Panel Selection · Topics Included in the Guidelines · Development of the Evidence Model · Search and Review of the Literature · Literature Abstraction and Preparation of Evidence Tables · The Formulation of the Evidence into the Guidelines · Consideration of Special Populations and Situations · External Review of the Guidelines · Caveats to Recommendation Use
1.b. Topics Included in the Guidelines
The panel decided to focus on all adult (18 years of age and older) overweight and obese patients with a body mass index (BMI) 25, and particularly those with cardiovascular risk factors. Excluded from the analysis were patients with known genetic or hormonal syndromes and pharmacologically induced obesity.
In addition, since pediatric obesity contributes to about one-third of adult obesity, the panel felt that some attention needed to be focused on the issue of overweight in children and adolescents (see Appendix III). Treatment issues surrounding overweight children and adolescents are quite different from the treatment of adults. The panel recommended that this issue warrants its own project as soon as possible.
The therapeutic interventions requiring examination included diet, physical activity, behavior therapy, pharmacological therapy, surgery, and combinations of these. No clinical interventions were excluded at the outset. Because of the importance and complexity of the primary prevention of obesity, the panel decided not to deal with these concerns in detail and that the issue be addressed in a separate document. However, clinical interventions to prevent further weight gain in patients already overweight, or those patients not currently overweight at high risk for becoming overweight, were considered relevant therapeutic interventions. The guidelines also contain some information on the cost of obesity.
In terms of reliable diagnostic measures, the panel decided to concentrate on useful tools readily available in a physician's office, i.e., weight, height and BMI. The panel did not search for evidence to prove that measures of body composition or metabolic rate are useful tools; however, they did include studies using these diagnostic measures.