Screening and counseling associated with obesity diagnosis in a national survey of ambulatory pediatric visits
Screening and counseling associated with obesity diagnosis in a national survey of ambulatory pediatric visits
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DOI：
10.1542/peds.2004-1517
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发表时间：
2005-07-01
期刊：
影响因子：
8
通讯作者：
Barlow, SE
中科院分区：
文献类型：
--
作者：
Cook, S;Weitzman, M;Barlow, SE
客观的。检查临床医生报告的肥胖诊断以及儿童和青少年门诊期间血压评估以及饮食和运动咨询的频率。方法。 1997 年至 2000 年国家门诊医疗保健调查和国家医院门诊医疗保健调查合并在一起，对 2 至 18 岁的临床医生进行了访问。检查了健康儿童就诊（WCV）的肥胖诊断频率、血压筛查以及与患者和临床医生特征相关的饮食和运动咨询。多变量模型检查了患者和就诊特征与饮食和运动咨询的关系。结果。 1997-2000 年，在 2 至 18 岁青少年就诊的 32 930 例中，诊断出肥胖症的比例为 0.78%，占 WCV 的 0.93%。诊断为肥胖的 WCV 中 61.1% 报告了血压评估，而未诊断为肥胖的 WCV 中这一比例为 43.9%。诊断为肥胖的WCV具有较高的饮食咨询率（88.4% vs 35.7%）和较高的运动咨询率（69.2% vs 18.6%）。在诊断为肥胖的就诊中，88.4% 的人接受了饮食咨询，69.2% 的人接受了运动咨询，而没有诊断出肥胖的 WCV 中，这一比例为 35.7% 和 18.6%。在多变量分析中，与 WCV 饮食咨询相关的因素是儿科医生发现的肥胖诊断（比值比 [OR]：12.9；95% 置信区间 [CI]：3.0-55.3）（OR：2.5；95% CI：1.6-3.9），2 至 5 岁儿童与 12 至 18 岁儿童相比（OR： 0.7；95% CI：0.5-1.0），以及自费与私人保险就诊相比（OR：0.6；95% CI：0.4-0.9）。运动咨询与饮食咨询的相关性与饮食咨询相似，但与白人青少年相比，黑人青少年访问运动咨询的频率较低（OR：0.5；95% CI：0.3-0.8）。结论。临床医生可能会在 WCV 期间忽视肥胖。增加肥胖诊断的计划可以提高饮食和运动咨询率，但即使诊断出肥胖，也会错过筛查和干预的重要机会。
Objective. To examine clinician-reported diagnosis of obesity and frequency of blood pressure assessment and diet and exercise counseling during ambulatory visits made by children and adolescents.Methods. The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey 1997 to 2000 were combined for visits to clinicians of 2- to 18-year-olds. Well-child visits (WCVs) were examined for frequencies of obesity diagnosis, blood pressure screening, and diet and exercise counseling in relation to patient and clinician characteristics. Multivariate models examined the relationship of patient and visit characteristics with diet and exercise counseling.Results. Of the 32 930 ambulatory visits made by 2- to 18-year-olds in 1997-2000, obesity was diagnosed at 0.78% of all visits and 0.93% of WCVs. Blood pressure assessment was reported in 61.1% of WCVs with obesity diagnosis compared with 43.9% of WCVs without obesity diagnosis. WCVs with obesity diagnosis had higher diet counseling rates (88.4% vs 35.7%) and higher exercise counseling rates (69.2% vs 18.6%). Diet counseling was reported for 88.4% and exercise counseling was reported for 69.2% of visits with an obesity diagnosis compared with 35.7% and 18.6% during WCVs without a diagnosis of obesity. In multivariate analyses, factors associated with diet counseling at WCVs were diagnosis of obesity (odds ratio [OR]: 12.9; 95% confidence interval [CI]: 3.0-55.3), being seen by pediatricians (OR: 2.5; 95% CI: 1.6-3.9), 2- to 5-year-olds compared with 12- to 18-year-olds (OR: 0.7; 95% CI: 0.5-1.0), and self-pay compared with private insurance visits (OR: 0.6; 95% CI: 0.4-0.9). Associations with exercise counseling were similar to those for diet counseling, but exercise counseling occurred less frequently in visits by black youths compared with white youths (OR: 0.5; 95% CI: 0.3-0.8).Conclusions. Clinicians may overlook obesity during WCVs. Programs to increase obesity diagnosis could improve diet and exercise counseling rates, but even with diagnosis of obesity, significant opportunities for screening and intervention are missed.