Moving Forward With The Edmonton Obesity Staging System

Over the last several days I have been examining various aspects and implications of our recent publications showing that the Edmonton Obesity Staging System (EOSS) does a far better job of predicting mortality than does BMI (in fact BMI does almost nothing in this regard).

Not only does EOSS make intuitive sense to clinicians and most patients (especially the ones who are at EOSS 0) it is also a better way to individualize patient management strategies.

But, despite these two publications in three independent samples that included over 20,000 participants, many important questions remain to be addressed:

it is not clear whether all comorbidities should receive the same weight for defining the EOSS stage – for e.g. should chest pain due to reflux disease count the same as chest pain due to ischemic heart disease (probably not)?

What is the natural history of EOSS stage progression? Or in other words, how long does it take for patients to move from Stage 0 to Stage 1 or from Stage 2 to Stage 3? Are there really patients, who never progress? Are there predictors of progression? If yes, can this progression be delayed or prevented?

What does it take to reverse Stages and does reversing the obesity Stage improve prognosis (it probably does)?

How do cost-effectiveness and risk-benefit ratios of obesity treatment for patients look at different EOSS stages? I am guessing that both increase at higher stages, but is this really the case?

Can we develop a simplified version of EOSS (EOSS-lite?) that only counts certain comorbidities or only acknowledges certain dimensions of quality of life?

Is EOSS a concept that health professionals, decision makers, and funders are ready to adopt and will it improve practice and outcomes?

These are all questions that future research will need to address, some of this work is already underway, but I’d be happy to hear from potential collaborators or people wanting to do some of this research on their own.

If nothing else, I at least hope that the EOSS discussion has opened a whole new way of thinking about clinical assessment and definition of obesity and will find its way into clinical care pathways and management guidelines.

From everything I hear, this is already beginning to happen.

Edmonton, Alberta

Padwal RS, Pajewski NM, Allison DB, & Sharma AM (2011). Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne PMID: 21844111

Kuk JL, Ardern CI, Church TS, Sharma AM, Padwal R, Sui X, & Blair SN (2011). Edmonton Obesity Staging System: association with weight history and mortality risk. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme PMID: 21838602