Sculati O, Bettoncelli G, Brignoli O, Corgatelli G, Ponti D, Rumi A, Zucchi A
Dipartimento di Prevenzione, U O Nutrizione, ASL di Brescia.
Ann Ig. 2006 Jan-Feb;18(1):41-8.
General practitioners (GP's) presence is homogeneously distributed in the Lombardy territory. GP's are easy accessible by people so they could play a key role in the prevention of overweight and obesity. In this study GP's included in everyday medical activity a primary prevention strategy regarding nutrition and lifestyle. The goal was to maintain a constant BMI for one and a half year for at least 50% of the patients (stable means without progression within BMI's range). During the same time another endpoint was to decrease from 1 to 3 units the BMI in overweight patients in half of the observed population. Subjects were randomly recruited during routinely ambulatory activity, without a specific BMI based selection. Diet quality was assessed with a food frequency questionnaire regarding "protective foods" as vegetables, fruits and legumes. Some "basic" information about nutrition and lifestyle where then provided through explanation of issues printed on A4 page brochure. Percentage BMI's range variation before and after the intervention show a stability in the observed population, with an increase 0,3% for normal weight males and 0,9% for females. BMI was constant in 72,2% of the subjects considering a 1 unit variation and in 92,2% considering 3 units variation. Within subjects who varied 1 unit (27,7%) more subjects decreased rather than gained weight (16% vs 11,7%); within subjects who varied 3 units (7.8%), 4,5% decreased and 3,3 increased their BMI. GP's demonstrate to have an efficient role in weight gain control with a simple and regular prevention strategy towards healthy lifestyles and simple nutritional tips. It is important for patients to comprehend the importance the doctor give to the overweight and obesity problem, apart from the medical issue considered during the visit. GP's have a key role for healthy life-style change programs among their patients. These results provide new arguments about the opportunity to invest public resources towards population (managed in collaboration with GP's coordinated by a public health department such as NU), rather than towards a single patient. The project management was supervised by the Nutrition Unit (NU) of the public heath system SIAN (ASL di Brescia).
全科医生（GP）在伦巴第地区的分布较为均匀。人们很容易就能找到全科医生，因此他们在预防超重和肥胖方面可以发挥关键作用。在本研究中，参与日常医疗活动的全科医生纳入了一项关于营养和生活方式的一级预防策略。目标是使至少50%的患者在一年半的时间里保持恒定的体重指数（BMI）（稳定是指在BMI范围内无进展）。与此同时，另一个终点是使观察人群中一半的超重患者的BMI降低1至3个单位。研究对象是在日常门诊活动中随机招募的，没有基于特定BMI的选择。饮食质量通过一份关于“保护性食物”（如蔬菜、水果和豆类）的食物频率问卷进行评估。然后通过解释印在A4纸手册上的问题，提供了一些关于营养和生活方式的“基本”信息。干预前后BMI范围变化的百分比显示，观察人群保持稳定，正常体重男性增加了0.3%，女性增加了0.9%。考虑到1个单位的变化，72.2%的受试者BMI保持不变；考虑到3个单位的变化，92.2%的受试者BMI保持不变。在BMI变化1个单位的受试者中（27.7%），体重下降的受试者多于体重增加的受试者（16%对11.7%）；在BMI变化3个单位的受试者中（7.8%），4.5%的受试者BMI下降，3.3%的受试者BMI上升。全科医生通过对健康生活方式和简单营养建议采取简单且常规的预防策略，在控制体重增加方面发挥了有效作用。除了就诊时考虑的医疗问题外，让患者理解医生对超重和肥胖问题的重视很重要。全科医生在其患者的健康生活方式改变计划中起着关键作用。这些结果为将公共资源投入人群（与由公共卫生部门如NU协调的全科医生合作管理）而非单个患者提供了新的依据。该项目由公共卫生系统SIAN（布雷西亚ASL）的营养科（NU）监督管理。
