Edmonton obesity staging system
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Edmonton Obesity Staging System (EOSS) Arya M Sharma, MD, FRCP(C) Professor of Medicine Chair in Obesity Research & Management University of Alberta Edmonton, AB, Canada www.drsharma.ca
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The Edmonton obesity staging system (EOSS), is a 5-point ordinal classification system that considers comorbidity and functional status, in predicting mortality in a nationally representative US sample. In analysis of three large independent data sets (NHANES, COOPER Study), the Edmonton obesity staging system independently predicted increased mortality even after adjustment for contemporary methods of classifying adiposity. The Edmonton obesity staging system may offer improved clinical utility in assessing obesity-related risk and prioritizing treatment.
Transcript of Edmonton obesity staging system
Edmonton Obesity Staging System (EOSS)
Arya M Sharma, MD, FRCP(C)Professor of Medicine
Chair in Obesity Research & ManagementUniversity of Alberta
Edmonton, AB, Canadawww.drsharma.ca
www.drsharma.ca
Edmonton Obesity Staging System (EOSS)
Stage 0
Sharma AM & Kushner RF, Int J Obes 2009
Stage 1
Stage 2
Stage 3
Stage 4
Med
ical
Men
tal
Func
tiona
l
abse
nt
abse
nt
abse
nt
pre-
clini
cal
risk
fact
ors
mild
mild
co-morbidity
moderate
moderateend-organ
damage
severesevere
end-stage
end-stage
end-stage
Obesity
www.drsharma.ca
Edmonton Obesity Staging System (EOSS)
Stage 0 Normal blood pressure
Sharma AM & Kushner RF, Int J Obes 2009
Stage 1 Pre-hypertension
Stage 2
Hypertension
Stage 3LVHCHD
Stage 4HeartFailure
Hypertension
www.drsharma.ca
Edmonton Obesity Staging System (EOSS)
Stage 0 Normal blood glucose
Sharma AM & Kushner RF, Int J Obes 2009
Stage 1 IFT/IGT
Stage 2
Type 2Diabetes
Stage 3Micro-/macro-vascular
disease
Stage 4BlindnessESRD
Type 2 Diabetes
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www.drsharma.ca
EOSS Predicts Mortality in NHANES III
Padwal R, Sharma AM et al. CMAJ 2011www.drsharma.ca
EOSS Predicts Mortality at Every Level of BMINHANES III
Padwal R, Sharma AM et al. CMAJ 2011
Overweight
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Association Between EOSS and Mortality Risk in Aerobics Center Longitudinal Study (n = 29 533)
Kuk JL, et al. Appl. Physiol. Nutr. Metab. 2011;36: 570www.drsharma.ca
EOSS Distribution Across BMI CategoriesNHANES III (1988-1994)
15%
28%
47%
10%
5%
17%
64%
14%
Class II
8%
19%
59%
14%
Class I
5%14%
67%
14% EOSS Stage 0
EOSS Stage 1
EOSS Stage 2
EOSS Stage 3
Overweight
ClassIII
Padwal R, Sharma AM et al. CMAJ 2011
50 million
23 million
10 million
6 million
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EOSS Case 1
24 year-old physically active female, BMI of 32 Kg/m2
no demonstrable risk factors, no functional limitations, or mental health issues
Class I, Stage 0 Obesity
- Focus on prevention of further weight gain- Health benefits of more aggressive obesity
treatment likely marginal
Sharma AM & Kushner RF, Int J Obes 2009www.drsharma.ca
EOSS Case 2
32 year-old male BMI of 36 Kg/m2
hypertension, sleep apnea, depression
Class 2, Stage 2 Obesity
- Clear benefits of obesity treatment
Sharma AM & Kushner RF, Int J Obes 2009www.drsharma.ca
EOSS Case 3
63 year-old male BMI of 74 Kg/m2
disabling osteoarthritis (wheel chair)severe hypoventilation, fibromyalgia,
generalized anxiety disorder
Class 3, Stage 4 Obesity
- Aggressive obesity treatment unless deemed palliative
Sharma AM & Kushner RF, Int J Obes 2009www.drsharma.ca
www.drsharma.ca
www.drsharma.ca
www.drsharma.ca
Key Points
• EOSS provides a rational framework for clinical prioritization and management
• EOSS stage is a better predictor of obesity risk than BMI or waist circumference
• Assessing EOSS stage should be part of the clinical assessment of obesity
• Management strategies should be based on EOSS stage
www.drsharma.ca
www.DrSharma.ca
