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Edmonton Obesity Staging System (EOSS) Tool

Readers of these pages will recall that earlier this year Robert Kushner and I published a proposal for a new clinical obesity staging system in the International Journal of Obesity.

Rather than BMI (a measure of weight), the Edmonton Obesity Staging System (EOSS) ranks severity of obesity based on clinical assessment of weight-related health problems, mental health and quality of life. We proposed that this system would provide a far better guide to clinical decision making than using BMI class alone.

As we have now implemented the use of this system in our clinic and in the referral requirements to our program, we have also developed a simple chart and pocket tool that can be used as a reminder in a clinical setting.

Click here for Edmonton Obesity Staging System Chart

Click here for Edmonton Obesity Staging System Pocket Card

All comments are greatly appreciated.

Edmonton, Alberta


  1. How nice to see a practical and more holistic tool like this!

    Is there a working definition for “mild, moderate, significant, and severe”?

    Is it only “OR”, or would the staging be the same if a patient has more than one of the listed criteria? i.e., “AND /OR”

    There are a couple of typos in the pocket card “an established obesity-related comorbidities” and “obesity-realted”.

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  2. I would LOVE to see this evaluation method implemented! I HATE that in the current system for bariatric surgery approval, so many weight-related health issues are ignored simply because they’re not life-“threatening” (regardless of the fact that they ARE life-COMPROMISING), and I hate even more that the psychological toll of obesity-related social-discrimination, ostracism, self-hatred and low self-esteem has NEVER been taken into consideration. The current system basically negates the whole idea of physical and MENTAL health being connected. So — I hope this excellent new staging tool can make a big splash, fast…beyond Edmonton!

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  3. I was wondering if you use questionnaires for assessing quality of life and work performance.
    This is such a great system from a clinical point of view. I’ve used it for some time now in order to decide which patients need the most intervention.

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  4. Because excess weight on someone’s body is difficult or impossible to get off, it is important that doctors react IMMEDIATELY when a patient is at STAGE 1. At this stage prevention could save a person from slipping into more and more trouble.

    If a patient in Stage 1 gets a follow-up appointment for 2 months later to make sure the patient has not gained weight or worsened in other parts of the assessment, the patient would know that this really is a significant health issue. The patient would be more motivated to be careful with diet and exercise, and to watch excess weight just as closely as high blood pressure or high blood sugar or any other indicator of a danger to health.

    If a doctor says “watch your weight” but doesn’t make a follow-up appointment, the patient feels this is not very important to the doctor, and so it is not really much of a health problem.

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  5. Look, Anonymous. What you’ve just described is essentially eliminating the whole “Stage 1 patients don’t need intervention”. Jesus, people want to just pathologize any fat people.

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  6. I’m concerned about linking depression as caused by fat. I am a recurrent depressive. I gain weight during depressive episodes. In that respect depression causes weight gain, and treating the *depression* (in my case, celexa and wellbutrin) did reduce/prevent weight gain.

    On the other hand, going on a diet results in suicide ideation and other symptoms of depression. I don’t think that’s what you want to have happen. (It was also seen in the I can also induce depression symptoms by shorting myself on sleep or exercise – self-care requires exercising and eating regularly, getting enough sleep, and so forth.

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  7. Thanks doctor sahab!

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  8. Gostaria de receber informações sobre EOSS. Tenho 56 anos, 90 Kg., tive um problema na parede externa inferior do coração, mais levo uma vida saudável, ando uma hora por dia, de Segunda-Feira a Sábado, como muita fruta, tomo muito chá, como muito grão, granola, aveia e etc, e tenho uma complexão ossea muito pesada e não aceito o padrão imposto pelo sistema IMC. Portanto gostaria de conhecer melhor este sistema de medição de gordura corpórea. Sou eternamente agradecido pela sua resposta. Um abraço.

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  9. I attended your talk as ASBP and really liked the EOSS and want to start using it in our practice.
    I tried to download the EOSS tools but can’t open them – I get a message that the pdf is damaged. Could you please email them to me?

    Also I viewed your video explaining EOSS on youtube, but the background noise of the woman talking is so distracting, the video is not that helpful. Please re-record it – this would be very helpful to show our students and clinical staff.

    Thank you.


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  10. I discovered more interesting things on this weight loss issue. 1 issue is that good nutrition is very vital any time dieting. A tremendous reduction in junk food, sugary food items, fried foods, sugary foods, red meat, and whitened flour products could possibly be necessary. Retaining wastes unwanted organisms, and toxins may prevent aims for fat loss. While selected drugs for the short term solve the problem, the unpleasant side effects are certainly not worth it, and they never supply more than a momentary solution. It’s a known undeniable fact that 95% of fad diets fail. Many thanks for sharing your ideas on this website.

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  11. Dear Dr Sharma
    your classification is extremely helpful
    I shall be grateful if you could provide us with specific questions we ask our patients with obesity

    1. when interviewing the patient on mechanical/ mental /milieu issues
    2. when classifying their answers into mild/ moderate or severe problems

    for example binge eating
    ?frequency of binge eating per week ?
    portions used for binge eating

    thanks and regards

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