Obesity Prevention and Treatment in Primary Care
Obesity Prevention and Treatment in Primary Care
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DOI：
10.1016/j.acap.2018.05.004
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发表时间：
2018-09-01
影响因子：
3.1
通讯作者：
Perrin, Eliana M.
中科院分区：
文献类型：
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作者：
Brown, Callie L.;Perrin, Eliana M.
尽管采取了广泛的公共卫生和临床干预措施，肥胖率仍然很高，基于证据的预防战略仍然难以捉摸。许多共识指南建议，提供者应通过测量身高和体重，计算体重指数（BMI），并在每次访问时将健康背景下的体重状况敏感地传达给家人，对2岁以上的所有儿童进行肥胖筛查。然而，预防性咨询应该从婴儿期开始开始，重点是健康的喂养、活动和家庭生活方式行为。对于超重或肥胖的儿童，美国儿科学会概述了4个治疗阶段：1）初级保健提供者应提供“预防加”，即使用动机性访谈来实现家庭行为或环境中健康生活方式的改变; 2）需要下一级肥胖治疗、结构化体重管理的儿童，需要初级保健提供者以外的额外支持（如营养师，物理治疗师或心理健康顾问）和更结构化的目标设定与团队，包括供应商擅长体重管理咨询; 3）严重肥胖的儿童和有动机的家庭可能受益于转介到综合多学科干预，如肥胖治疗诊所;和4）在多学科儿科肥胖症治疗诊所中提供三级护理干预，具有用于评估干预的标准临床方案，包括药物治疗和手术虽然在预防性健康访问期间提供所有所需的预防和治疗咨询对提供者来说无疑是一个挑战，但通过在出生时开始提供预期指导，提供者可以回答父母的问题，增加父母的知识基础，并与父母和儿童和青少年合作，帮助他们健康成长。这一点在日益有毒的食品环境中尤为重要，因为有许多激励和信息要求不健康饮食，适当的身体活动存在障碍，并且伴随着肥胖的耻辱。关注关键的营养和身体活动习惯，并在幼年时建立这些健康的行为，将使儿童形成健康的成长轨迹。然而，还需要做更多的工作来确定最佳的循证实践，以便提供者为家庭提供咨询，改善目标行为，环境改造和育儿技能，并减少肥胖患病率和治疗方面的巨大差异。
Despite extensive public health and clinical interventions, obesity rates remain high, and evidence-based preventive strategies are elusive. Many consensus guidelines suggest that providers should screen all children after age 2 years for obesity by measuring height and weight, calculating body mass index (BMI), and sensitively communicating weight status in the context of health to the family at each visit. However, preventive counseling should begin in infancy and focus on healthy feeding, activity, and family lifestyle behaviors. For children with overweight or obesity, the American Academy of Pediatrics outlines 4 stages of treatment: 1) Primary care providers should offer "prevention plus," the use of motivational interviewing to achieve healthy lifestyle modifications in family behaviors or environments; 2) children requiring the next level of obesity treatment, structured weight management, need additional support beyond the primary care provider (such as a dietitian, physical therapist, or mental health counselor) and more structured goal setting with the team, including providers adept at weight management counseling; 3) children with severe obesity and motivated families may benefit from referral to a comprehensive multidisciplinary intervention, such as an obesity treatment clinic; and 4) tertiary care interventions are provided in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols for evaluation of interventions, including medications and surgery. Although it is certainly a challenge for providers to fit in all the desired prevention and treatment counseling during preventive health visits, by beginning to provide anticipatory guidance at birth, providers can respond to parents' questions, add to parents' knowledge base, and partner with parents and children and adolescents to help them grow up healthy. This is especially important in an increasingly toxic food environment with numerous incentives and messages to eat unhealthfully, barriers to appropriate physical activity, and concomitant stigma about obesity. Focusing on key nutrition and physical activity habits and establishing these healthy behaviors at an early age will allow children to develop a healthy growth trajectory. However, much more work is needed to determine the best evidence-based practices for providers to counsel families on improving target behaviors, environmental modifications, and parenting skills and to decrease abundant disparities in obesity prevalence and treatment.