Evidence-Based Practice Guidelines

Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline, the Journal of Clinical Endocrinology & Metabolism, (Styne et al., 2017).

  • Guideline Developers

The guideline was developed by the Journal of Clinical Endocrinology and Metabolism. It was co-sponsored by the European Society of Endocrinology and the Pediatric Endocrine Society (Styne et al., 2017).

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  • Were the developers representative of key stakeholders in the specialty?

The developers of the guideline were representative of the stakeholders in the specialty. The Pediatric Endocrine Society is an organization that deals with endocrine issues that concern children. The organization believes that hormones are a key player in driving a child’s development and growth. Many of the problems that children have when growing up such as during puberty and sexual development have their base in the endocrine system (Styne et al., 2017).

  • Who funded the guideline development?

The Endocrine Society funded the guideline development (Styne et al., 2017).

  • Were any of the guidelines developers funded researchers of the reviewed studies?

None of the guideline developers were funded researchers of the studies under review (Styne et al., 2017).

  • Did the team have a valid development strategy?

There was a valid strategy as there was commissioning of two systematic reviews that were used to support the guideline. They were:

1) Treatments of Paediatric Obesity: An Umbrella Systematic Review 

2) The Association of Weight Loss and Cardiometabolic Outcomes in Obese Children: Systematic Review and Meta-Regression 

The first review was a collective review of randomized controlled trials (RCTs) with a period of more than six months. It assesses medication, lifestyle, surgery and community based strategies in obese children. The objective of the review was to gauge the efficiency of the strategies and to determine the credibility of the evidence used.  Data from 133 RCTs was used which enrolled 30,445 patients where each intervention had an evidence profile (Styne et al., 2017).

The second review was a study-level meta-regression that established variances in BMI related to cardiometabolic changes in subjects that were either obese or overweight. 

  • Was an explicit, sensible, and impartial process used to identify, select, and combine evidence?

The Endocrine Society through its Clinical Guidelines Subcommittee thought that prevention and treatment of childhood obesity as a vital issue that needs to have practice guidelines; it therefore created a task force to prepare evidence-based recommendations. The task force followed the recommendations of an international group; the Grading of Recommendations, Assessment, Development, and Evaluation group, which is a group at the international level that has expertise in developing and implementing evidence-based guidelines. Recommendations were developed using the best available research evidence where the researchers used constant graphical and language descriptions of the quality and strength of the evidence (Styne et al., 2017).

The Task Force believes that people whose care is based on the strong recommendation will benefit more. The weak recommendations need more cautious concern of the individual’s circumstances, ideals, and inclinations to establish the next step. Each recommendation is linked to an illustration of the ideals and evidence that was considered by the Task Force when the recommendations were made. For example, the considerations could have been remarks, which are a reflection of the best evidence available that apply to an ordinary person during treatment (Styne et al., 2017).

  • Did its developers carry out comprehensive, reproducible literature review within the past 12 months of its publication/revision?

Yes they did. The original guidelines were published 8 years ago and since then, 1778 references have been added to PubMed in relation to childhood obesity. The Task Force has used some of this data, according to relevance, to improve the initial literature. For example, the definition and epidemiology part has the most current statistics in tendencies in childhood obesity that include a current stabilization of the frequency. There are also new definitions for acute obesity that are added with a note that this group continues to be large. Another issue that is addressed is the prevalence of childhood obesity in ethnic minorities that include a discussion of the limits of application of the BMI equation to the different ethnic groups. In the evaluation section, there are current guidelines on the use of laboratory assessment for diagnosis and managing comorbidities related to obesity (Styne et al., 2017).

  • Were all the options and outcomes considered?

Yes, all options and possible outcomes were considered (Styne et al., 2017).

  • Is each recommendation in the guideline tagged by the level/strength of evidence upon which it is based and linked to the scientific evidence?

Yes it is. The task force used the term “we recommend” to refer to the strongest recommendation as number 1 and ‘we suggest” for weak recommendations as number 2. Circles with crosses were used to signify the evidence quality one crossed circle signifies very low, two crosses signify low quality, three crosses signify average quality while four crosses indicate high quality (Styne et al., 2017).

  • Do the guidelines make explicit recommendations (reflecting value judgments about the outcomes)?

The guidelines make clear recommendations that lead to favorable outcomes. For example, the Task Force suggests patients to be genetically tested when they present with signs of early onset of obesity, below 5 years, who have clinical charactitics of genetic obesity syndrome (acute hyperphagia) or a family history of acute obesity; this was ranked as (2|⊕⊕○○).  In the process of assessing obese children, clinicians need to establish treatable genetic conditions and causes. Diagnosis of obesity related to the child’s genes can be useful in providing information that will help the child’s family and clinician to manage his condition and reduce the social stigma associated with obesity. Also, genetic counselling is another strategy that clinicians should provide. When a genetic diagnosis is made, it provides guidelines for management which includes bariatric surgery since most children with genetic obesity do not respond to different measures that intend to make them lose weight (Styne et al., 2017).

  • Has the guideline been subjected to peer-review and testing?

The guideline has not been subjected to peer-review.

  • Is the intent of use provided (i.e. national, regional, local)?

The guideline is meant to be used nationally, that is, the United States. 

  • Are the recommendations clinically relevant?

The recommendations are clinically relevant. This is because they aim to prevent and manage childhood obesity to prevent children transitioning into adulthood with the condition. If they do this, the cost of treatment will be very high as obesity will lead to other comorbidities, for example, the Task Force recommends the use of BMI and CDC normative BMI percentiles to make a diagnose obese children who are 2 years and older (Styne et al., 2017).

  • Will the recommendations help me in caring for my patients?

The recommendations will help me care for my patients as they provide a framework of how clinicians should perform an obesity or overweight diagnosis. The recommendations include a guideline on how clinicians should evaluate a child to make a credible obesity diagnosis. It states all the steps the clinician should take starting with measuring the height, weight, and BMI of the child (Styne et al., 2017). 

  • Are the recommendations practical / feasible? Are resources (people and equipment) available?

The recommendations are practical as much of the evaluation of through a physical exam. The equipment used in diagnosis is available as well as the people to be evaluated. The clinician can evaluate a child when they are brought for baby wellness clinic or partner with school administrations to evaluate the children at school (Styne et al., 2017).

  • Are the recommendations a major variation from current practice? Can the outcomes be measured through standard care?

The recommendations do not vary much from current practice; they are practical and can be applied during a routine doctor’s appointment. Some of the recommendations involve collaborating with the family in adopting healthy eating and incorporating regular exercise for the child. A reduction in caloric intake through consumption of more vegetables and fruits and limiting refined carbohydrates and dietary fat plays a role in reducing the risk of acquiring obesity and Type 2 Diabetes Mellitus. This is a recommendation that can be applied easily (Styne et al., 2017).

Another recommendation states that children who attend public schools in the US have 40% of their caloric intake at school. It is in this regard that the guideline recommends that there should be elimination of transfats, saturated fats, and reduced sugar in foods that is provided in school (Styne et al., 2017).

ReferenceStyne, D. M., Arslanian, S. A., Connor, E. L., Farooqi, I. S., Murad, M. H., Silverstein, J. H., & Yanovski, J. A. (2017). Response to Letter: “Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline”. The Journal of Clinical Endocrinology & Metabolism, 102(6), 2123-2124. doi:10.1210/jc.2017-00561

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