Nutrition and Physical Fitness Web Sites: A 4-Star Guide on Where to Look and What to Look For

The current obesity epidemic in the United States has fueled interest in nutrition and physical fitness. For many, the Internet has become a key source of information on these subjects.

Because of the proliferation of Web sites, patients can quickly become overwhelmed or confused by conflicting recommendations. How will they know where to look to find high-quality information on the Internet? Here we offer tips you can share with your patients to help them evaluate Web sites.

WEB SITE CRITERIA

Currently, there are no uniform guidelines for assessing Web sites on nutrition and fitness. However, the following criteria may be useful:

•Content.

•Credibility.

•Currentness.

•Configuration.

Content. Accurate information is a principal requirement of any Web site. If a site has citations or references, review them for accuracy. Ideally, the information should be free of bias. What is the stated objective, if any? How detailed is the content? Is it comprehensive? Is there a contact site where one may request clarification? Sites with nutritional information should feature discussions of food categories, substitutions, calories, recipes, and nutrients. On fitness Web sites, exercises for various medical conditions should be explained or illustrated. Basic discussions of physiology and a listing of potential contraindications should be provided. Content should be balanced, with a discussion of the pros and cons for each modality. Because Web resources rarely have editors or fact checkers, one must read the information with a discerning eye.

The depth and style of the presentation often depend on the target audience. Information geared to a lay audience tends to be more cursory, whereas information for health care professionals may be too academic.

Credibility. It is important to identify the source of information on a Web site. Web sites are typically sponsored by an academic institution (.edu), professional association (.org), commercial organization (.com), or government agency (.gov). Although there is no inherent bias in any particular type of site, the source of the information can affect the type of material provided and how it is presented. Check to determine if there is identifiable expertise. Does the site identify the source of the information? What are the credentials of the site? Is the sponsorship clearly identified? Are there advertisements? Is the goal to sell a product or convey information? Has the site won any awards? Several "seals of approval" have recently appeared; it is important to determine how the ratings were developed and applied before one views such a seal as enhancing credibility.

Currentness. It is imperative that Web sites remain up-to-date. Check to see if the Web page is dated; the date usually appears at the bottom of the page. Many sites list when the original information was posted. Determine when the information was last updated. Information relating to nutrition and physical fitness is constantly changing. Preferred sites are ones that are updated at least once every few months.

Configuration. This criterionrefers to the design and functionality of the site. Is it laid out clearly? Does the layout seem logical? Is it easy to navigate? Is one able to search the site based on key words? Is there a site map that essentially serves as a table of contents?

When evaluating the configuration, check to see whether there are links to other sites. If so, what types of links are provided? Do they seem credible? Are the links to existing pages? Web sites come and go; if the site has links to expired pages, that may also indicate a failure to remain current.

The following Web sites (on pages 1686 to 1687) provide accurate, up-to-date information. The ratings of the sites are based on our own evaluations.

NUTRITION WEB SITES

www.nutrition.gov

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This site provides comprehensive access to most federal government information about nutrition, food research, healthful eating, and food safety. It offers an online database on various nutrients, which can be downloaded to a computer or personal digital assistant. The database provides information that often is difficult to locate. It also offers numerous resources on food statistics and a list of available research grants.

www.5aday.gov

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This site is supported by the National Cancer Institute, which is part of the NIH. The information is geared toward a general audience and offers practical guidelines on how to incorporate more fruits and vegetables into the diet. It also provides recipes, tips on budgeting for healthy meals and snacks, and advice on preparation of tasty school lunches. There is an online survey to rate one's health habits and advice on how to improve eating patterns.

www.usda.gov/cnpp

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The Center for Nutrition Policy and Promotion, part of the US Department of Agriculture, offers scientific data to support nutrition recommendations. It includes the latest dietary guidelines, food guide pyramid graphics, and a healthy eating index. The index is a summary measure of overall diet quality. It provides a picture of the type and quantity of foods people eat and the degree to which diets comply with specific recommendations. The site offers an online Web course.

www.nhlbi.nih.gov/about/oei

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This site was established by the National Heart, Lung, and Blood Institute. It is content-dense, with separate information areas for researchers, health professionals, and the general public. The site offers a body mass index calculator (including a downloadable version for palmtop computers), a "portion distortion" interactive quiz, and an interactive menu planner. For clinicians, it provides an interactive tool to generate individualized and evidence-based assessment and treatment recommendations for overweight patients.

