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Editorial |

Mental Health and Obesity in Pediatric Primary Care:  A Gap Between Importance and Action

Robert C. Whitaker, MD, MPH
Arch Pediatr Adolesc Med. 2004;158(8):826-828. doi:10.1001/archpedi.158.8.826.
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For each of the last 2 years, the editors and editorial board members of the ARCHIVES, as a group, have selected a topic for a special issue of the journal. Each person in the group was encouraged to nominate topics important to our readers, particularly those delivering primary care. Each of us then scored all the nominated topics, and the issue for that year was devoted to the topic receiving the highest score—obesity in August 2003 and this current issue on mental health.

Despite the diversity and quality of the research contained in these 2 issues, what can pediatric primary care providers find in them that will alter their practice? There is less than one might hope. This reveals a striking gap, for both obesity and mental health conditions, between their importance as pediatric health problems and the extent to which current research leads to any recommended actions in clinical practice. The gap can be explained by 2 important similarities between obesity and mental health conditions. First, the biological susceptibility and dysfunction that lead to these chronic conditions appear to be based in the brain. Second, the social context in which these conditions occur is as relevant as it is complicated. Exploring these similarities yields insight into why it is so challenging to have constructive dialogue with families about these conditions and how that dialogue might be improved.

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