The recommendations for adolescent preventive services stem from the conclusion that the current health threats to adolescents are predominantly behavioral rather than biomedical, that more of today’s adolescents are involved in behaviors with the potential for serious health consequences, that adolescents are involved in health-risk behaviors at younger ages than previous generations, that many adolescents engage in multiple health-risk behaviors, and that most adolescents engage in at least some type of behavior that threatens their health and well-being (26). Gynecologists are in a good position to detect high-risk behaviors and to determine whether multiple risk-taking behaviors exist; for example, the early initiation of sexual activity and unsafe sexual practices are associated with substance use (30,31). Adolescents who are sexually active are much more likely than are adolescents who are not sexually active to have used alcohol (6.3 times greater risk), to have used drugs other than marijuana (four times greater risk), and to have been a passenger in a motor vehicle with a driver who was using drugs (nearly 10 times greater risk) (32). Thus, by being aware of comorbidities, gynecologists can screen for these behaviors and potentially intervene before serious harmful health consequences occur. In recognition of the role that obstetricians-gynecologists could play in providing preventive services for adolescents, ACOG issued guidelines that suggest an initial visit (not necessarily including gynecologic examination) to the obstetrician-gynecologist for health guidance, screening, and the provision of preventive health care service between the ages of 13 and 15 years and subsequent annual preventive health care visits (29).
During periodic assessments, patients should be counseled about preventive care based on their age and risk factors. Obesity, smoking, and alcohol abuse are associated with preventable problems that can have major long-term impacts on health. Patients should be counseled about smoking cessation and moderation in alcohol use and directed to appropriate community resources as necessary. Positive health behaviors, such as eating a healthy diet and engaging in regular exercise, should be reinforced. Adjustments may be necessary based on the presence of risk factors and the woman’s current lifestyle and condition. Efforts should focus on weight control, cardiovascular fitness, and reduction of risk factors associated with cardiovascular disease and diabetes (1).
Nutrition Patients should be given general nutritional information and referred to other professionals if they have special needs (1). Assessment of the patient’s body mass index (BMI; weight [in kilograms] divided by height [in meters] squared [kilograms per square meter]) will give valuable information about the patient’s nutritional status. Tables and methods to calculate BMI are available in print and electronic resources. Patients who are 20% above or below the normal range require evaluation and counseling and should be assessed for systemic disease or an eating disorder. Of adult women in the United States, 64% are overweight (BMI 25.0–29.9) or obese (BMI ≥30) 36% are obese (33,34). Overweight and obesity substantially increase the risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary artery disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, and cancers of the endometrium, breast, and colon (35). ACOG has emphasized the role of the obstetrician-gynecologist in the assessment and management of obesity (36).