www.caloriecontrol.org

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The Calorie Control Council, a nonprofit trade association, is composed of companies that make low-calorie, reduced-fat versions of foods and beverages. The site contains information on cutting calories and fat in order to achieve and maintain a healthy weight. This site provides a calorie calculator to determine the number of calories and fat grams in a serving of food (and the number of calories consumed each day) and an activity calculator that lists how many calories are burned during various exercises and activities. It provides numerous recipes and up-to-date nutrition information, including assessments of fad diets. It also has a news section, which features recent articles and studies relating to calories and nutrition.

www.healthychoices.org

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Healthy Choices for Kids Online, a nutrition education program, was created by the growers of Washington State apples. A site mainly for children, it offers 4 interactive courses on topics such as active lifestyle and nutrition. The chapters all include worksheets, coloring pages, and quiz questions. This site is also available in Spanish.

www.deliciousdecisions.org

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This site was established by the American Heart Association. Although it is geared toward persons with, or at risk for, heart disease, the information is relevant for everyone. The site provides basic nutrition information; a cookbook for persons with heart disease; and tips on dining outside the home, supermarket shopping, and healthy snacking.

FITNESS WEB SITES

www.fitness.gov

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This is the official site of the President's Council on Physical Fitness and Sports. It includes information about the President's Challenge, a physical activity/fitness awards program for children and adults in which more than 65 million persons have already participated. The site includes an extensive list of health organizations that promote fitness. It also includes research digests with the latest information on various physical activities, such as resistance training.

www.recreation.gov

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This site, created by the US Department of the Interior, is dedicated to outside activities-from autotouring to winter sports-that promote health and fitness. Detailed information on recreation areas and weather advisories is provided. The site also offers information about-and the ability to make reservations at-the national parks.

www.bam.gov

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This site, developed by the CDC, is dedicated to children aged 9 to 13 years who want to learn more about health, fitness, and nutrition. The information on this site, which has been compiled from children's contributions, uses simple language, games, and interactive tools that enable children and teachers to learn about national education standards for science and health. It also allows children to set up their own fitness calendar to encourage physical activity every day.

www.shapeup.org

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This site developed by Shape Up America!-a nonprofit organization founded by C. Everett Koop, MD-has 3 objectives: to promote a new understanding of healthy weight and increased physical activity; to provide information about the proven ways to lose weight and keep it off; and to increase collaboration among national and community organizations to promote healthy living and increased physical activity as major public health priorities. The site has separate sections for laypersons and health care professionals. The professional section includes materials that health care providers can order for patients. For those interested in walking, the site describes the innovative 10,000 Steps Program. The site also offers a virtual store to buy equipment and a calendar of conferences on physical activity.

www.acefitness.org

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This site, designed by the American Council on Exercise (ACE), is dedicated to improving the professional standards of the fitness industry. It encourages all members of society-including children and elderly and disabled persons-to enjoy the benefits of exercise. Topics on the site include cardiovascular exercise, flexibility, and strength and resistance training. It also provides tools for locating health clubs or personal trainers that meet the standards of the ACE. The site includes a daily update of health and fitness headlines from major publications.

www.justmove.org

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This site, developed by the American Heart Association, contains an online exercise diary to track fitness goals, recommendations for increasing one's activity level (including suggestions for those with special physical or health needs), and an extensive fitness database. Although this site is geared toward persons with heart disease, the information is universally applicable.

www.kidshealth.org

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KidsHealth provides health information about children from before birth through adolescence. Created by the Nemours Foundation's Center for Children's Health Media, the site contains information for parents, children, and teenagers. There are sections on exercise, sports, and strength training. All the information on the site was approved by an expert panel of physicians. The site is also available in Spanish.

www.smallstep.gov

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This interactive Web site, developed by the US Department of Health and Human Services, encourages people to make small activity and dietary changes-such as using stairs instead of an elevator, or eating an apple instead of a candy bar-to improve their health. It lists 100 examples of such changes. The Small Step Activity Tracker allows one to set physical activity goals, track progress, and earn a certificate for reaching goals. The site is also available in Spanish.