Wake Melissa, Gold Lisa, McCallum Zoë, Gerner Bibi, Waters Elizabeth
Department of Pediatrics, Centre for Community Child Health, The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
Ambul Pediatr. 2008 Sep-Oct;8(5):336-41. doi: 10.1016/j.ambp.2008.06.006. Epub 2008 Aug 20.
A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory.
Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002-2003 that targeted overweight/mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children.
The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 (P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved.
This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.
针对儿童肥胖流行的常见政策回应是建议初级保健医生对超重/肥胖儿童进行筛查并提供咨询。正如文献所表明的，这种方法可能无效；记录最终可能不会改变体重指数（BMI）轨迹的简短初级保健肥胖干预措施所产生的机会成本非常重要。
“生活、饮食与运动”（LEAP）是一项随机对照试验，2002年至2003年由家庭医生实施了一项简短的二级预防干预措施，目标是5至9岁的超重/轻度肥胖儿童。通过病历对初级保健利用情况进行前瞻性审计，家长通过书面问卷报告家庭资源使用情况。将干预组儿童与对照组儿童的结果指标进行比较，主要指标为BMI（主要指标），次要指标为家长报告的身体活动和饮食习惯。
每个干预家庭的LEAP成本比对照家庭高4094澳元，主要是由于用于儿童身体活动的家庭资源增加。每个干预家庭的卫生部门总成本为873澳元，每个对照家庭为64澳元，相差809澳元（P < .001）。在15个月时，与对照组相比，干预组儿童在调整后的BMI或每日身体活动得分方面没有显著差异，但饮食习惯有所改善。
这种简短干预导致家庭和卫生保健部门成本增加，而这些成本本可用于其他确实能给健康和/或家庭福祉带来益处的用途。这对美国、英国和澳大利亚等国家具有启示意义，这些国家目前的指南建议在初级保健部门对儿童高BMI进行常规监测和咨询。
