1 Evidence Model for Treatment of Overweight and Obesity Cardiovascular Disease Cardiovascular Mortality and Morbidity Noncardiovascular Mortality and.

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

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

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

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

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

6 Ref #SubjectsDesignInterventionResults Wood NEJM 1988 N:155 F:0 Age: 44 Weight: 94 RCT 52 Wks 1. Control 2. Diet 3. Exercise Weight (kg) Body Fat Cholesterol Evidence Table

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.