Huang Jian, Yu Herbert, Marin Estela, Brock Stephanie, Carden Donna, Davis Terry
Lusiana State University Health Sciences Center, Shreveport, Louisiana 71130-3932, USA.
Acad Med. 2004 Feb;79(2):156-61. doi: 10.1097/00001888-200402000-00012.
Primary care physicians are an important source of information on weight management. Nevertheless, weight loss counseling by these physicians remains inadequate. This study sought to determine physicians' barriers to providing weight loss counseling in a public hospital, patients' recall of physicians' weight loss recommendations, and the influence of physicians' counseling on patients' understanding, motivation, and behavior regarding weight loss.
In 2001, four focus groups of faculty and residents were held at two primary care clinics affiliated with the Louisiana State University Health Sciences Center-Shreveport to determine the barriers to providing weight loss counseling. Scripted probes were used to uncover consensus norms. In 2001-02, structured exit interviews were conducted with 210 overweight or obese patients recruited from the clinics to determine patients' recall of physicians' weight loss recommendations, and patients' understanding of the relationship between weight and health, and their stages of readiness for weight loss.
Physicians identified major barriers to providing weight loss counseling, including insufficient confidence, knowledge, and skills. Obesity was underdocumented as a distinct clinical diagnosis. Only 5% of the patients recalled being given the combined weight loss strategy of diet and exercise. However, patients who recalled being counseled to lose weight were more likely to understand the risks of obesity, the benefits of weight loss, and were at a higher stage of readiness for weight loss.
Physicians' weight loss counseling had a significant effect on patients' understanding of and motivation for weight loss. However, physicians provided insufficient guidance on weight management strategies, possibly because of inadequate counseling skills and confidence.
基层医疗医生是体重管理信息的重要来源。然而，这些医生提供的减肥咨询仍然不足。本研究旨在确定公立医院医生提供减肥咨询的障碍、患者对医生减肥建议的回忆，以及医生咨询对患者关于减肥的理解、动机和行为的影响。
2001年，在路易斯安那州立大学健康科学中心什里夫波特分校附属的两家基层医疗诊所，针对教员和住院医师举行了四个焦点小组讨论，以确定提供减肥咨询的障碍。使用书面探针来揭示共识规范。在2001 - 2002年，对从诊所招募的210名超重或肥胖患者进行了结构化出院访谈，以确定患者对医生减肥建议的回忆、患者对体重与健康关系的理解，以及他们的减肥准备阶段。
医生确定了提供减肥咨询的主要障碍，包括信心、知识和技能不足。肥胖作为一种独特的临床诊断记录不足。只有5%的患者回忆起被告知饮食和运动相结合的减肥策略。然而，回忆起接受过减肥咨询的患者更有可能理解肥胖的风险、减肥的益处，并且处于更高的减肥准备阶段。
医生的减肥咨询对患者对减肥的理解和动机有显著影响。然而，医生在体重管理策略方面提供的指导不足，可能是因为咨询技能和信心不足。
