Clinical Assessment: Edmonton Obesity Staging System

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.


Although higher BMI levels are generally associated with greater mental, medical and functional problems, anthropometric measures alone are not a good reflection of the severity or extent of obesity-related comorbidities. Sharma and Kushner have recently suggested a clinical staging system to complement the BMI when describing the severity of obesity.

The Edmonton Obesity Staging System consists of the following five stages:

Stage 0: Patient has no apparent obesity-related risk factors (e.g., blood pressure, serum lipids, fasting glucose, etc. within normal range), no physical symptoms, no psychopathology, no functional limitations or impairment of well-being.

Stage 1: Patient has one or more obesity-related sub-clinical risk factors (e.g., elevated blood pressure, impaired fasting glucose, elevated liver enzymes, etc.), mild physical symptoms (e.g., dyspnea on moderate exertion, occasional aches and pains, fatigue, etc.), mild psychopathology, mild functional limitations and/or mild impairment of well-being.

Stage 2: Patient has one or more established obesity-related chronic diseases requiring medical treatment (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.), moderate functional limitations and/or moderate impairment of well-being.

Stage 3: Patient has clinically significant end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitations and/or significant impairment of well-being.

Stage 4: Patient has severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being

The Edmonton Obesity Staging System is used together with BMI class as follows:

Case 1: A 24-year-old physically active female with a BMI of 32 kg/m2 with no demonstrable risk factors, functional limitations or self-esteem issues would have Class I, Stage 0 Obesity. In this patient the focus would be on prevention of further weight gain. Health benefits of more aggressive obesity treatment would likely be marginal.

Case 2: A 32-year-old male with a BMI of 36 kg/m2 who also has essential hypertension and obstructive sleep apnea would have Class II, Stage 2 Obesity. This person would have a clear indication for obesity treatment.

Case 3: A 45-year-old female with BMI of 54 kg/m2 who is in a wheelchair because of disabling arthritis and severe hypopnea would have Class III, Stage 4 Obesity. This patient will either require aggressive obesity treatment or be deemed palliative.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

If you have already read Best Weight, please take a few minutes to leave a review on the Amazon or Barnes & Nobles website.