A critical appraisal of:
Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology,
using the AGREE II Instrument

1. Scope and Purpose

1. The overall objective(s) of the guideline is (are) specifically described.

Rating: 7

The guidelines serve as a protocol for standardized production of CPG, algorithms, and checklists.

2. The health question(s) covered by the guideline is (are) specifically described.

Rating: 7

The guideline identifies a target population and provides recommendations for interventions.

3. The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described.

Rating: 7

The guidelines define obesity. It is specific about conditions for which it applies.

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2. Stakeholder Involvement

4. The guideline development group includes individuals from all relevant professional groups.

Rating: 7

This was a multi-speciality endeavor including American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

5. The views and preferences of the target population (patients, public, etc.) have been sought.

Rating: 4

While many groups worked together to develop the guidelines, there is limited perspective from patients.

6. The target users of the guideline are clearly defined.

Rating: 7

There is a clear audience defined.

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3. Rigour of Development

7. Systematic methods were used to search for evidence.

Rating: 7

Guidelines include a table containing publications on bariatric surgery, especially randomized controlled trials (RCTs), meta-analyses, and reviews

8. The criteria for selecting the evidence are clearly described.

Rating: 7

9. The strengths and limitations of the body of evidence are clearly described.

Rating: 7

10. The methods for formulating the recommendations are clearly described.

Rating: 6

11. The health benefits, side effects, and risks have been considered in formulating the recommendations.

Rating: 7

The risks are described in detail.

12. There is an explicit link between the recommendations and the supporting evidence.

Rating: 7

13. The guideline has been externally reviewed by experts prior to its publication.

Rating: 7

14. A procedure for updating the guideline is provided.

Rating: 6

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4. Clarity of Presentation

15. The recommendations are specific and unambiguous.

Rating: 1

Recommendations are very clear and precise

16. The different options for management of the condition or health issue are clearly presented.

Rating: 7

17. Key recommendations are easily identifiable.

Rating: 6

The guidelines contain s lot of information and it can be more difficult to find specific recommendations.

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5. Applicability

18. The guideline describes facilitators and barriers to its application.

Rating: 6

19. The guideline provides advice and/or tools on how the recommendations can be put into practice.

Rating: 7

20. The potential resource implications of applying the recommendations have been considered.

Rating: 6

21. The guideline presents monitoring and/or auditing criteria.

Rating: 7

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6. Editorial Independence

22. The views of the funding body have not influenced the content of the guideline.

Rating: 7

23. Competing interests of guideline development group members have been recorded and addressed.

Rating: 7

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