Being an informed patient is an empowering concept.1 In the modern healthcare marketplace, the doctor-patient relationship has become a two-way street. It's no longer a situation in which the doctor tells the patient what to do. Today, patients can be full partners in managing their care and well-being.2
What does it take to be an informed patient, one who can participate in a meaningful way and not be merely the passive recipient of the doctor's instructions and recommendations?
The first key is to identify a doctor - a chiropractor or family physician, depending on the circumstances - in whom you have confidence. Here are a few essential points to consider
The questions you ask are not just to keep talking and capture more of the doctor's time spent with you. An informed patient does some preparation - some homework - before the actual office visit. The Internet offers a lot of valuable information on both chiropractic and medical treatment. And, it's important to remember that not all information is accurate and authoritative - consider the source of the "information".
Do your best to evaluate the doctor's recommendations. First, what are the expected results? How quickly should you begin to feel better? Are there potential side-effects of the recommended treatment? What are the alternatives?
Alternatives may include other forms of therapy within the doctor's office and may also include consultation with another specialist. The main point is not to be left with a confusing array of choices, but to have enough information to go forward with a treatment plan that makes the most sense, both to your doctor and to you.
If a prescription is involved, make sure you write down the exact spelling of the medication and the exact dosage and frequency. Prescriptions are usually scribbled, and both doctors and pharmacists can make a mistake. Don't let your doctor simply hand you an illegible piece of paper. Insist on ensuring that you understand what is being prescribed, and be sure to ask your doctor about potential side effects, risks, and interactions with any other medicines you may be taking.
As in all relationships, the doctor-patient relationship is based on clear communication and mutual trust and understanding. You can help your doctor help you by being informed and participating in the decision-making process.
1Informed Consent. "Ethics in Medicine". University of Washington School of Medicine. http://depts.washington.edu/bioethx/topics/consent.html#ques1
2"Be an active healthcare consumer". Agency for Healthcard Research and Quality. http://www.ahrq.gov/path/beactive.htm
Not too long ago, the Eighth Joint National Committee (originally commissioned by the National Heart, Lung, and Blood Institute) released a new set of evidence-based guidelines for evaluation and treatment of hypertension (high blood pressure). The guidelines committee, comprised of 17 academics, spent five years reviewing evidence as preparation for developing the new recommendations.
The committee’s report represents nothing less than a sea change in the treatment of patients with higher-than-normal blood pressure readings. The primary shift is from a long-held standard of implementing treatment when a person’s blood pressure is higher than 140/90 mmHg. The new guidelines recommend beginning treatment only when blood pressure readings are higher than 150/90 mmHg. The new standard is a huge modification of decades-old practice methods, and has generated substantial controversy.1.2 Of course, a good portion of the pushback is from those who have a vested interest in maintaining the status quo, such as physicians who dispense medications from their office and earn substantial income from selling antihypertensive drugs at multiples of their wholesale costs. In addition to physicians who act as pharmacies, drug companies who manufacture antihypertensive medications also stand to lose significant revenue. But aside from considerations related to the practice of medicine as a business, the real issues should be focused on the benefits and harms to patients. In this context, it may be reasonably stated that fewer medications are, by and large, a good thing.
The new blood pressure guidelines have two primary impacts. First, for people over age 60, treatment for presumed hypertension should be initiated when blood pressure readings are higher than 150/90 mm/Hg. More than 7.4 million Americans over age 60 will be in the new safe range. Many of these millions of people have been taking antihypertensive medication for years, possibly needlessly as implied by the new guidelines. Next, for all those under age 60, there is insufficient medical evidence that a systolic blood pressure (the first number in the reading) threshold exists that would dictate treatment. In other words, for many years the systolic threshold had been 140 (as in 140/90 mmHg). Higher systolic readings virtually mandated antihypertensive treatment. Although the committee expressed its opinion that the systolic threshold of 140 mmHg ought to be maintained for those younger than age 60, even though evidence for such a threshold is weak. Thus, it may be that many millions more people have been taking antihypertensive medication without such recommendations being backed by sound scientific research.
The point here is not that people should stop taking their blood pressure medication.3 All such types of decisions should be made in consultation with the prescribing physician. The main consideration is having the ability to make informed choices. Some medication regimens may be appropriate. Some may not. Some may need to be reevaluated. As always, regular chiropractic care is of value by providing you with the best opportunity to achieve maximum good health.
