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Vol. 88. Num. 6.01 June 2018
Pages 299-356
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Vol. 88. Num. 6.01 June 2018
Pages 299-356
Original Article
DOI: 10.1016/j.anpede.2017.07.008
Spanish collaborative study: Description of usual clinical practice in infant obesity
Estudio colaborativo español: descripción de la práctica clínica habitual en obesidad infantil
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Alfonso Lechuga Sanchoa, Enrique Palomo Atanceb, María José Rivero Martinc, Mercedes Gil-Camposd,h, Rosaura Leis Trabazoe,h, María Pilar Bahíllo Curiesesf, Gloria Bueno Lozanog,h,
Corresponding author
gbuenolozano@gmail.com

Corresponding author.
, on behalf of the Working Group on Obesity of the Spanish Society of Endocrinology
a Departamento Materno-Infantil y Radiología, Facultad de Medicina, Universidad de Cádiz, UGC de Pediatría, Hospital Universitario Puerta de Mar, Cádiz, Spain
b Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
c Servicio de Pediatría, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
d IMIBIC, Facultad de Medicina, Universidad de Córdoba, Unidad de Metabolismo e Investigación Pediátrica, Hospital Universitario Reina Sofía, Córdoba, Spain
e Departamento de Pediatría, Facultad de Medicina, Universidad de Santiago de Compostela, Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
f Servicio de Pediatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
g Departamento de Pediatría, Radiología y Medicina Física, Facultad de Medicina, Universidad de Zaragoza, Servicio de Pediatría, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
h ciberobn isciii, Spain
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Tables (4)
Table 1. Variables included in the survey addressed to paediatricians members of the Sociedad Española de Endocrinología Pediátrica.
Table 2. Analysis of the adherence to the recommendations given in the sections “Intervention in Paediatrics”, “Psychological intervention” and “Bariatric surgery” of the Clinical Practice Guideline for the Prevention and Treatment of Obesity in Children and Adolescents.
Table 3. Alternative treatments.
Table 4. Approach to patients that do not respond to initial treatment.
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Abstract
Introduction

Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines.

Material and methods

An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of “Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity” issued by the Spanish Ministry of Health.

Results

A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used.

Conclusions

There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition.

Keywords:
Obesity
Guide
Clinical practice
Children
Adolescent
Resumen
Introducción

La obesidad infantil es un problema de salud de alta prevalencia. Aunque existen guías clínicas para su manejo, la variabilidad en su abordaje clínico es un hecho. El objetivo de este estudio es describir la práctica clínica habitual en unidades de Endocrinología Pediátrica y evaluar su adecuación a la guía recomendada.

Material y métodos

Se realizó un estudio observacional, transversal y descriptivo mediante encuesta a endocrinólogos infantiles de la Sociedad Española de Endocrinología Pediátrica. Las preguntas fueron formuladas en base a las recomendaciones de la «Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantojuvenil» del Ministerio de Sanidad español.

Resultados

Se obtuvieron 125 encuestas de todas la Comunidades Autónomas. Se observó variabilidad en el número de pacientes atendidos al mes y en la frecuencia de las visitas. El 70% de los encuestados no dispone de un nutricionista ni de psicólogo o psiquiatra al que derivar los pacientes. En el tratamiento, las medidas dietéticas son las más empleadas; un 69% nunca ha prescrito fármacos para perder peso. De los que prescriben, el 52,6% no utilizan el consentimiento informado como paso previo a su empleo.

Conclusiones

Pocos centros cumplen las recomendaciones de la Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantil en un plan de calidad establecido. La práctica clínica difiere mucho entre los endocrinólogos pediátricos encuestados, sin existir protocolos unificados de actuación, y con escasa disponibilidad de recursos para el tratamiento integral que precisa esta enfermedad.

Palabras clave:
Obesidad
Guía
Práctica clínica
Niño
Adolescente

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