Chen Cathy, Eichen Dawn, Kang Sim D Eastern, Strong David, Boutelle Kerri N, Rhee Kyung E
Northern California Kaiser Permanente Medical Group, Sacramento, CA, USA.
Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA.
Child Obes. 2024 Oct;20(7):459-467. doi: 10.1089/chi.2023.0114. Epub 2024 Jan 24.
Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial. Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group. Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment. While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.
尽管对自身有效开展体重管理咨询的能力信心不足，但初级保健提供者（PCP）仍有望提供此类咨询。本分析在一项随机对照试验中，研究了接受初级保健提供者常规护理的儿童与接受两种结构化体重管理项目之一的儿童之间体重状况的变化。对那些被转诊至“医生办公室指导自助式肥胖治疗”研究但未参与的亲子二元组数据进行了分析，以确定与参与试验的儿童相比，其体重状况的变化。家庭被分为四组：第1组，高参与度的结构化治疗；第2组，低参与度的结构化治疗；第3组，接受一些体重管理咨询的初级保健提供者/常规护理；第4组，未接受咨询的初级保健提供者/常规护理。人体测量数据和初级保健提供者提供的体重管理咨询信息从电子健康记录中提取。主要结局指标为每组在治疗结束时和6个月随访时儿童BMI z评分的变化、相对于第95百分位数的BMI百分比变化以及相对于第95百分位数的BMI差值变化。随着时间推移，第1组和第2组的体重状况显著下降，其中第1组下降幅度最大。第3组和第4组相对稳定。治疗后，第2组、第3组和第4组的体重状况变化与第1组存在显著差异。虽然结构化体重管理项目对体重状况有显著影响，但那些接受初级保健提供者一些咨询的儿童体重状况并未显著增加，且体重相对稳定。应加大力度支持初级保健提供者在办公室开展体重管理咨询工作。