1Mitka M:Groups spar over new hypertension guidelines. JAMA 311(7):663-664, 2014
2Kieldsen SE, et al: Hypertension management by practice guidelines. Blood Press 23(1):1-2, 2014
3Sheppard JP, et al: Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study. Br J Pract 2014, Jan;64(618):e38-46. doi: 10.3399/bjgp14X676447
An old cliche for getting to know someone in a new social situation entails asking, "What's your sign?" The notion, of course, is that a simple identifier such as astrological sign would provide grounding for a potential relationship - romance, friendship, or even a new bowling partner. As there are only twelve signs of the zodiac, the odds were good that you'd be able to make something out of your respective astrological signs and go from there. Many marriages, businesses, and contract bridge teams can trace their origins to what were considered favorable astrological pairings.
Although many believe that astrology can offer sound advice regarding matters of health and well-being, there are other more quantifiable categorizations that do impact your health and are backed by reproducible scientific study and research. One such series classifies physical body type into three groupings - ectomorphic, mesomorphic, and endomorphic. These body types are termed somatotypes. This useful classification is both predictive and prescriptive with respect to a person's current and future levels of health.
Ectomorphs are those people who are relatively long and lean. Ballet dancers, competitive figure skaters, and distance runners are almost always ectomorphs. Fashion models are usually ectomorphs, as are many professional beach volleyball players. In baseball, shortstops, second basemen, and center fielders are typically ectomorphs. The character Dr. Gregory House is a typical ectomorph.
Mesomorphs are those people who are more heavily muscled. In football, running backs, linebackers, and safeties are usually metamorphs. Powerlifters are metamorphs, as are shotputters, discus and javelin throwers, and sprinters. Star Trek's Lieutenant Worf is a typical metamorph.
Endomorphs are those people who have proportionately more body fat than muscle, with more of the body mass concentrated in the abdominal area. Endomorphs are more typically engaged in sedentary occupations. The fictional detective Nero Wolfe and Count Fosco of Wilkie Collins's "The Woman in White" are famous endomorphs.
Overall, mesomorphs are characterized by musculoskeletal robustness and endomorphs are characterized by subcutaneous adipose tissue accumulation. In comparison to either group, ectomorphs are characterized by an increased tendency to musculoskeletal injury, including muscle and tendon strains and joint and ligament sprains. Overall, there is an increased risk for cardiovascular disease in those who are thin as well as in those who are more-than-moderately obese.
Chiropractic care can provide benefit to persons of any body type. By optimizing the flow of health-promoting information between your nerve system and the rest of your body, chiropractic care helps you function at peak efficiency. Your body type is a physical expression of the interaction between your genetic inheritance and innumerable environmental factors. Regular chiropractic care helps you make the most out of your physical structure and helps improve your health and well-being.
1Yeung EH, et al: Childhood size and life course weight characteristics in association with the risk of incident type 2 diabetes. Diabetes Care, March 9, 2010 (Epub ahead of print)
2Singh AP, Singh SP: Somatotypic variations. An analysis of some traditional occupation. J Hum Ecol 19(4):249-251, 2006
3Peeters MW, et al: Heritability of somatotype components: a multivariate analysis. Int J Obesity 31:1295-1301, 2007
Your IQ that's measured in school has to do with problem solving - mental gymnastics. Your spinal IQ also has to do with problem solving - these are "problems" of the physical kind.
How far to bend over to lift those grocery bags out of your car's trunk? How much muscle force is necessary to pick up and carry your five-year-old child? What specific muscles are needed to maintain your "downward dog" position for 30 seconds in yoga class? How far can your back muscles stretch when you do a back bend at the ballet barre? These are the problems your spinal IQ tries to solve.
Spinal IQ is an inborn ability. Our bodies were designed for the rigors of physical work - they are very smart and very adaptable. One of our built-in control systems is the specialized set of nerve endings known as proprioceptors.
Proprioception is our internal awareness of position in three-dimensional space.1,2 This three-dimensional positioning allows us to keep our balance when we walk or run. Proprioception tells our muscles and joints how to work together to throw a baseball from third to first, to drive to the basketball hoop and sink a lay-up, or to hit a tennis ball to the corner of the opponent's service box and win the point.
