Obesity in children. Part 2: Prevention and managementBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1848 (Published 22 October 2008) Cite this as: BMJ 2008;337:a1848
All rapid responses
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
1. Kipping RR, Jago R, Lawlor DA. Obesity in children. Part 2:
Prevention and management. BMJ 2008 Oct 22;337:a1848. doi:
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: No competing interests