Division of Child Development and Community Health (Department of Pediatrics), University of California San Diego, USA.
J Dev Behav Pediatr. 2011 Nov;32(9):688-91. doi: 10.1097/DBP.0b013e318235ee1a.
: Maria is a 9-year-old Latina girl who was followed up by her pediatrician since birth with normal developmental milestones, good school achievement, and without significant medical problems. She was not in the pediatric office for the past 3 years. At the age of 9 years, she presented for a health supervision visit. Her pediatrician looked at her growth chart-90 pounds (95th percentile) and height 52 inches (50th percentile)-that confirmed a clinical impression of obesity on physical examination. Her body mass index was 23.4 (>95th percentile for age).During 10 years in primary care pediatric practice, the pediatrician typically prescribed a management plan for obese school-aged and adolescent patients that started with parent and child education about potential health problems associated with obesity followed by a recommendation to decrease the caloric intake and encourage active exercise each day. She then arranged for follow-up visits to monitor weight and adherence to the management plan. However, a moment of self-refection suggested that most of her patients did not follow her advice in a sustained way. Obesity persisted in most cases. The pediatrician wondered if there was an alternative-better yet, evidence-based-approach to pediatric obesity that might provide a better outcome.
玛丽娅是一个 9 岁的拉丁裔女孩，从出生起就由儿科医生定期随访，她的发育里程碑正常，学业成绩良好，没有重大的健康问题。过去 3 年她都没有在儿科医生的办公室就诊。9 岁时，她来做健康检查。儿科医生查看了她的生长图表——体重 90 磅（第 95 个百分位），身高 52 英寸（第 50 个百分位）——这证实了体格检查中肥胖的临床印象。她的体重指数为 23.4（超过同年龄组的第 95 个百分位）。在初级保健儿科实践的 10 年中，儿科医生通常为肥胖的学龄期和青春期患者制定管理计划，首先对家长和孩子进行有关肥胖相关潜在健康问题的教育，然后建议减少热量摄入并鼓励每天积极锻炼。然后，她安排了随访，以监测体重和管理计划的依从性。然而，她自我反思了一下，发现她的大多数患者并没有持续遵循她的建议。大多数情况下，肥胖仍然存在。儿科医生想知道是否有另一种更好的、基于证据的方法来治疗儿童肥胖症，也许可以带来更好的结果。
