Registration and management of children with overweight by general practitioners in The Netherlands

General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit. To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints. A retrospective cohort study. Health records from 2012–2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2–18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted. From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations. This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP’s role, warrant further investigation. Especially when overweight is not the primary reason for visit. Children rarely visit general practitioners for weight-related issues. GPs recognise children with overweight but document and refer them less frequently than children who visit the GP for a weight-related issue. Addressing overweight/obesity at the point of visit is an opportunity to improve weight control in children.

全科医师（General Practitioners, GPs）是众多欧洲国家医疗服务的首诊入口，其在儿童超重/肥胖的应对与管理中发挥着至关重要的作用。荷兰临床指南鼓励全科医师在患者就诊期间主动探讨体重相关问题，无论患者初始就诊的原因为何。为探究全科医师针对儿童超重/肥胖的就诊频率、管理模式与随访情况，以及全科医师对因其他主诉就诊的超重/肥胖儿童的识别情况，本研究开展了一项回顾性队列研究。本研究分析了2012-2021年莱茵蒙德基层医疗数据库（Rijnmond Primary Care Database, RPCD）中2至18岁因超重/肥胖就诊于全科医师的儿童健康记录，将研究对象分为两组：因体重相关问题就诊的儿童（组1），以及因其他主诉就诊但被全科医师识别为超重或肥胖的儿童（组2）。研究提取了患者人口学特征、就诊原因及管理策略相关数据。在120991名儿童中，共识别出3035名有明确记录的超重或肥胖儿童，其中208名被排除。最终纳入研究的队列共2827名个体：55%属于组1，45%属于组2。每年的首次就诊频率稳定在约每总人年0.5%。组1的转诊率（74%）与随访就诊率（45.5%）均高于组2（组2转诊率为17%，随访就诊率为19.7%）。本研究揭示了两组儿童在管理上存在令人担忧的差异。儿童超重/肥胖的有效管理策略及全科医师的作用值得进一步探究，尤其是当超重/肥胖并非患者初始就诊的主要原因时。儿童因体重相关问题主动就诊于全科医师的情况极为罕见。全科医师能够识别超重儿童，但相较于因体重相关问题就诊的儿童，其对这类儿童的病例记录与转诊频率均更低。在就诊时主动处理超重/肥胖问题，是改善儿童体重控制状况的重要契机。