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Should EOSS Guide Access to Obesity Surgery?

Regular readers are by now quite familiar with the Edmonton Obesity Staging System (EOSS), which describes how ‘sick’ rather than just how ‘big’ patients are.

In a paper just published in OBESITY SURGERY, we discuss how EOSS could be applied to better determine indications for bariatric surgery.

As we point out:

“…health technology assessments specify that bariatric surgery is cost-effective in patients with diabetes (EOSS stage 2). In contrast, the cost-effectiveness of bariatric surgery in patients without comorbidities (EOSS <2) is far less clear. Thus, it is likely that a formal health economics analysis based on the EOSS criteria will support the cost-effectiveness of bariatric surgery for EOSS 2/3 patients, with minimal (if any) cost-effectiveness (even in the long-term) in EOSS 0/1 individuals.”

We also note that:

“It may be argued that bariatric surgery prioritized to EOSS scores 2 and 3, who have increased severity of obesity-related comorbidities, rather than scores 0/1 may miss the opportunity to apply bariatric surgery as a preventative measure. However, in a public-funded health-care system, with limited access and resources, it is prudent to prioritize these resources to those in greatest need. In addition, there is little known about the natural history of obesity, and thus, it remains challenging to predict who will indeed progress to higher EOSS stages and who will remain stable.”

Clearly, our recent publications on EOSS have made it evident that BMI criteria alone are neither a good measure of health nor an adequate predictor of mortality.

Whatever the utility of BMI in population surveys may be, it’s use in clinical decision making is clearly limited – this will need to be reflected in future guidelines and practice recommendations.

Edmonton, Alberta

Gill RS, Karmali S, & Sharma AM (2011). The Potential Role of the Edmonton Obesity Staging System in Determining Indications for Bariatric Surgery. Obesity surgery PMID: 22002510


  1. Are there studies identifying the processes used to evaluate candidates for bariatric surgery? Surely co-morbidities are identified prior in a systematic way.

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  2. As a patient, it seems to me the “magic” of bariatric surgery is the diet that one has live on following surgery. That being the case, would it not be just as effective to simply live on that diet without actually having the surgery. Of course I realize that that’s much easier said than done, but if a person could actually do that, wouldn’t it be a far better obesity management strategy? Have there been any studies on this?

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