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Health Is Not Measured In Pounds

As anyone watching the news over the past 24 hours will probably have noticed, yesterday saw the release of two large studies looking at whether or not the Edmonton Obesity Staging System is a better predictor of mortality risk than BMI alone – the short answer is “yes”.

The results from these studies was reported by all major media outlets around the globe including CNN, TIME, MSNBC, and virtually all national print, radio, and tv stations. It was also picked up by the blogsphere.

Interestingly, when I first suggested the use of a staging system for obesity in 2008, it was born out of both a practical need and my own medical experience with obese patients.

The practical need was to better determine, who needs to be seen in our obesity program, given the rather limited resources and long waiting times.

My medical experience had long taught me that the commonly used BMI classification of obesity, or even the suggested use of waist circumference were rather blunt instruments in determining which patients needed obesity treatments and which did not.

So, the idea was simply to create a clinical tool that would help us decide, which obese patients required our attention most urgently.

However, as readers will imagine, with all the talk about ‘healthy” weights and ‘benefits’ of weight loss, our proposal was met with considerable scepticism – not about whether or not obese people with obesity related health problems (EOSS 2-4) needed treatment, but rather whether or not obese people who appeared pretty healthy (EOSS 0/1) were indeed at a low risk from their excess weight.

So we looked for large datasets in which we could apply EOSS and compare it to BMI in predicting death.

In one collaboration, on which my colleague Raj Padwal took the lead, assisted by David Allison and Nicholas Pajewski from the University of Birmingham, Alabama, we looked at the impact of EOSS on mortality in two separate sets of the NHANES study – a representative sample of the US population. The results of this analysis were published yesterday in the Canadian Medical Association Journal.

In another collaboration, on which Jennifer Kuk and Chris Ardern (York University, Toronto) took the lead with help from Timothy Church (Pennington Biomedical Research Center, Baton Rouge, LA), and Xuemi Sui and Steven Blair (University of South Carolina), we looked at the impact of EOSS on mortality in the Aerobics Center Longitudinal Study (n = 29 533). The results were released yesterday in the Applied Physiology, Nutrition & Metabolism.

In today’s post, I will not go into details of the studies or begin a lengthy discussion of the findings – suffice it to say, till someone comes up with an even better way to clinically assess the health status of obese patients, to help decide who does and who does not need obesity treatment, the Edmonton Obesity Staging System may be just the tool that clinicians, payers, and patients have been looking for, to help dispel the notion that health can be measure by simply stepping on a scale.

Edmonton, Alberta


  1. Congratulations! This is much needed, and I predict that it will rapidly become the gold standard in primary care risk assessment.

    One question that comes to mind is to what extent assessment and analysis of US populations generalize to other populations. And did your results show any differences for subpopulations – smokers, high ETOH use, age, rural vs urban, and gender, for example?

    I am very appreciative of what and how much you generously share on your blog. Many thanks!

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  2. While I appreciate the effort to recognize that one can be obese and healthy, I donhave one important question: when a “normal” weight(i.e. BMI under 30) presents with hypertension, diabetes or any of the health issues you cite, how do you believe theybshould be treated? Is weight loss part of thetreatment of diabetes and hypertension for someone with a BMI of 25? Because ultimately you end up placing the problem with weight, rather thn with treatable medical problems Why would it be more problematic for an obese person who is hypertensive and diabetic to be treated in the same fashion as someone who is not obese with those same conditions.

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  3. Dr. Sharma — for the last couple of days I’ve been following the media reaction to these studies with great interest, along with the sometimes vitriolic comments from readers in response. Two questions (objections) have come up that I’d like to ask you about.

    First, were metabolically healthy obese compared against all normal weight people or against only metabolically healthy normal weight people?

    Second, did these studies receive funding from the food industry? I saw the conflict of interest statement on one where the researchers had been funded (not sure for this study or just in general) by both Coca-Cola and Jenny Craig, so I kind of figure those two balance out somewhat.

    I am really glad to see the conversation changing from weight to health — only wish the popular sentiment out there were not so nasty.

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  1. Arya, the EOSS and everything | Quantum Acceptance - [...] who, among people whose BMI put them in the obese category, was at greatest risk of death. Arya Sharma…

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