American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60006, USA.
Pediatrics. 2010 Feb;125(2):265-72. doi: 10.1542/peds.2008-2985. Epub 2010 Jan 18.
The purpose of this study was to examine pediatrician implementation of BMI and provider interventions for childhood overweight prevention and treatment.
Data were obtained from the American Academy of Pediatrics (AAP) Periodic Survey of Fellows No. 65, a nationally representative survey of AAP members. Surveys that addressed the provision of screening and management of childhood overweight and obesity in primary care settings were mailed to 1622 nonretired US AAP members in 2006.
One thousand five (62%) surveys were returned; 677 primary care clinicians in active practice were eligible for the survey. Nearly all respondents (99%) reported measuring height and weight at well visits, and 97% visually assess children for overweight at most or every well-child visit. Half of the respondents (52%) assess BMI percentile for children older than 2 years. Most pediatricians reported that they do not have time to counsel on overweight and obesity, that counseling has poor results, and that having simple diet and exercise recommendations would be helpful in their practice. Pediatricians in large practices and those who had attended continuing medical education on obesity were more familiar with national expert guidelines, were more likely to use BMI percentile, and had higher self-efficacy in practices related to childhood and adolescent overweight and obesity. Multivariate analysis revealed that pediatricians with better access to community and adjunct resources were more likely to use BMI percentile.
BMI-percentile screening in primary pediatric practice is underused. Most pediatricians believe that they can and should try to prevent overweight and obesity, yet few believe there are good treatments once a child is obese. Training, time, and resource limitations affect BMI-percentile use. Awareness of national guidelines may improve rates of BMI-percentile use and recognition of opportunities to prevent childhood and adolescent obesity.
本研究旨在考察儿科医生实施 BMI 及提供者干预措施以预防和治疗儿童超重的情况。
数据来自美国儿科学会（AAP）第 65 期定期调查，这是一项针对 AAP 成员的全国代表性调查。2006 年，向 1622 名未退休的美国 AAP 成员邮寄了调查，内容涉及在初级保健环境中提供筛查和管理儿童超重和肥胖的问题。
有 1500 份（62%）调查问卷被退回；有 677 名从事初级保健工作的临床医生符合调查条件。几乎所有（99%）受访者都报告在就诊时测量身高和体重，97%的人在大多数或每次儿童就诊时都通过目测评估超重情况。半数受访者（52%）评估年龄大于 2 岁儿童的 BMI 百分位值。大多数儿科医生表示，他们没有时间对超重和肥胖进行咨询，咨询效果不佳，并且如果有简单的饮食和运动建议，这将有助于他们开展工作。在大型诊所工作的儿科医生和参加过肥胖继续教育的医生对国家专家指南更熟悉，更有可能使用 BMI 百分位值，并且在与儿童和青少年超重和肥胖相关的实践中自我效能感更高。多变量分析显示，能够更好地利用社区和辅助资源的儿科医生更有可能使用 BMI 百分位值。
在初级儿科实践中，BMI 百分位值筛查的使用不足。大多数儿科医生认为，他们可以并且应该尝试预防超重和肥胖，但很少有人认为一旦孩子肥胖，就有好的治疗方法。培训、时间和资源限制影响 BMI 百分位值的使用。了解国家指南可能会提高 BMI 百分位值的使用率，并认识到预防儿童和青少年肥胖的机会。
