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EOSS: Time To Drop Stage 0?



Readers will be well aware of the Edmonton Obesity Staging System (EOSS), which classifies the severity of obesity on a five-point ordinal scale based on presence of medical, mental, and/or functional health issues related to excess weight.

By design, EOSS considers Stage 0 in individuals, who meet the BMI criteria for obesity but do not have any apparent health issues.

However, given the recent change in definition of obesity expressed in the newly released Canadian Adult Obesity Clinical Practice Guidelines, obesity is defined as, “the presence of excess or abnormal body fat that impairs health”, BMI should no longer be used as the defining characteristic of obesity.

Thus, one would not consider someone who has no health impairments, irrespective of BMI, to have obesity.

As a result, the EOSS stage 0 no longer makes sense, as this individual, by definition, would no longer meet the key criterion for obesity, namely an impairment in health (perhaps one may consider the term “pre-obesity” in this context?).

This also means that it is now time to abandon the term “healthy obesity” – either you have obesity, meaning you have a health impairment attributable to excess body fat, or you simply do not have obesity!

In practice, you need to be able to list exactly what weight-related health impairments a given person has before labelling them as having obesity.

If you cannot specifically list the health impairments (at least possibly) attributable to excess body fat, then that individuals, irrespective of BMI, does no longer meets the diagnostic criteria for obesity.

This seismic change in how we apply the term “obesity” to a clinical diagnosis will take time to implement and be adopted. No doubt, many will long back for simpler times, where you could just step on a scale, plug the numbers into a BMI calculator, and make a diagnosis based on tables or charts.

It will be interesting to see how long it will take for this new definition to be widely adopted in policy and practice.

@DrSharma
Berlin, D

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