Comparing the predictive ability of the Edmonton Obesity Staging System with the body mass index for use of health services and pharmacotherapies in Australian adults: A nationally representative cross‐sectional study

Abstract

SummaryWe assessed the value of the Edmonton Obesity Staging System (EOSS) compared with the body mass index (BMI) for determining associations with use of health services and pharmacotherapies in a nationally representative sample of participants in the 2011–2013 Australian Health Survey. A subsample of participants aged 18 years or over, with at least overweight (BMI ≥ 25 kg/m2) or central obesity (waist measurement of ≥102 cm for men; ≥88 cm for women), and who had provided physical measurements (n = 9730) were selected for analysis. For statistical significance of each predictor, we used logistic regression for model comparisons with the BMI and EOSS separately, and adjusted for covariates. For relative explanatory ability, we used the Nagelkerke pseudo R2, receiver operating characteristic curve, and area under curve statistic. The EOSS was significantly better than the BMI for predicting polypharmacy and most of the health service use variables. Conversely, the BMI was significantly better than the EOSS for predicting having discussed lifestyle changes relevant to weight loss with the primary care physician. Clinicians, health care professionals, consumers, and policy makers should consider the EOSS a more accurate predictor of polypharmacy and health service use than the BMI in adults with overweight or obesity.

Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight‐related health problems in clinical and community settings: A rapid review of observational studies

“…These included four cohort studies, 21,22,28,29 seven case series 17–20,30–32 and nine cross‐sectional studies 33–41 . Five studies were from the United States, 21,22,29,35,41 four from Canada, 19,20,28,36 four from Germany, 17,18,31,32 two from Italy 39,40 and one each from Australia, 33 Spain, 34 Poland, 30 South Korea 37 and Brazil 38 . Of these, 12 studies were in clinical populations with sample sizes between 100 and 400 in six studies, 19,28,31,32,34,41 500 and 1000 in three studies 17,38,39 and greater than 1000 in two studies 18,20 .…”

“…Of these, 12 studies were in clinical populations with sample sizes between 100 and 400 in six studies, 19,28,31,32,34,41 500 and 1000 in three studies 17,38,39 and greater than 1000 in two studies 18,20 . The other eight were in community populations with sample sizes between 100 and 1000 in three studies, 35,36,40 8000 and 10 000 in two studies 21,33 and 17 000 and 30 000 in three studies 22,29,37 . As shown below, EOSS definitions varied substantially across the studies (Table 2).…”

“…Outcomes in studies of clinical populations were mostly postoperative complications following bariatric surgery, 17–19,30,31 treatment outcomes including postoperative changes in nonalcoholic fatty liver disease (NAFLD), 19,20,30–32 as well as associations with cesarean rates, 28 disability, 39 cardiovascular disease risk markers, 41 age/sex, BMI 38,39 and lifestyle risk factors 34 . Outcomes in studies of community populations were mortality, 21,22,29 lifestyle risk factors, 35 quality of life, skeletal strength and fitness in young participants, 36 and associations with obesity, 35,37 polypharmacy and health services use, 33 as well as work ability 40 …”

“…We present the results of our quality assessment of each study in the supporting information (Table S3). Cohort studies had eight, 28 nine 21,29 and 10 22 out of 11 quality items; case series studies had six, 30–32 eight, 17 nine, 18,20 and 10 19 out of 10 quality items; and cross‐sectional studies had four, 41 five, 34,35,38,39 six 36,37 and seven 33,40 out of eight quality items.…”

“…Of eight studies in community populations, three consistently reported that the EOSS significantly predicted mortality outcomes, 21,22,29 especially for EOSS 3 and eligible bariatric surgery subgroups 21,22 . One study reported that the EOSS was consistently associated with polypharmacy and health service use 33 . One study in young participants reported that the EOSS was inversely associated with quality of life scores, but there were no associations with objectively measured functional health (muscular strength and fitness) 36 .…”