Background: Development of a short evidence-based clinical guideline on obesity in Malta.

Objectives: To develop recommendations around two clinical areas; bariatric surgery and pharmacology for the treatment of obesity in Malta with Maltese healthcare professionals.

Methods: The guideline topic of obesity was selected by the Maltese healthcare professionals; the guideline group of healthcare practitioners was convened. Questions on bariatric surgery and pharmacology were based on the NICE obesity guideline (CG189) ‘Obesity; identification, assessment and management of overweight and obesity in children, young people and adults.’ and group agreed to update the evidence base. Systematic reviews were presented to the group for discussion to base recommendations on.

Results: Interpretation of the data on effectiveness and risks were similar to that made by other committees using this evidence base, however, recommendations were drafted that were seen as suitable to the economic context. Differences included; agreeing not to put pharmacological therapy on the national formulary, increasing the range of BMI in which treatment should start, due to the increased number of people with obesity in Malta. The language used to write the recommendations was also altered from that which is the preferred style in NICE guidelines.

Conclusion: Interpretation of the data was similar but the parameters for formulation of recommendations were dependant on the epidemiology of obesity in Malta, resource availability and the overall cultural context. Participants were very clear that to have a lower BMI for treatment to commence would be overwhelming for services. The style of writing was considered to be inappropriate with concern being raised that the meaning of the recommendation would be lost as such a style did not ‘translate’ to the Maltese environment. The recommendations were contextualised, with an understanding of not only of the language and healthcare demographics, but knowing how to target and focus the recommendations to achieve successful implementation.