Proprioception is very important in spinal IQ. The spine is a complex system of bones, joints, muscles, and ligaments - a smart proprioception system helps all the parts work together smoothly and seamlessly.
To keep all the parts functioning we need to take an active role. In modern society, if we're not proactive, it's easy for our bodies to break down. Two key strategies for maintaining high levels of spinal IQ are regular strenuous exercise and regular chiropractic check-ups.
Exercise helps our bodies stay smart.3 When we exercise, our joints are mechanically stressed and challenged throughout their complete ranges of motion. This activity stimulates proprioceptors - training them to do their job well and building new and stronger connections between nerve cells. Exercise also builds muscle strength and flexibility, and in the process the muscles are getting smarter, too.
Chiropractic care enhances the benefits of your exercise program by helping ensure optimal functioning of your spine and nerve system. With regular chiropractic care, your proprioceptive system is optimized and your body's ability to adapt to physical challenges is restored.
Your chiropractor will be glad to assist you in designed an exercise program that will work for you, helping you to improve your spinal IQ and your health.
1Armstrong B, et al: Head and neck position sense. Sports Med 38(2):101-117, 2008
2Chow DH, et al: Changes in spinal curvature and proprioception of schoolboys carrying different weights of backpack. Ergonomics 50(12):2148-2156, 2007
3Akuthota V, et al: Core stability exercise principles. Curr Sports Med Rep 7(1):39-44, 2008
"Who you are speaks so loudly I can't hear what you're saying." This truism is well-known in human potential circles and can often be heard at personal growth-and-development seminars. But the implications of this meaningful phrase are often ignored in our day-to-day activities and relationships. Sometimes we pretend that others are unable to see through our facade of words and that they cannot recognize our hidden qualities, desires, and intentions.
In the world of Snow White, Sleepy, Grumpy, Bashful, and Happy were exactly that. The dwarves were their names! In our world, though, Madison, Cassidy, Jason, and Patrick don't help us out that much. But people unknowingly present many signposts that function equally well as do names of the dwarves from Snow White. Tone of voice, eye contact, posture, and facial expressions are some of the clues to what's really going on. In fact, if one is able to pay attention and accurately interpret the information available, other people might just as well be holding up pictures of the Seven Dwarves in front of their faces. The character of their inner selves is clear.
Other people really do know what's going on with us. If we could get the full impact of this powerful proposition, all of our interactions would benefit. Also, our stress levels will usually go down. When we're interacting meaningfully and communicating clearly, we become less stressed. The unlooked-for benefit is our health improves as a result.
Here's a quick way to get how you're being in the world. Do dogs growl when they pass you on the street or when you enter the home of a dog and its human companions? Similarly, do cats hiss at you? When you're introduced to a baby or toddler, does the kid start to fuss or cry? These are all pretty good signs of a certain kind of personal vibe.
The flip side is also accurate. When dogs see you, do they start licking your hand, jumping around, and generally letting you know they want to play? Do cats rub around your legs and purr? Do babies smile and gurgle at you? Do little kids show you their toys and smile shyly at you? These are all signs of a different kind of vibe.
Animals and young children are excellent barometers of the qualities of the people around them. Who you are being is not a mystery to them. They get it all. Many of us lose this inner sight and interact with others based on what they say. In this respect, everyone loses - we think if we say the right words, it'll all be ok.
The notion of being-in-the-world is important in health care interactions. The doctor you've waited two hours to see says nice words, but you sense he doesn't really care - he just wants to move on to the next patient. Likewise at the front desk - they're perfectly polite, but you're aware they're super-stressed and can't wait to get out the door themselves.
In contrast, chiropractors are aware of the importance of the human component of their interactions with patients. A chiropractor's office is a welcoming environment - people often say their chiropractor's office "feels just like home". You get the sense your chiropractor is authentically interested in your health and well-being, making sure to take the time to really listen to your concerns and make sure you're getting the service you need. Chiropractic is a healing profession and the quality of the doctor-patient relationship is an important part of the healing process.
