JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Clinical Trial
Reducing children's television viewing to prevent obesity: a randomized controlled trial.
Some observational studies have found an association between television viewing and child and adolescent adiposity. ⋯ Reducing television, videotape, and video game use may be a promising, population-based approach to prevent childhood obesity.
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Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease (CVD) risk factors, but the role of physical inactivity is not prominent in these recommendations. ⋯ In this analysis, low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors.
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Multicenter Study
Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults.
Dietary composition may affect insulin secretion, and high insulin levels, in turn, may increase the risk for cardiovascular disease (CVD). ⋯ Fiber consumption predicted insulin levels, weight gain, and other CVD risk factors more strongly than did total or saturated fat consumption. High-fiber diets may protect against obesity and CVD by lowering insulin levels.
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Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines. ⋯ Studies on improving physician guideline adherence may not be generalizable, since barriers in one setting may not be present in another. Our review offers a differential diagnosis for why physicians do not follow practice guidelines, as well as a rational approach toward improving guideline adherence and a framework for future research.