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Evidence Model for Treatment of Overweight and Obesity

Noncardiovascular Mortality and Morbidity. Cardiovascular Mortality and Morbidity. Cardiovascular Disease. High Blood. Glucose. Dyslipidemia. Pressure. Intolerance. Abdominal. Weight. Fitness. Fat. ). ). Assess. Treat. (. Kcal Out. (. Kcal In.

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Evidence Model for Treatment of Overweight and Obesity

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  1. Noncardiovascular Mortality and Morbidity Cardiovascular Mortality and Morbidity Cardiovascular Disease High Blood Glucose Dyslipidemia Pressure Intolerance Abdominal Weight Fitness Fat ) ) Assess Treat ( Kcal Out ( Kcal In Evidence Model for Treatment of Overweight and Obesity Overweight Individual

  2. Evidence Model for Treatment of Overweight and Obesity Overweight Individual Glucose Intolerance High Blood Pressure Dyslipidemia Abdominal Fat Weight Fitness ( Kcal In) Assess ( Kcal Out) Treat

  3. Evidence Collection Schema Evidence Model defines ~39 relationships MEDLINE literature search assesses each relationship in Evidence Model MEDLINE literature search assesses each relationship in EVIDENCE MODEL ProCite reference database marked for duplicates (18,217 dupes) Literature search merged into ProCite reference database (43,627 records) 19,596 records not relevant Print titles of ProCite database (25,410 records) two rounds of screening) Expert Panel member literature search merged into ProCite database (2,226 abstracts) 8,040 abstracts screened (two rounds) 2,440 abstracts marked as possibly relevant for article retrieval 5,600 abstracts not relevant Critical review status sheet database and 394 RCT articles sent to San Antonio Cochrane Center

  4. Evidence Collection Schema(continued) Evidence Model defines ~39 relationships MEDLINE literature search assesses each relationship in Evidence Model Literature search merged into ProCite reference database (43,627 records) ProCite reference database marked for duplicates (18,217 dupes) A

  5. Evidence Collection Schema(continued) A 19,596 records not relevant Print titles of ProCite database (25,410 records) (two rounds of screening) Expert Panel member literature search merged into ProCite database (2,226 abstracts) 8,040 abstracts screened (two rounds) 2,440 abstracts marked as possibly relevant for article retrieval 5,600 abstracts not relevant Critical review statussheet database and 394 RCT articles sent to the San Antonio Cochrane Center

  6. Evidence Table Ref # Subjects Design Intervention Results 28499 N:155 RCT 1. Control Weight (kg) Wood F:0 52 Wks 2. Diet 1. 95.4 NEJM Age: 44 3. Exercise 2. 93 1988 Weight: 94 3. 94.1 Body Fat 27.2 1. 25.5 2. 25.5 3. Cholesterol 5.7 1. 5.7 2. 5.64 3.

  7. Inclusion and Exclusion Criteria • Timeframe of the study—at least 4 months. • For long-term maintenance—1 year or more. • Excluded studies with self-reported weights, patients not overweight, dropout rate >35%, or no appropriate control group.

  8. Criteria To Evaluate the Evidence • A—Strong evidence: Evidence from well-designed randomized controlled trials (or trials that depart only minimally from randomization) that provides a consistent pattern of findings. • B—Suggestive evidence (from randomized studies): Evidence as in A, but involving a smaller number of studies and/or a less consistent pattern of findings.

  9. Criteria To Evaluate the Evidence (continued) • C—Suggestive evidence (from nonrandomized studies): Evidence from the panel’s interpretation of uncontrolled or observational studies. • D—Expert judgment: Evidence from clinical experience or experimental research.

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