1Seedat S, et al: Life stress and mental disorders in the South African stress and health study. S Afr Med J 99(5 Pt 2):375-382, 2009
2Beeri MS, et al: The effects of cardiovascuclar risk factors on cognitive compromise. Dialogues Clin Neurosci 11(2):201-212, 2009
3Koetaka H, et al: Long-term effects of lifestyle on multiple risk factors in male workers. Environ Health Prev Med 14(3):165-172, 2009
You are the CEO of your own personal enterprise. In addition to whatever business you might be running or might be in, your personal corporation consists of the value you generate during your time on Earth.
Some persons such as government officials make choices and take actions that obviously affect the lives of many others. For most of us it may seem that we have less scope and reduced impact, but that is not necessarily so. Our choices and actions affect those people closest to us - our family, friends, and colleagues - and their choices and actions affect persons closest to them. An ever-widening series of ripples continues to flow, affecting more and more people, all stemming from the actions we take and the choices we make today. If we haven't recognized this potential and this power, all that's required is raising our gaze to the horizon and widening our field of view.
In order for a corporation - a personal corporation - to be effective it needs to have a sound balance sheet. If there's a lot of red ink it's going to be difficult to be able to provide goods and services. Depletion of resources leads to depletion of energy. We need to provide a steady stream of raw materials so we're able to create new products that are desired in the marketplace.
Our personal corporations require specific raw materials 1,2,3
If we're not receiving sufficient amounts of any of these inputs, the debit side of our balance sheet increases. We don't have enough energy to accomplish our daily tasks, let alone do the things that will make our corporation profitable. With sufficient inputs we have energy to spare and our corporation thrives.
What are some outputs of a healthy personal corporation? A healthy, happy family. A creative work environment. Ongoing engagement in rewarding social activities. An ongoing experience of accomplishment. Self-expression. Peace. Joy.
In order for our personal corporation to continue to grow and prosper, it's basic needs must be met. In addition, it's always a good idea to make sure all the parts are working properly. That's where chiropractic care comes in. Just as an accountant reviews the financial health of a corporation, your chiropractor reviews its physical health. She makes "adjustments" wherever and whenever necessary, enabling your personal corporation to continue to evolve.
1Fitzbiggon ML, Beech BM: The role of culture in the context of school-based BMI screening. Pediatrics 124(Suppl 1):S50-S62, 2009
2Maizes V, et al: Integrative medicine and patient-centered care. Explore (NY) 5(5):277-289, 2009
3O'Donnell MP: Definition of health promotion 2.0: embracing passion, enhancing motivation, recognizing dynamic balance, and creating opportunities. Am J Health Promot 24(1):4, 2009
You're at the doctor's office because you think something might be wrong. Rationally, you know tests are probably necessary, but getting the tests done sometimes provokes a lot of anxiety in all of us. We want to know the results, but are very concerned about the outcome."You need blood work" your doctor remarks casually. Your insides do an immediate flip-flop and you feel as if you've just begun hurtling down a very steep roller-coaster.
And when the results come back, it's tough to understand the medical jargon, particularly if the tests are "positive". We've all had the experience of "going south" and not listening to another word that's said after the initial "your test results are positive". Our minds are racing ahead, imagining all the awful possibilities.
Rarely, a considerate physician will be able to put the lab results in a less-worrisome perspective for the patient. For patients, it's important to know some key facts - facts that will empower you any time you need lab tests done.
First, statistically one out of every 20 tests performed will be reported as "abnormal" - even though the result is "normal" for the person being tested. If you are perfectly healthy and have 20 tests done on your blood sample, one of those 20 test results will be "out of the normal range" based on statistics alone.1
This is because a normal test range is calculated by eliminating the top 2.5% and the bottom 2.5% of results for a large group of normal people. This leaves the "normal range" as 95%. So if 20 tests are done, statistically one will be "abnormal", because its results fall in the top or bottom 2.5%. The result is normal for you, but reported as "abnormal".
Other factors to consider are the sensitivity and specificity of the lab test.2 Sensitivity relates to the test's precision in detecting the disease when the disease is present. If a test for colon cancer was 90% sensitive, it would miss ten cases of the disease out of every 100 cases. Specificity relates to whether a positive test actually indicates the presence of the disease you're being tested for. If a test is 90% specific, in ten cases out of 100 positive results, the patient does not actually have the disease.
