PRE-OBESITY+

PRE-OBESITY⁺ is a service sponsored by the Canadian Obesity Network/Réseau canadien en obésité that incorporates the McMaster PLUS email alerting system and a searchable database of preliminary clinical research and clinical care research evidence from the medical literature on obesity.

Health professionals and others with an interest in obesity are invited to register so that they can receive email alerts and searching access for literature that is matched to their personal interests.

Research staff evaluate original and review articles in over 130 journals (including the Cochrane Library) and select articles that are patient oriented, involving “intact” humans, and are about obesity or overweight. Here, we define obesity according to the World Health Organization’s classification system. People who are overweight have a body mass index (BMI) of 25 or greater, or a waist circumference above 80 cm (for women) or above 94 cm (for men). People with obesity have a BMI of 30 or greater, or a waist circumference above 88 cm (for women) or above 102 cm (for men).

These articles are then assessed on whether they meet criteria for applicability in the clinical setting and then for the rigour of their methods. The criteria are based on the purpose of the research: therapy or prevention, quality improvement, diagnosis, prognosis, etiology, economics, clinical prediction guides, and differential diagnosis. This systematic review is highly reproducible and undergoes periodic quality assurance checks.¹ Some articles do not fall into any of these categories and are “unclassified”.

Articles are identified in PRE-OBESITY⁺ according to whether the study methods were sufficiently rigorous. Articles that fit one or more purpose categories and are methodologically sound are classed as ready for clinical attention and are sent for rating by practising clinicians (clinical care research articles, indicated by red). Articles that either fit a purpose category and do not meet the criteria for methodological rigour or are unclassified are considered to be preliminary clinical research. Non-systematic reviews are also considered not to meet criteria for clinical attention. These original and review research articles are not sent for clinical rating (preliminary clinical research articles, indicated by black)

¹Wilczynski NL, McKibbon KA, Haynes RB. Enhancing retrieval of best evidence for health care from bibliographic databases: calibration of the hand search of the literature. Medinfo. 2001;10(Pt 1):390-3.

editorials, opinion pieces, letters
case reports
cost assessments
basic research, animal studies, and studies with human materials not directly linked to individual human subjects.

Ratings of clinical care research articles (those that meet criteria for purpose and methodological rigour) for clinical relevance and newsworthiness by at least 3 practitioners with an interest in obesity.

Email alerts about new clinical care research evidence adjusted to the user’s preset levels of relevance, newsworthiness, and frequency. Each clinical care research alert includes ratings from health care practitioners with an interest in obesity and electronic links to the article’s abstract on PubMed (if available) and to the fulltext article on PubMed or the publisher’s site (if available for free).

Email alerts about new preliminary research evidence matched to the user’s preset area of interest and frequency level. Alerts for each article have electronic links to the article’s abstract on PubMed (if available) and to the fulltext article on PubMed or the publisher’s site (if available for free).

A cumulative, continuously updated searchable bibliographic database of the alerts and, for clinical care research articles, associated ratings.

A user interface allowing each user to register for a subset of the accumulating database by practitioner type for clinical care research articles, and by research topic area for preliminary clinical research articles.

A link to EvidenceUpdates, a service from the BMJ Group and McMaster University’s Health Information Research Unit that provides access to current best evidence from research, tailored to the user’s health care interests, to support evidence-based clinical decisions.

Links to related resources and tools

Summary of content

Feature	Clinical Care Research Articles	Preliminary Clinical Research Articles
Feature	(classified for purpose)	Classified for purpose	Unclassified
Purpose Criteria	Fit criteria and pass them	Fit criteria but fail them	Do not fit criteria
Rated	Yes	No	No

The information contained in PRE-OBESITY⁺ is intended for health professionals and is provided on an “as is” basis without warranty of any kind, expressed or implied.

PRE-OBESITY⁺ provides an educational service for practising clinicians and researchers and others interested in the management of obesity, designed to alert them to important new research; however, we cannot warrant its accuracy. The clinical care research articles are intended to support evidence-based decision making by providing links to published research reports about the diagnosis, treatment, prediction and prognosis, etiology, and economics of obesity. However, “evidence does not make decisions”², and clinicians making decisions about the care of their patients must take into account the limitations of evidence from research as well as the unique nature of their patients’ circumstances and wishes. The research portion is intended to support research that will lead to clinical advancements. Readers should be aware that professionals in the field may have different opinions about the interpretation of evidence from research. Because of this fact and also because of regular advances in medical research, we strongly recommend that readers independently verify any information they choose to rely on. Ultimately it is the readers’ responsibility to make their own professional judgements.

PRE-OBESITY⁺ attempts to provide access to the best new obesity research of relevance for clinical practice and research. It does not report all research but uses explicit criteria to define a subset of published research, first, that is likely to be valid and ready for clinical attention in these disciplines, and second, that is not yet ready for clinical attention but is at a preliminary stage. For the clinical care research articles, practitioners with an interest in obesity then provide their assessments of the relevance and newsworthiness of the reports through an online review process, the McMaster Online Rating of Evidence (MORE). Individual clinicians who then receive these reviews must apply their own judgement concerning the strength and applicability of this evidence to their own patients.

Description or reference to a product or publication does not imply endorsement of that product or publication.

To the fullest extent permitted by law, the Canadian Obesity Network/Réseau canadien en obésité and McMaster University are not responsible for any losses, injury, or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental, or consequential, resulting from the application of the information on PRE-OBESITY⁺

²Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice [editorial]. ACP Journal Club. 2002;136:A11-3.

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