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When is a Condition Obesity Related?

Yesterday, I blogged about the proposed Edmonton Obesity Staging System. This prompted a number of comments and questions.

Here a few quick answers regarding the Staging System:

1) The terms mild, moderate, and severe are of course subjective. In some cases there are objective measures (e.g. valid scales) to assess the severity of symptoms but in other cases, this call is really to be made by the medical professional based on the interview, physical exam and other assessments.

Although there may be some variability in judgement between clinicians, hopefully, the inter-rater reliability will not be too far off.

2) What is the definition of obesity related comorbidity?

Unfortunately, excess weight can lead to a wide range of health problems. However, it is often not entirely clear whether or not a specific problem in a given patient is really entirely weight related.

Thus for e.g. although obesity is a common cause of fatty liver disease, there are many other factors that can lead to excess accumulation of liver fat. Often it may only be possible to tell if a problem is obesity related when the problem actually gets better or even disappears with weight loss.

I generally suggest that in order to be considered obesity related, a problem has to meet at least two of the following three criteria.

1) There is good epidemiological evidence that the condition is more common in people with overweight or obesity.

2) There is evidence that the condition actually gets worse with weight gain and/or better with weight loss.

3) There is a plausible biological link between the condition and excess weight.

It the condition meets at least two of these criteria, it may be fair to assume that it is likely weight-related unless there is substantial reason to suspect another cause.

Once again, the final proof that a specific condition is in fact weight-related can only come from the demonstration that the condition actually does get better with weight loss (This of course does not apply to conditions like obesity related cancers, which, once established are unlikely to disappear or get better with weight loss).

Hopefully, these explanations provide some clarification. Several research projects are currently underway to further validate this staging system to increase its utility in medical research and practice.

Once again, all ideas and comments are greatly appreciated.

Edmonton, Alberta


  1. In SLovakia is obesity considered as a simple , moderate and severe – but health insurance system does not consider exogene / not secondary / obesity as a separate disease, so does not cover neither treatment, nor physicians work with that kind of patienst. Only if obesity is a symptom or result of some endocrinal disease, can be expenses of that treatment forwarded for reimbursment to the contracted health insurance company, except of using any farmacological medication / sibutramin for example/ . Not any health insurance covers using of anti obesity medication, same with cognitive – behavioral treatment or other psychological interventions or bariatric or other surgery – uless is patient in lifetreathening state. What is common overthere overseas ?

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  2. Good point – this view of obesity is not uncommon – may health systems do not provide professional help to people struggling with excess weight. Not only is this a “gift” to the commercial weight loss industry, but we also know that this is a huge cost to the health care system as sooner or later, without professional help, people battling excess weight will develop problems like diabetes, hypertension, sleep apnea, fatty liver disease, osteoarthritis and countless other health problems.
    By not paying for obesity treatments (irrespective of cause) health care payers are simply setting themselves up for substantially greater costs later down the road.
    I also truly believe that lack of payment is simply another manifestation of weight bias and discrimination.

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  3. I guess it is more on docs professional organisations and societies to give obesity same importancy as to other parts of the metabolic syndroma are giving . SImply – if metanalysis of almost all studies show that obesity compare to “normal ” weight increasing of morbi – moratility endpoints and worsen outcoms of any treatment of hypertesnsion, diabetes etc. we sholud treta it very seriously and we should reach targeted weight which should be calculate on the starting weight of the patioents on teh first visit at the office regards to other comorbidities and age and this target weight should be reached in time period of before agreed. We should have a guidlelines how to measure succes of obesity tretament and how this will improove prognosisi of obese subject, based on evidence based medicine – just same as we have for hypertension, dyslipéidaemia, diabetes etc . . First we have to change obesity picture in the physicians head. Most of the physicians tolerates obesity of the patients, event if they agree to treat other risk factors as good as possible …

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