So if a test has low sensitivity, actual cases of the disease may be missed. If a test has low specificity, test results reporting the presence of the disease may be wrong. All these factors need to be considered in accurately interpreting test results. Things are not always as they seem.3
Bottom line - test results always need to be evaluated in the specific context of the patient. An isolated lab result - or set of results - needs to be related to the patient's condition and circumstances. An accurate diagnosis is not based on lab results alone. That could be a big mistake. Similarly, x-ray, ultrasound, or MRI results need to be interpreted in context also.
Trying to interpret an x-ray without any clinical information is likely to lead to a wrong conclusion. Context is everything. If you have questions, we will be able to explain why certain tests are necessary.
1Thomas SL, et al: How accurate are diagnoses for rheumatoid arthritis and juvenile idiopathic arthritis in the general practice research database? Arthritis Rheum 59(9):1314-1321, 2008
2Friston KJ, et al: Classical and Bayesian inference in neuroimaging: theory. Neuroimage 16(2):465-483, 2002
3Kobayashi M, et al: Intraindividual variation in total and percent free prostate-specific antigen levels in prostate cancer suspects. Urol Int 74(3):198-202, 2005
Many people have medicine chests in their bathroom, small shelving units filled with bottles of pills, capsules, and tablets. Others, instead, have first-aid and personal grooming cabinets in their bathrooms, containing rows of bandages, tubes of antiseptic, rubbing alcohol, and adhesive tape, as well as dental care supplies, shaving supplies, and sample-size bottles of shampoo. Of course, we can't always draw accurate conclusions about a person's lifestyle and level of health from the contents of his or her bathroom cabinet. But most of us, if we could choose, would likely want to focus on personal grooming and first aid rather than prescription medications. The key question is how we can actually make such a choice.
From the medicine chest perspective, many people have various disorders that require them to take prescription medications on a short-term or long-term basis. Persons with type 2 diabetes need to take regular doses of drugs such as metformin or glyburide. Persons who have rheumatoid arthritis may be taking Imuran, Remicade, or glucocorticoids. If you have persistent high blood pressure, you may be taking a beta-blocker or an ACE inhibitor. If you've just undergone a root canal procedure, your dentist may have prescribed a two-day supply of Vicodin.
But others have medicine chests filled with sleeping pills such as Ambien and Lunesta, cold and flu medications such as decongestants and antihistamines, and mood elevators such as Wellbutrin and Prozac.1 Again, many people have medical conditions that require prescription medications, but many others have come to rely on such drugs even though a sound medical reason for taking medication may no longer exist. In such circumstances, changes in lifestyle may provide more and longer-lasting benefit than that being obtained via use of no-longer-needed medication.
For example, numerous studies have shown that regular vigorous exercise results in profound adaptations of one's personal physiology and biochemistry. Such changes consistently improve a person's mood and allow for a full night of restful sleep.2 Healthful alterations in diet also result in mood stabilization and facilitate deeper, more beneficial sleep.3 Lifestyle changes incorporating both regular vigorous exercise and healthful diets provide enhanced benefit.
Of course, one should never discontinue prescription medications without consulting the doctor who has prescribed them. Implementing your long-term lifestyle enhancements is one of two necessary steps. The second step is letting your doctor know what you're doing and discussing with him or her the possibility of reducing the dose or even going off one or more of the "lifestyle" drugs you've been taking. By taking these steps you've begun the journey of converting your "medicine chest" into something else entirely.
1Tragni E, et al: Prevalence of the prescription of potentially interacting drugs. PLoS One 2013 Oct 11;8(10):e78827. doi: 10.1371/journal.pone.0078827
2Matta Mello PE, et al: Neuroscience of exercise: from neurobiology mechanisms to mental health.Neuropsychobiology 68(1):1-14, 2013
3Hryhorczuk C, et al: Metabolic disturbances connecting obesity and depression. Front Neurosci 7:177, 2013
In 2009 there's been lots of conversation about health care, both at the federal and state levels.1-3 Not all the talk has been friendly. Those favoring broad reforms describe serious problems in the health care "system". Those opposing change have spread rumors about impending "socialized medicine". Whatever the outcome, chiropractic health care continues to address many of the real shortcomings of the current health care situation in the United States.
First and foremost, chiropractic care focuses on the patient. So much of health care is focused on the profit-taking bottom line. Necessary services are denied coverage and unnecessary services are prescribed, all to further some faceless organization's return on investment. Chiropractic care has one goal in mind - to help the patient be healthy and get well in the fastest amount of time possible. Other forms of health care talk but chiropractic walks the walk. Chiropractic health care is truly patient-centered.
