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ForumsPublic SquareHas anyone dealt with adolescent obesity: aap guidelines and glp-1 use in minors?

Has anyone dealt with adolescent obesity: aap guidelines and glp-1 use in minors?

josh_phd_bmore Tue, Jan 9, 2024 at 10:52 AM 12 replies 2,199 viewsPage 1 of 3
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josh_phd_bmore
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Baltimore, MD
Jan 9, 2024 at 10:52 AM#1

I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same direction.

The bit I cannot resolve on my own is how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.

I would rather have one careful answer than five confident ones.

16 19NurseKim_ATL, paul_denver, TinaHashiRN and 13 others
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Dr.BariatricHTX
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Feb 2024
Houston, TX
Jan 9, 2024 at 11:18 AM#2

Short answer first, then the reasoning. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

Ask again with the specifics and you will get a better answer than this one.

17 20pete_RVA, CarlaRPh_TPA, steph_laguna and 14 others
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Dr.PulmRoch
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Rochester, MN
Jan 9, 2024 at 11:44 AM#3
Dr.BariatricHTX said:
Read four things before the headline number.

Bayesian meta-analysis perspective on the trial evidence: traditional frequentist meta-analyses report point estimates and confidence intervals. Bayesian approaches provide probability distributions that are more intuitive for clinical decision-making.

For example: "There is a 98.5% probability that semaglutide 2.4mg produces >10% weight loss vs placebo" is more actionable than "RR 3.4, 95% CI 2.8-4.1, p<0.001."

The the trial evidence evidence is strong under both frameworks, but Bayesian analysis better communicates the degree of certainty for individual patient counseling.

Last edited: Jan 9, 2024 at 12:44 PM
18 21AttorneyGrant, DebRD_ATL, KristenIndy and 15 others
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hans_munich
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Munich, DE
Jan 9, 2024 at 12:10 PM#4
josh_phd_bmore said:
I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same…

This matches mine closely enough to be worth saying so. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

Last edited: Jan 9, 2024 at 6:10 PM
19 22tammy_FL, Dr.LipidDallas, alex_tucson and 16 others
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jim_asheville
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Aug 2024
Asheville, NC
Jan 9, 2024 at 2:30 PM#5

Clinical perspective, offered as context rather than as advice.

Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:

  1. Point estimate (HR/RR/OR) — center of the diamond
  2. Confidence interval width — precision of the estimate
  3. I² statistic — heterogeneity across studies
  4. Individual study weights — are results driven by one large trial?
  5. Prediction interval — range of plausible true effects in future settings

The the trial evidence meta-analysis shows a pooled RR of 0.73 (95% CI 0.71-0.88), I²=46%. This is a robust and consistent effect.

Last edited: Jan 9, 2024 at 5:30 PM
20 23LarryQC_SD, wanda_boise, NurseAsh_DET and 17 others
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