authors: Sayward E. Harrison, PhD, Deborah Greenhouse, MD

Abstract

Abstract: Rapid increases in childhood obesity reflect widespread changes in diet and physical activity, which are of significant concern because obesity increases a child’s risk for negative health outcomes and frequently creates a pathway to adult obesity. Diet and nutrition play a key role in maintaining energy balance and preventing weight gain; therefore, they are obvious targets for obesity prevention efforts. Primary care providers are in an optimal position to convey messages about healthy eating to children and families, and specific guidelines exist for how to incorporate diet and nutrition prevention into primary care. Providers should be aware of the scientific evidence supporting these preventive practices. This review provides a summary of recommendations for integrating diet and nutrition into pediatric primary care and presents a call to action to make diet/nutrition assessment, counseling, and intervention routine aspects of the preventive care visit.

 

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Barlow SE. Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S164-S192.
 
2. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012;307:483-490.
 
3. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008;9:474-488.
 
4. Brisbois TD, Farmer AP, McCargar LJ. Early markers of adult obesity: a review. Obes Rev 2012;13:347-367.
 
5. Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101(3 Pt 2):518-525.
 
6. Park MH, Falconer C, Viner RM, et al. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 2012;13:985-1000.
 
7. Llewellyn A, Simmonds M, Owen CG, et al. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev 2016;17:56-67.
 
8. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond) 2011;35:891-898.
 
9. Trust for America’s Health, Robert Wood Johnson Foundation. The state of obesity 2016: better policies for a healthier America. http://www.stateofobesity.org/files/stateofobesity2016.pdf. Accessed November 1, 2016.
 
10. Johnson JA 3rd, Johnson AM. Urban-rural differences in childhood and adolescent obesity in the United States: a systematic review and meta-analysis. Child Obes 2015;11:233-241.
 
11. Singh GK, Kogan MD, van Dyck PC. Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Arch Pediatr Adolesc Med 2010;164:598-607.
 
12. Proctor BD, Semega JL, Kollar MA. Income and poverty in the United States: 2015-current population reports. https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-256.pdf. Published September 2016. Accessed October 22, 2017.
 
13. Zammitti EP, Cohen RA, Martinez MM. Health insurance coverage: early release of estimates from the National Health Interview Statistics, January-June 2016, 2016. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf. Published November 2016. Accessed November 30, 2016.
 
14. Kivimäki M, Lawlor DA, Smith GD, et al. Substantial intergenerational increases in body mass index are not explained by the fetal overnutrition hypothesis: the Cardiovascular Risk in Young Finns Study. Am J Clin Nutr 2007;86:1509-1514.
 
15. Lake JK, Power C, Cole TJ. Child to adult body mass index in the 1958 British birth cohort: associations with parental obesity. Arch Dis Child 1997;77:376-381.
 
16. Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med 1999;29(6 Pt 1):563-570.
 
17. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006;95:904-908.
 
18. Taveras EM, Rifas-Shiman SL, Sherry B, et al. Crossing growth percentiles in infancy and risk of obesity in childhood. Arch Pediatr Adolesc Med 2011;165:993-998.
 
19. Taveras EM, Rifas-Shiman SL, Oken E, et al. Short sleep duration in infancy and risks of childhood overweight. Arch Pediatr Adolesc Med 2008;162:305-311.
 
20. Lumeng JC, Taveras EM, Birch L, et al. Prevention of obesity in infancy and early childhood: a National Institutes of Health workshop. JAMA Pediatr 2015;169:484-490.
 
21. Taveras EM, Gillman MW, Kleinman KP, et al. Reducing racial/ethnic disparities in childhood obesity: the role of early life risk factors. JAMA Pediatr 2013;167:731-738.
 
22. Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004;8:1-182.
 
23. Dombrowski SU, Knittle K, Avenell A, et al. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ 2014;348:g2646.
 
24. Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA 2016;315:2292-2299.
 
25. Silveira PP, Gaudreau H, Atkinson L, et al. Genetic differential susceptibility to socioeconomic status and childhood obesogenic behavior: why targeted prevention may be the best societal investment. JAMA Pediatr 2016;170:359-364.
 
26. Institute of Medicine. Accelerating progress in obesity prevention: solving the weight of the nation. http://www.nationalacademies.org/hmd/~/media/files/report%20files/2012/apop/apop_insert.pdf. Published 2012. Accessed November 12, 2016.
 
27. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2012. Vital Health Stat 10 2013:1-81.
 
28. Wald ER, Moyer SC, Eickhoff J, et al. Treating childhood obesity in primary care. Clin Pediatr (Phila) 2011;50:1010-1017.
 
