 by Emily Oken, MD, MPH In July, I attended a workshop on the Healthy Birth, Growth, and Development Initiative organized by the Bill and Melinda Gates Foundation. The workshop brought together experts in nutrition, growth, and statistical modeling to advise the Gates Foundation on its efforts to maximize brain development by interventions during the first 1000 days of life (conception through age 2). What will be their key measure of success?
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 Even when guidelines are clear, doctors do not always follow national screening guidelines. So how do they behave in situations which may be too unsettled for guidelines to reign? Take the example of cholesterol screening for children. The National Heart, Lung, and Blood Institute (NHLBI) comes on strong and recommends universal screening for those ages 9 to 11 years. The American Academy of Pediatrics (AAP) toes a middle ground, and the U.S. Preventive Services Task Force (USPSTF) just doesn’t believe there’s enough evidence to recommend any pediatric lipid screening. So how often are pediatricians screening for cholesterol levels?
The short answer is not very often.  Obesity is the scourge of the 21st century. Carrying extra weight in adulthood causes diabetes and heart disease. In childhood, obesity not only presages adult obesity, but it also leads to asthma, depression, orthopedic problems and other ills among children themselves. Rates of obesity in children and adults are just about as high as they can be in western societies, and they are rapidly increasing in the developing world. By 2030, close to a billion people across the globe will have diabetes or prediabetes.
 A colleague and I recently wrote a JAMA commentary that revisited the arguments in favor of menu labeling. People eat large calorie meals when dining at restaurants, and they often don’t know how many calories they are consuming. Calorie labeling provides immediately accessible calorie information at the moment when customers are making decisions. Also, calorie labeling might prompt restaurants to reduce the calories in items, especially those with the most egregious calorie counts (check out Dave’s Hot and Juicy ¾ pounder at Wendy’s or the 12 inch Big Hot Pastrami at Subway, both coming in at over 1000 calories, even before the sides are added on).
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