Primary care
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Approximately two-thirds of the US population is overweight or obese. Physical activity is recommended for preventing obesity, aiding in weight loss, and decreasing rates of chronic diseases. This article reviews current statistics for obesity, physical activity, and physician counseling patterns. Principles of exercise physiology relating to cardiopulmonary fitness and chronic disease are also reviewed and methods for increasing physical activity in adults and children are suggested.
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Perinatal overweight and obesity is a major public health and clinical care issue that requires deliberate and immediate attention. Preconception and prenatal assessment and counseling should address the risks associated with obesity, recommendations for weight gain, proper nutrition and dietary intake, and physical activity. Nutrition and exercise guidance should be offered to all perinatal overweight and obese women with an emphasis on effective strategies to overcome barriers. All women should be encouraged to adopt a healthy lifestyle and achieve a healthy weight before becoming pregnant.
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The National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention reports a steady increase in obesity over the last 30 years. The greatest increase was seen in 15 to 19 year olds, whose obesity prevalence almost doubled from 10.5% to 19.4%. ⋯ Future treatment strategies to combat the obesity epidemic will have to extend beyond the health care provider's office. Behavior modification remains the key component to pediatric obesity prevention and treatment.
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Parallel to rising obesity rates is an increase in costs associated with excess weight. Estimates of future direct (medical) and indirect (nonmedical) costs related to obesity suggest rising expenditures that will impose a significant economic burden to individuals and society as a whole. ⋯ Cost disparities associated with subsets of the population experiencing higher than average rates of obesity are explored. Finally, potential solutions with the highest estimated impact are offered, and future directions are proposed.
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Corneal abrasions and corneal foreign bodies are frequently encountered ophthalmological injuries that are commonly diagnosed and managed by primary care physicians. The clinical course of a corneal epithelial defect can range from a relatively benign self-healing abrasion to a potentially sight-threatening complication such as a corneal ulcer, recurrent erosion, or traumatic iritis. A detailed clinical history regarding risk factors and exposure, along with a thorough slit lamp examination with fluorescein dye are essential for proper diagnosis and treatment, as well as to rule out penetrating globe injuries. Referral to an ophthalmologist is recommended in difficult cases or if other injuries are suspected.