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CLINICAL REVIEW: Ruth R Kipping, Russell Jago, and Debbie A Lawlor Obesity in children. Part 2: Prevention and management BMJ 2008; 337: a1848 [Full text]

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Worrying quality of clinical practice guidelines about obesity in children

Pablo Alonso-Coello, Mario Delgado-Noguera , Sera Tort, Ignasi Gich, and Xavier Bonfill.   (31 October 2008)

Worrying quality of clinical practice guidelines about obesity in children 31 October 2008
Pablo Alonso-Coello, Researcher Iberoamerican Cochrane Center, Hospital Sant Pau, (CIBERESP), Barcelona 08041, Spain., Mario Delgado-Noguera , Sera Tort, Ignasi Gich, and Xavier Bonfill. Send response to journal: Re: Worrying quality of clinical practice guidelines about obesity in children	We have read with great interest the rigorous and synthetic review Kipping and colleagues put together1. Nevertheless, we would like to bring their attention to the issue of the quality of guidelines and the variation in their content and/or recommendations. The authors argue that many countries have developed guidelines for managing obesity and that their differences reflect variations in the structure of health services, resources, culture, and behaviour between countries. We believe that, being that true, there is an additional and more worrying reason underneath this variability which is the low quality of clinical practice guidelines (CPG) about this topic. We recently developed a systematic review to identify and assess the quality of CPGs for the prevention and treatment of obesity and overweight in childhood2. We assessed the quality with the AGREE instrument3. The quality of the 22 included guidelines was generally low. Only two of the six domains included in the AGREE instrument had a mean score over 50%, these being “Scope and purpose” and “Clarity of presentation.” In the latter, although half of the guidelines had a quick reference guide or summary to facilitate the identification of key recommendations, less than 20% had specific guidance for patients. Of most concern was the low score (just over 35%) obtained in the “Rigor of development” domain, indicating that many of the recommendations were based on unsound grounds and far from an evidence-based approach. Nearly half of the documents did not report the databases searched or a structured approach to evaluate the quality of the evidence or grade the strength of recommendations. This lack of a rigorous and systematic evaluation of the best available evidence is a major drawback and could lead to unreliable or even harmful recommendations for patients. Finally, according to the reviewers, only six out of the 22 guidelines could be recommended and applied. The increasing burden of obesity among children and the potential for long-term co-morbidities, make imperative that clinicians have access to rigoursly developed recommendations. As in other healthcare fields, much improvement is needed in the quality of CPGs for obesity in children. In order to make the needed shift happen, in practice, guideline producers should, when developing or updating guidelines, adhere more closely to the AGREE instrument. References 1. Kipping RR, Jago R, Lawlor DA. Obesity in children. Part 2: Prevention and management. BMJ 2008 Oct 22;337:a1848. doi: 10.1136/bmj.a1848. 2. Delgado-Noguera M, Tort S, Bonfill X, Gich I, Alonso-Coello P. Quality assessment of clinical practice guidelines for the prevention and treatment of childhood overweight and obesity. Eur J Pediatr. 2008 Sep 25. [Epub ahead of print] 3. AGREE Collaboration (2003) Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 12(1):18–23. Competing interests: None declared