Chiropractic care is personalized. A patient in a chiropractor's office feels like part of the family. Chiropractors make the time to talk with their patients, asking the right questions and addressing their concerns. Chiropractic patients don't feel rushed. They don't feel as if their doctor's main priority is getting through this patient visit and moving on to the next. Chiropractic patients have the experience their doctor is very interested in their well-being and has designed treatment that will specifically address their specific problems. Chiropractic care is not a cookie-cutter, one-size-fits-all approach to health care.
The majority of the health care system is notoriously fragmented. Patients are bounced from one specialist to another, as various doctors attempt to diagnose a small part of a complex problem. In contrast, chiropractic care is holistic, addressing many of the health requirements of the whole person. Chiropractic treatment restores balances to the nervous system and musculoskeletal system, addressing multiple problems at once. Also, many chiropractors design rehabilitative exercise protocols and nutritional programs for their patients, as well as provide postural recommendations and stress management techniques.
And, chiropractic care is available to the entire family - toddlers, young people, parents, and grandparents. Chiropractic treatment is safe and gentle, and highly effective for a broad range of conditions. Whether an 80-year-old grandmother has osteoporosis-related lower back pain or an 8-year-old softball player has an injured knee, chiropractic care has good solutions for both.
Chiropractic directly addresses many problems in today's health care system. Chiropractic is a results-driven, cost-effective method focused on holistic health care. Chiropractic care is an integrated system that effectively promotes a family's wellness and well-being.
1Relman A: The Health Reform We Need and Are Not Getting. The New York Review of Books, July 2, 2009
2Stolberg SG: Obama to Forge a Greater Role on Health Care. The New York Times, June 6, 2009
3Porter ME: A Strategy for Health Care Reform. Toward a Value-Based System. N Engl J Med 360(24):2610, 2009
Spring is near. In New York City, yellow, white, and purple crocuses have raised their cup-shaped flowers above the ground for all to see. In California, western buttercups, ground pink, and bush lupine have begun to bloom. Humans, too, are awakening to the glory of a new Spring.
For most species, Winter is a time of rest and recovery. A time of renewal. When the clock strikes Spring, oak trees, azaleas, prairie dogs, red-tailed hawks, salmon, and butterflies are ready to go. But people are often out-of-touch with the rhythms of their home planet. We struggle against the elements, dreading Winter and battling cold, sleet, and snow for three or four long months.
When Spring finally comes we're often too stressed out from our Winter blues to enjoy what's unfolding right in front of us. We didn't use our Winter time to build new reserves of strength. But Spring signals a new year, full of new possibilities. We have a new opportunity to grow and develop, just like every other species with whom we share our beautiful planet.
We can allow ourselves to be inspired by the subtle news of a new Spring. The sun is higher in the sky and the days are longer. The air is fresher, carrying the scent of revitalized soil. Fresh water sparkles, glinting and glistening in dancing sunbeams.1,2
It's time for us to join the party. As humans, we don't grow new branches, twigs, and leaves. We don't grow new antlers or a new coat of fur. What we can do, though, is grow new cells, particularly muscle cells. And we can make the cells we already have much healthier and much stronger.
Being active provides the access to this process of renewal and rebirth. For many of us, this will be a brand-new way of being. Three-quarters of American adults do not get enough physical activity to meet public health recommendations. This data directly correlates with the associated facts that two-thirds of American adults are overweight or obese.3
We want to be healthy, fit, and well. This new Spring is the time to begin taking small steps toward reinventing ourselves as people who really are well, who really are physically fit, and who really manifest abundant, vibrant health. Consult your chiropractor for professional advice and guidance in designing your new fitness-and-exercise programs. We will provide expert assistance and support you in your wellness journey. In modern society, lack of good health is the norm. It takes time and effort to ensure we restore ourselves to the abundance of good health that is our birthright.
1Colston KW: Vitamin D and breast cancer risk. Best Pract Res Clin Endocrinol Metab 22(4):587-599, 2008
2Bener A, et al: High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta Diabetol 2008 Oct 10
3Spiotta RT, Luma GB: Evaluating obesity and cardiovascular risk factors in children and adolescents. Am Fam Physician 78(9):1052-1058, 2008
