The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers. INTRODUCTION IN 1997, THE World Health Organization declared obesity a global epidemic with major health implications. 1 According to the 1999 -2000 National Health and Nutrition Examination Survey (www.cdc.gov/nchs/nhanes.htm), the prevalence of overweight or obesity in children and youth in the United States is over 15%, a value that has tripled since the 1960s. 2 The health implications of this epidemic are profound. Insulin resistance, type 2 diabetes mellitus, hypertension, obstructive sleep apnea, nonalcoholic steatohepatitis, poor self-esteem, and a lower health-related quality of life are among the comorbidities seen more commonly in affected children and youth than in their unaffected counterparts. [3][4][5][6][7] In addition, up to 80% of obese youth continue this trend into adulthood. 8,9 Adult obesity is associated with higher rates of hypertension, dyslipidemia, and insulin resistance, which are risk factors for coronary artery disease, the leading cause of death in North America. 10 Assessment of OverweightIdeally, methods of measuring body fat should be accurate, inexpensive, and easy to use; have small measurement error; and be well documented with published reference values. Direct measures of body composition, such as underwater weighing, magnetic resonance imaging, computed axial tomography, and dual-energy radiograph absorptiometry, provide an estimate of total body fat mass. These techniques, however, are used mainly in tertiary care centers for research purposes. Anthropometric measures of relative fatness may be inexpensive and easy to use but rely on the skill of the measurer, and their relative accuracy must be validated against a "gold-standard" measure of adiposity. Such indirect methods of www.pediatrics.org/cgi

Objective: To review weight loss and maintenance for severely obese individuals enrolled in intensive behavioral weight loss program using very-low or low-energy diets. Design: Chart review of consecutively treated patients between 1995 and 2002 seen at three weight loss centers. Subjects: One thousand five hundred and thirty one patients with severe obesity (X40 kg/m 2) treated in three cities ('Study Group'). Of these, 1100 completed the 12-week core curriculum ('Completer Group'). Weight loss X100 lbs (445 kg) was seen in 268 patients ('100-Pound Group'). Measurements: Charts were reviewed for baseline characteristics, weekly weights, follow-up weights and side effects. Results: In the Study Group, average weight loss7s.e. for 998 women was 23.970.6 kg (18.5% of initial body weight (IBW)) and for 533 men was 36.071.0 kg (22.5%) over 30 weeks. For Completers, average weight loss for women was 30.870.6 kg (23.9%) and for men was 42.671.1 kg (26.7%) over 39 weeks. In the 100-Pound Group, average weight loss for women was 58.271.2 kg (41.5%) in 65 weeks and for men was 65.771.5 kg (37.5%) in 51 weeks. Side effects, assessed in 100 patients losing 445 kg, were mild to moderate in severity. Severe adverse events unrelated to the diet were noted in 5% of patients and during weight loss 1% had elective cholecystectomies. Follow-up weights were available for 86% of Completers at an average of 72 weeks with average maintenance of 23 kg or 59% of weight loss; follow-up weights were available for 94% of the 100-Pound Group at an average of 95 weeks with average maintenance of 41 kg or 65% of weight loss maintained. Conclusions: Intensive behavioral treatment with meal replacements is a safe and effective weight-loss strategy for selected severely obese individuals.

Among sexually active Massachusetts adolescents, voluntary HIV testing is uncommon. Teens who have had multiple sexual partners and who do not believe condoms are effective in preventing transmission were most likely to have been tested. Issues requiring clearer communication to patients include the testing process, its availability, and confidentiality. Physicians can play an influential role in the promotion of HIV testing by discussing HIV risk behaviors with patients and offering those at risk voluntary HIV counseling and testing.

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