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Disease Severity and Staging of Obesity

sharma-edmonton-obesity-staging-systemRegular readers will be well aware of our work on the Edmonton Obesity Staging System (EOSS), that classifies individuals living with obesity based on how “sick” rather than how “big” they are.

For a rather comprehensive review article on the issue of determining the severity of obesity and potentially using this as a guide to treatment, readers may wish to refer to a paper by Whyte and colleagues from the University of Surrey, UK, published in Current Atherosclerosis Reports.

This paper not only nicely summarizes the potential effects of obesity on various organs and organ systems but also discusses the use of staging systems (EOSS and Kings) as a way to better characterize the impact of excess weight on an individual.

As the authors note in their summary,

Using a holistic tool in addition to BMI allows highly informed decision-making and on a societal level helps to identify those most likely to gain and where economic benefit would be maximised.”

Not surprisingly, the Edmonton Obesity Staging System, which has been validated against large data sets as a far better predictor of mortality than BMI, waist circumference or metabolic syndrome, is being increasingly adopted as a practical tool to guide clinical practice.

Merida, Mexico

ResearchBlogging.orgWhyte MB, Velusamy S, & Aylwin SJ (2014). Disease severity and staging of obesity: a rational approach to patient selection. Current atherosclerosis reports, 16 (11) PMID: 25278281


  1. Pity the cost of reading this paper is £30! it would be interesting to know the criteria, particularly if it is being used to select patients for bariatric surgery. The recent report that found more complications in subsequent re-modelling operations after surgical weight loss (due to poor nutrition following surgery) makes it imperative that use of bariatric surgery is very carefully considered, and used only when all else seems to have failed.

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  2. What is the goal of the EOSS?

    I understand it aims to classify the degree of disease, but what for?
    Have you evaluated if it improves care? Lowers mortality? Lowers medical costs?

    Also, have you evaluated the potential for harm?
    It seems to me that it can only be used to decide who gets bariatric surgery next on the waiting list. The sickest ones get treated, whereas the less sick ones will have to get worse before they can get treated.

    I know I sound pessismistic, but I honestly don’t understand how the EOSS could help most patients. 🙁

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  3. One way the EOSS can help some patients is by pointing out that some of us with high BMIs aren’t actually sick, and may not need treatment at all, other than adopting healthy behaviors to improve our health (whether or not we lose weight).

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  4. If the EOSS says that you aren’t actually sick, besides being obese (which I think is a disease, but not everyone agrees), then you get no treatment at all.

    We are going to wait until you get diabetes before we address the obesity, which we knew all along was a strong risk factor for diabetes.

    You seem to think that is a good thing. How so?

    As for the healthy behaviors regardless of your weight, well, yes, of course. I think we all agree on that (at least in theory). But it doesn’t (or shouldn’t) have anything to do with the EOSS.

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    • EOSS is about risk assessment – every treatment (including lifestyle change) carries risk. For someone with a low risk (= low EOSS stage) only the safest treatment would be recommended because a treatment that has a higher risk (e.g. a medication or bariatric surgery) may do more harm than good. For someone with a high EOSS stage, the risk of taking a medication or having surgery is most certainly less than the risk of doing nothing – this is when you would decide in favour of a treatment. Most people who have obesity (over 75%) will never get diabetes – if you treated every obese person just to prevent diabetes you will be exposing a lot of people to the risk of treatment with no discernible benefit. In contrast, if you only treat people with early signs of diabetes (pre-diabetes = EOSS Stage 1), you will only be exposing people who actually have a high risk of diabetes to your treatment. This not only saves cost but also reduces potential harm from the treatment to people who carry no risk of ever getting diabetes (no matter how fat they get).

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  5. Thanks for the thoughtful response.

    It wasn’t clear to me that the current EOSS stage was used as a proxy for risk of future problems (or risk of doing nothing). It makes a whole lot more sense to me when you put it that way.

    Oh, and good point about the risks associated with any treatment, including lifestyle changes. That one is easy to overlook (and must not be a popular opinion among your collegues, judging by all the “interventionism” I see).

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