Using the Edmonton Obesity Staging System to Predict Risk Weight Risks
The Body Mass Index (BMI) scale has been criticized as not giving a full picture of the relationship between weight status and health risks. Researchers from the University of Alberta have created a new scale that takes into consideration other factors besides height and weight to give people a more complete awareness about what they can do to reduce complications from excess weight and possibly extend their lives.
According to the World Health Organization, more than 65% of the world’s population lives in countries where obesity is a leading contributor to death. Obesity is the fifth leading cause of death in the world, but other life-shortening ailments, such as heart disease and diabetes, are often worsened by the presence of excess weight.
The Edmonton Obesity Staging System (EOSS) is a tool that encompasses not only weight, but also factors such as physical symptoms, psychological symptoms, and functional limitations that are co-morbid factors to obesity. The five-stage scale was first presented by Dr. Arya M Sharma MD in the International Journal of Obesity in 2009. A more recent study of the EOSS, published in the Canadian Medical Association Journal, suggests that physicians use the scale to more reliably predict an overweight or obese patient’s risk for death and the degree to which they require medical care.
“With EOSS, physicians can rapidly assess needs, and just as importantly, prioritize treatment resources, such as surgery. The potential for significantly improved patient outcomes and optimizing health services is huge,” says Sharma.
Stage 0 of the EOSS finds that a person who is clinically obese by the BMI scale (BMI greater than 30) has no apparent obesity-related risk factors such as high blood pressure, high cholesterol, or high blood sugar. They do not display physical symptoms from their weight, such as being out of breath upon exertion, nor do they have psychological issues (ie: depression or impairment of well-being) related to weight status.
In Stage One, the patient does have subclinical risk factors, such as borderline hypertension, impaired fasting glucose (but not clinical diabetes), or elevated liver enzymes. They have mild physical symptoms such as dyspnea on moderate exertion or mild aches and pains and fatigue, but these do not require medical intervention. Quality of life is not impacted due to weight.
In both Stage Zero and One, the patient does not meet clinical criteria for extensive medical care, but should be referred to a primary care physician for advice on how to prevent further weight gain and to prevent these mild symptoms from progressing.
Stage Two patients have established obesity-related chronic diseases – high blood pressure, Type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, etc. They have moderate psychological symptoms such as depression, eating disorders, or anxiety disorders. Quality of life is beginning to be impacted due to functional limitations to daily activities. Close monitoring and management of corborbidities is recommended.
Stage Three is when a patient has significant obesity-related damage. These include myocardial infarction (heart attack), heart failure, diabetic complications such as eye disease or kidney failure, and incapacitating osteoarthritis. Major depression or suicide ideation may be an issue. Quality of life and impairment of well-being is severely impacted. Patients in this stage need more intensive obesity treatment and aggressive management of their co-morbid conditions. Bariatric surgery should be considered for those who qualify.
The last stage, Stage Four, is considered potentially end-stage obesity due to se4vere disability, severely disabling psychological symptoms and/or severe functional limitations. If a patient can tolerate aggressive obesity management, they should be enrolled in the appropriate program. For others, palliative measures including pain management, occupational therapy, and psychological support is indicated.
For physicians, a one-page flow-chart of the Edmonton Obesity Staging System Tool is available through the University of Alberta and Alberta Health Services.