Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA.
Am J Prev Med. 2011 Jul;41(1):24-32. doi: 10.1016/j.amepre.2011.03.016.
Few national data exist to assess primary care physicians' (PCPs') clinical practices with regard to childhood obesity.
To survey pediatricians and family practice physicians regarding their assessment, counseling, and management of diet, physical activity, and weight status among pediatric patients in the primary care setting.
A nationally representative cross-sectional survey of pediatricians and family practice physicians sampled from the American Medical Association (AMA) Masterfile was conducted in 2008 and analyzed in 2010. Outcomes included physicians' self-reported practice behaviors regarding assessments of pediatric patients' weight status, counseling of diet and physical activity, and referrals and follow-ups.
Response rate excluding physicians listed as "no-contact" by the AMA was 73.7% among pediatricians and 66.9% among family physicians. Less than 50% of all PCPs assessed BMI percentiles regularly in children. Eighteen percent of all PCPs reported referring children for further evaluation or management. Fifty-eight percent of all PCPs reported never, rarely, or only sometimes tracking patients over time concerning weight or weight-related behaviors. Pediatricians were more likely than family physicians to assess weight status and provide behavioral counseling (p's<0.001).
Active PCP participation in assessing or managing childhood obesity in the primary care setting appears low relative to the frequency of the problem in the U.S. Interventions to reduce the barriers to physician engagement in the assessment and management of healthy lifestyles are needed to prevent and control childhood obesity.
关于初级保健医生（PCPs）在儿童肥胖方面的临床实践，很少有全国性数据可供评估。
调查儿科医生和家庭实践医生，了解他们在初级保健环境中对儿科患者的饮食、身体活动和体重状况的评估、咨询和管理。
2008 年对美国医学协会（AMA）主文件中抽取的儿科医生和家庭实践医生进行了一项全国性代表性横断面调查，并于 2010 年进行了分析。结果包括医生自我报告的关于评估儿科患者体重状况、咨询饮食和身体活动以及转介和随访的实践行为。
排除 AMA 列为“无联系”的医生后，儿科医生的回应率为 73.7%，家庭医生的回应率为 66.9%。不到 50%的所有 PCP 定期评估儿童的 BMI 百分位。18%的所有 PCP 报告转介儿童进行进一步评估或管理。58%的所有 PCP 报告从未、很少或只是有时跟踪患者的体重或与体重相关的行为。儿科医生比家庭医生更有可能评估体重状况并提供行为咨询（p 值<0.001）。
与美国儿童肥胖症的发生率相比，初级保健环境中 PCP 积极参与评估或管理儿童肥胖症的情况似乎较低。需要采取干预措施，以减少医生在评估和管理健康生活方式方面的参与障碍，以预防和控制儿童肥胖症。
