National patterns of physician activities related to obesity management
National patterns of physician activities related to obesity management
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DOI：
10.1001/archfami.9.7.631
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发表时间：
2000-07-01
期刊：
影响因子：
--
通讯作者：
Schoenfeld, DA
中科院分区：
文献类型：
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作者：
Stafford, RS;Farhat, JH;Schoenfeld, DA
背景：与肥胖的临床识别和管理相关的全国医生实践情况尚不明确。
目的：评估基于门诊的肥胖相关实践的全国模式，并确定这些实践的独立预测因素。
设计：对医生门诊就诊情况进行系列横断面调查。
地点：美国的门诊医疗。
患者：我们分析了1995 - 1996年全国门诊医疗调查中抽取的55858次成人医生门诊就诊情况。1988 - 1994年第三次全国健康和营养检查调查的数据被用于评估并随后对肥胖报告不足的情况进行调整。
主要观察指标：门诊就诊时肥胖的报告情况以及医生对被确定为肥胖的患者进行减肥、运动和饮食方面的咨询。
结果：在1995 - 1996年全国门诊医疗调查的就诊中，医生仅在8.6%的就诊中报告了肥胖。1988 - 1994年第三次全国健康和营养检查调查的22.7%的患病率表明，医生仅在38%的肥胖患者中报告了肥胖。在被确定为肥胖的患者的就诊中，医生经常提供减肥咨询（35.5%）、运动咨询（32.8%）和饮食咨询（41.5%）。然而，根据人群患病率进行调整后，每项服务提供给所有肥胖患者的比例不超过四分之一。虽然患有肥胖相关合并症的患者得到了更积极的治疗，但在这些患者中，减肥咨询仅在52%的就诊中出现。
结论：在美国医生的门诊中，针对肥胖的特定干预措施并不常见。肥胖报告不足，在被确定为肥胖的患者中，干预措施也只是中等可能，即使对于那些患有严重肥胖相关合并症的患者也是如此。
Context: National physician practices related to the clinical recognition and management of obesity are unknown.Objectives: To estimate national patterns of office-based, obesity-related practices and to determine the independent predictors of these practices.Design: Serial cross-sectional surveys of physician office visits.Setting: Ambulatory medical care in the United States.Patients: We analyzed 55 858 adult physician office visits sampled in the 1995-1996 National Ambulatory Medical Care Surveys. Data from the Third National Health and Nutrition Examination Surveys, 1988-1994 were used to assess and, then, adjust for the underreporting of obesity.Main Outcome Measures: Reporting of obesity at office visits and physician counseling for weight loss, exercise, and diet among patients identified as obese.Results: Physicians reported obesity in only 8.6% of 1995-1996 National Ambulatory Medical Care Surveys visits. The 22.7% prevalence rate of the Third National Health and Nutrition Examination Surveys, 1988-1994 suggests that physicians reported obesity in only 38% of their obese patients. Among visits by patients identified as obese, physicians frequently provided counseling for weight loss (35.5%), exercise (32.8%), and diet (41.5%). Adjusted for population prevalence; however, each service was provided to no more than one quarter of all obese patients. While patients with obesity-related comorbidities were treated more aggressively, in these patients, weight loss counseling occurred at only 52% of the visits.Conclusions: Specific interventions to address obesity are infrequent in visits to US physicians. Obesity is underreported and interventions are only moderately likely among patients identified as obese, even for those with serious obesity-related comorbidities.