The Edmonton Obesity Staging System for Pediatrics (EOSS-P) better defines health risk than obesity class

As readers may recall, based on our findings that the Edmonton Obesity Staging System (EOSS) is a far better predictor of long-term mortality than BMI in adults, my pediatric colleagues developed an adaptation of EOSS for use in kids (EOSS-P).

Now, Stasia Hadjiyannakis and a consortium of pediatric colleagues from across Canada, in a paper published in The Lancet Child & Adolescent Health, show that EOSS-P is superior to BMI class (based on weight curves) in determining the burden of disease in kids.

The authors looked at data from the from the Canadian Pediatric Weight Management Registry (CANPWR), a cross-sectional study of children with obesity aged 5–17 years recruited from ten multidisciplinary paediatric weight management clinics in Canada.

The researchers classified the almost 850 participants into WHO BMI classes (class I as 2–3 SD scores, class II as >3 SD scores, and class III as >4 SD scores above the WHO growth standard median), and then applied the EOSS-P staging system (stages 0, 1, and 2/3) based on the clinical assessment of coexisting metabolic, mechanical, mental health, and social milieu issues.

Based on BMI, 64% or participants had severe obesity (ie, class II or III) and 80% were EOSS-P stage 2/3. Overall, mental health concerns were most common (61% of participants), followed by metabolic (41%), adverse social milieu (21%), and mechanical (10%) health issues.

While mental health issues (eg, anxiety and attention-deficit hyperactivity disorder) were equally distributed across BMI classes, metabolic health issues were slightly more common in higher BMI classes, and mechanical (eg, musculoskeletal issues and sleep apnoea) and social milieu (eg, bullying and low household income) issues increased with increasing BMI class.

Of children with class I obesity, 76% had overall EOSS-P stage 2/3, compared with 85% of children with class III obesity. Thus, although kids with class III obesity do on average have higher EOSS-P stages, over 3 in 4 kids with class I obesity also carry a high burden of risk (especially mental health and metabolic risk).

Thus, as in adults, BMI levels alone do not accurately reflect the actual health risk of individual kids, supporting the notion that the use of EOSS-P can better guide clinicians in managing kids presenting with obesity than BMI class alone.

Buenos Aires, Argentina