Ely Andrea Charbonneau, Greiner K Allen, Born Wendi, Hall Sandra, Rhode Paula C, James Aimee S, Nollen Nicole, Ahluwalia Jasjit S
Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City 66160, USA.
J Rural Health. 2006 Fall;22(4):364-6. doi: 10.1111/j.1748-0361.2006.00059.x.
Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic.
To better understand this dynamic, we surveyed 439 obese patients (body mass index >or=30) at the time of clinic visits in 2003 at diverse primary care settings in rural Kansas and conducted same-day interviews with their physicians (N = 28). We used Spearman's correlation to describe and compare patient and physician responses.
Most patients were women (66%). Their mean age was 55.8 years, and mean body mass index was 37.7. Half (51%) reported discussing their weight on that visit date. Overall, 51% of patients wanted to discuss weight more often with their physician and 54% wanted to discuss weight sooner. Patients and physicians gave similar assessments of the patient's preference for discussing weight loss, how often weight was discussed at visits, and the patient's motivation for weight loss. Spearman's correlations on these variables were .33, .54, and .25, respectively (all P < .001).
These patients and their physicians demonstrated a weak to moderate agreement on several variables crucial to initiating and continuing obesity care. Understanding patient and provider beliefs and preferences regarding obesity diagnosis and treatment is essential in designing obesity interventions for primary care.
尽管临床指南建议在初级保健中对肥胖进行常规筛查和治疗，但在初级保健环境中，医生与患者之间对于肥胖治疗必要性缺乏共识，这可能是导致肥胖流行的一个未被探索的因素。
为了更好地理解这种动态关系，我们于2003年在堪萨斯州农村的不同初级保健机构对439名肥胖患者（体重指数≥30）进行了门诊调查，并在同一天对他们的医生（N = 28）进行了访谈。我们使用斯皮尔曼相关性来描述和比较患者与医生的回答。
大多数患者为女性（66%）。他们的平均年龄为55.8岁，平均体重指数为37.7。一半（51%）的患者报告在就诊当天讨论了自己的体重。总体而言，51%的患者希望更频繁地与医生讨论体重问题，54%的患者希望更早讨论体重问题。患者和医生对患者讨论减肥的偏好、就诊时讨论体重的频率以及患者减肥的动机给出了相似的评估。这些变量的斯皮尔曼相关性分别为0.33、0.54和0.25（均P < 0.001）。
这些患者及其医生在启动和持续肥胖护理的几个关键变量上表现出弱至中度的一致性。了解患者和医疗服务提供者对肥胖诊断和治疗的信念及偏好对于设计初级保健中的肥胖干预措施至关重要。