29. Lumeng JC, Castle VP, Lumeng CN. The role of pediatricians in the coordinated national effort to address childhood obesity. Pediatrics 2010;126:574-575.
 
30. Seburg EM, Olson-Bullis BA, Bredeson DM, et al. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep 2015;4:157-173.
 
31. Krebs NF, Jacobson MS. American Academy of Pediatrics Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics 2003;112:424-430.
 
32. Sweeting H. Measurement and definitions of obesity in childhood and adolescence: a field guide for the uninitiated. Nutrition 2007;6:32.
 
33. Javed A, Jumean M, Murad MH, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis. Pediatr Obes 2015;10:234-244.
 
34. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 3rd ed. New York: Guilford Press, 2012.
 
35. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press, 2007.
 
36. Resnicow K, Harris D, Wasserman R, et al. Advances in motivational interviewing for pediatric obesity: Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and future directions. Pediatr Clin North Am 2016;63:539-562.
 
37. Resnicow K, McMaster F, Bocian A, et al. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics 2015;135:649-657.
 
38. Daniels SR, Hassink SG, Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics 2015;136:e275-e292.
 
39. Tolle MA. Addressing childhood obesity in primary care practice: a challenge and an opportunity. South Med J 2011;104:1-2.
 
40. White House Task Force on Childhood Obesity. Solving the problem of childhood obesity within a generation: report to the President. http://www.letsmove.gov. Accessed December 12, 2016.
 
41. Sethi S. Tackling the problem of childhood obesity. South Med J 2011;104:3-4.
 
42. Tanda R, Salsberry P. The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States. J Pediatr Health Care 2014;28:241-250.
 
43. Huang TT, Borowski LA, Liu B, et al. Pediatricians’ and family physicians’ weight-related care of children in the U.S. Am J Prev Med 2011;41:24-32.
 
44. Klabunde CN, Clauser SB, Liu B, et al. Organization of primary care practice for providing energy balance care. Am J Health Promot 2014;28:e67-e80.
 
45. Holt N, Schetzina KE, Dalton WT, et al. Primary care practice addressing child overweight and obesity: a survey of primary care physicians at four clinics in southern Appalachia. South Med J 2011;104:14-19.
 
46. DiMaria-Ghalili RA, Mirtallo JM, Tobin BW, et al. Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. Am J Clin Nutr 2014;99(5 Suppl):1184S-1193S.
 
47. Vitolins MZ, Crandall S, Miller D, et al. Obesity educational interventions in U.S. medical schools: a systematic review and identified gaps. Teach Learn Med 2012;24:267-272.
 
48. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med 2010;85:1537-1542.
 
49. Mihalynuk TV, Knopp RH, Scott CS, et al. Physician informational needs in providing nutritional guidance to patients. Fam Med 2004;36:722-726.
 
50. Jay M, Gillespie C, Ark T, et al. Do internists, pediatricians, and psychiatrists feel competent in obesity care? Using a needs assessment to drive curriculum design. J Gen Intern Med 2008;23:1066-1070.
 
51. Fani Marvasti F, Stafford RS. From sick care to health care-reengineering prevention into the U.S. system. N Engl J Med 2012;367:889-891.
 
52. American College of Physicians. The advanced medical home: a patient-centered, physician-guided model of health care. https://www.acponline.org/acp_policy/policies/adv_medicalhome_patient_centered_model_healthcare_2006.pdf. Published 2005. Accessed December 16, 2016.
 
53. Jortberg BT, Fleming MO. Registered dietician nutritionists bring value to emerging health care delivery models. J Acad Nutr Diet 2014;114:2017-2022.
 
54. Maryon-Davis A. Weight management in primary care: how can it be made more effective? Proc Nutr Soc 2005;64:97-103.
 
55. Watson-Jarvis K, Driedger L, Fenton TR. Pediatric dietician counseling availability associated with lower pediatrician-reported hospital admissions. Can J Diet Pract Res 2015;76:pe2-e2.
 
56. US Department of Health and Human Services. 2015-2020 dietary guidelines for Americans. https://health.gov/dietaryguidelines/2015. Published December 2015. Accessed December 15, 2016.
 
57. Association of the American Medical Colleges. MedEdPORTAL. 2016. https://www.mededportal.org. Accessed December 15, 2016.
 
58. American Academy of Pediatrics. Bright Futures: nutrition and pocket guide. https://brightfutures.aap.org/materials-and-tools/nutrition-and-pocket-guide/Pages/default.aspx. Published 2016. Accessed December 22, 2016.