"It's really important that pediatricians identify overweight children during well-child visits and use that time to talk about healthy weight," says Sarah Barlow, M.D., MPH, assistant professor of pediatrics at Saint Louis University School of Medicine, and a study author.

"The pediatrician can start by inquiring of the parent and child if they have any concerns about weight. That would give them a feel for where that family is in terms of their thinking about it."

Dr. Barlow, who specializes in pediatric obesity at SSM Cardinal Glennon Children's Hospital, said the study team reviewed the records of nearly 33,000 children who had routine doctor's appointments between 1997 and 2000. They found that a diagnosis of obesity was recorded on charts during less than 1 percent of well-child visits. The national rate of obesity among children at that time was substantially higher -- between 13 and 15 percent.

When doctors diagnosed obesity, they were more likely to talk to patients and their families about diet and exercise, the study found.

"A diagnosis of obesity is the strongest factor associated with diet and exercise counseling," Dr. Barlow says.

The findings, which examined reports from visits in a nationally representative sample of physician visits from 1997 to 2000, were published in July.

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Weight control is also highlighted as critical to raising HDL levels, with the researchers noting that every kilogram of weight lost raises a patient's HDL levels by an average 0.35 milligrams per deciliter. A reasonable weight loss goal, they suggest, for overweight or obese patients is 1 pound, or 0.45 kilograms, per week, with a target body mass index of less than 25.

Mild to moderate consumption of alcohol, no more than one to two drinks per day, they say, has been shown beneficial in raising HDL levels by an average of 4 milligrams per deciliter, irrespective of type of alcohol consumed. But the researchers caution that the potential risks here may outweigh the benefits in people with liver or addiction problems.

For dietary control, the researchers recommend a diet low in saturated fat and rich in the polyunsaturated fatty acids found in foods such as oils (olive, canola, soy and flaxseed), nuts (almonds, peanuts, walnuts and pecans), and cold-water fish (salmon and mackerel), and shellfish. Consumption of carbohydrates, they say, should be restricted because high glycemic products, such as processed cereals and breads, are associated with lower HDL levels.

In the report, the researchers cite niacin, also called nicotinic acid or vitamin B3, as the most effective medication for raising HDL cholesterol, leading to increases of 20 percent to 35 percent. Fibrate therapy is also effective, they say, producing an average increase of 10 percent to 25 percent. Statins are the least effective of the three drug classes, used primarily to reduce LDL cholesterol, raising HDL levels by 2 percent to 15 percent. When used in combination, low-dose statins and high-dose niacin have been shown to produce benefits of 21 percent to 26 percent.

"Our report offers people interim guidelines on how best to manage HDL cholesterol levels while awaiting the results of national clinical trials, which could prove more definitive," says Ashen, who was lead author of the article. "These guidelines also offer a good description of the problem posed by low levels of HDL cholesterol, along with details on how HDL cholesterol metabolism works in the body with LDL cholesterol.

"The guidelines should help physicians and nurses to manage their patients' blood lipid levels, including HDL cholesterol, with drug therapies currently available, and should help prepare them to manage future therapies, expected to be developed within the next five years, that focus on raising HDL-cholesterol levels."

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