I am thrilled to see the American Academy of Pediatrics’ updated clinical report “The Role of the Pediatrician in the Promotion of Healthy, Active Living” published in this month’s issue of Pediatrics (10.1542/peds.2023-065480). This is a “soup to nuts” primer on how to engage patients, families, and communities in the process of enhancing healthy lifestyle choices for children and adolescents.
This clinical report and its predecessors reflect an interesting evolution in our understanding of the components of healthy, active living. In 2006, the AAP published “Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity,” which focused on physical activity counseling for individual patients with the specific goal of obesity prevention. This was followed by the AAP’s 2015 clinical report on “The Role of the Pediatrician in Primary Prevention of Obesity,” which added guidance on nutrition and sleep, but remained focused on the goal of obesity prevention in the individual patient.
The 2024 updated report, co-authored by Dr. Natalie Muth and her colleagues on AAP’s Section on Obesity and Committee on Nutrition, reflects a far more expansive view of healthy lifestyle behaviors than was described in prior AAP policy documents. Clinician guidance on healthy living now includes screen time/media use and social-emotional wellness, in addition to activity, nutrition, and sleep, with the focus now on maintenance of overall well-being and not simply obesity prevention.
In addition, this current report addresses these issues at all levels of the socioecological model in pediatric preventive care (see Figure) rather than simply addressing behaviors in individual patients and families. Although we counsel our patients and families one at a time, the dominant drivers of lifestyle behaviors are the environment and resources that surround these families outside our clinic walls.
Figure 1. The Socioecological Model serves as a framework for promoting healthy, active living.
Dr. Muth and co-authors take several opportunities to emphasize the value of role-modeling in helping to guide the behavior of children and adolescents, and not just parental role-modeling, but provider role-modeling of healthy lifestyle choices as well.
One exercise that has the potential to influence your perspective is for you to attempt to engage in some of these healthy behaviors within the community you practice, even if it is not where you live. Making an effort to eat healthy and be physically active within the environment where your patients live and play, especially within communities that are disadvantaged, may be a real eye-opener and provide insight on the challenges your patients face:
- Are there ready sources of affordable, healthy food options?
- Are there safe places for children to engage in free play or organized sport or recreation?
Understanding community-based challenges is key to supporting patients’ lifestyle choices. Complement this local knowledge with the practical strategies and resources outlined in this report, and you will be well prepared to counsel your patients effectively and efficiently on these important foundations for health and well-being.
