Department of Medicine, Penn State Milton S. Hershey Medical Cetner, Penn State College of Medicine, Hershey, PA 17033, USA.
Int J Obes (Lond). 2013 May;37(5):751-3. doi: 10.1038/ijo.2012.113. Epub 2012 Jul 10.
Weight counseling for adults is uncommonly performed by primary-care providers (PCPs), despite recommendations. In order to design effective primary-care interventions, a full understanding of the epidemiology of weight counseling in primary care is needed. Our objective was to measure the frequency of weight counseling at the level of the PCP. We performed a cross-sectional study of 21 220 US adult outpatient primary-care visits with 954 PCPs in 2007-2008, using data from the National Ambulatory Medical Care Survey (NAMCS). Most (58%) PCPs performed no weight counseling during any patient visits. A total of 85 (8.9%) PCPs provided 52% of all weight counseling and were categorized as 'positive deviant' (PD) physicians. Patients seeing PD physicians were older, less likely to be female and more likely to have hypertension, diabetes and obesity. Adjusting for patient characteristics strengthened the association between PD status and receipt of weight counseling during visits (adjusted odds ratio=13.2 (95% confidence interval 11.5-15.7)). In conclusion, a minority of PCPs provide the majority of primary-care weight counseling in the United States. Studies of these PCPs may help to identify practical methods to increase weight counseling in primary-care settings.
尽管有相关建议，成年人的体重咨询在初级保健医生（PCP）中也很少进行。为了设计有效的初级保健干预措施，需要充分了解初级保健中体重咨询的流行病学情况。我们的目的是测量 PCP 层面的体重咨询频率。我们使用 2007-2008 年全国门诊医疗调查（NAMCS）的数据，对 954 名 PCP 的 21220 名美国成年门诊初级保健就诊者进行了横断面研究。大多数（58%）PCP 在任何就诊期间都没有进行体重咨询。共有 85 名（8.9%）PCP 提供了所有体重咨询的 52%，并被归类为“积极偏差”（PD）医生。看 PD 医生的患者年龄更大，女性比例更低，高血压、糖尿病和肥胖的比例更高。调整患者特征后，PD 状态与就诊期间接受体重咨询之间的关联更加紧密（调整后的优势比=13.2（95%置信区间 11.5-15.7））。总之，在美国，只有少数 PCP 提供了大部分初级保健体重咨询。对这些 PCP 的研究可能有助于确定在初级保健环境中增加体重咨询的实用方法。
