Intended for healthcare professionals

Letters Obesity in children

Quality of guidelines on obesity in children is worrying

BMJ 2008; 337 doi: (Published 11 November 2008) Cite this as: BMJ 2008;337:a2474
  1. Pablo Alonso-Coello, researcher1
  2. on behalf of Mario Delgado-Noguera, Sera Tort, Ignasi Gich, and Xavier Bonfill
  1. 1Iberoamerican Cochrane Centre, Hospital Sant Pau (CIBERESP), Barcelona 08041, Spain
  1. palonso{at}

    Kipping and colleagues argue that the differences between international guidelines on managing obesity reflect variations in the structure of health services, resources, culture, and behaviour between countries.1 However, a more worrying explanation is the poor quality of clinical practice guidelines.

    We recently conducted a systematic review of 22 guidelines for preventing and treating obesity and overweight in childhood,2 assessing quality with the AGREE instrument.3 Their quality generally low. Only two of the six domains included in the AGREE instrument (scope and purpose and clarity of presentation) had a mean score over 50%. Although half of the guidelines had a quick reference guide or summary to identify key recommendations, only four had specific guidance for patients.

    Of most concern was the low score (just over 35%) obtained in the rigour 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. We would recommend and apply only six of them.

    When developing or updating guidelines on obesity in children, developers should adhere more closely to the AGREE instrument.


    Cite this as: BMJ 2008;337:a2474


    • Competing interests: None declared.