Edmonton Obesity Staging System: association with weight history and mortality risk

Abstract

We sought to determine whether the Edmonton Obesity Staging System (EOSS), a newly proposed tool using obesity-related comorbidities, can help identify obese individuals who are at greater mortality risk. Data from the Aerobics Center Longitudinal Study (n = 29 533) were used to assess mortality risk in obese individuals by EOSS stage (follow-up (SD), 16.2 (7.5) years). The effect of weight history and lifestyle factors on EOSS classification was explored. Obese participants were categorized, using a modified EOSS definition, as stages 0 to 3, based on the severity of their risk profile and conditions (stage 0, no risk factors or comorbidities; stage 1, mild conditions; and stages 2 and 3, moderate to severe conditions). Compared with normal-weight individuals, obese individuals in stage 2 or 3 had a greater risk of all-cause mortality (stage 2 hazards ratio (HR) (95% CI), 1.6 (1.3-2.0); stage 3 HR, 1.7 (1.4-2.0)) and cardiovascular-related mortality (stage 2 HR, 2.1 (1.6-2.8); stage 3 HR. 2.1 (1.6-2.8)). Stage 0/1 was not associated with higher mortality risk. Lower self-ascribed preferred weight, weight at age 21, cardiorespiratory fitness, reported dieting, and fruit and vegetable intake were each associated with an elevated risk for stage 2 or 3. Thus, EOSS offers clinicians a useful approach to identify obese individuals at elevated risk of mortality who may benefit from more attention to weight management. Further research is necessary to determine what EOSS factors are most predictive of mortality risk, and whether these findings can be generalized to other obese populations.

Life Years Lost Associated with Obesity-Related Diseases for U.S. Non-Smoking Adults.

“…Depending on the age group, an additional ORD increased risk of death by a range of 34% to 411%. This finding is consistent with Kuk et al [28], who used the Edmonton Obesity Staging System (EOSS) to measure ORDs and found that the hazard rate for people at stage 2 of EOSS was 119% higher than the hazard rate for people at stage 1, and the hazard rate for people at stage 3 of EOSS was 35% higher than the hazard rate for people at stage 2. However, a direct comparison is difficult because the data, models, and measurements of ORDs are different.…”

“…However, most of the studies did not take ORDs into consideration, even though obesity-attributable comorbidities have been known to add variation to the simple relationship between mortality risk and body mass index (BMIthe ratio of weight in kilograms to the height in meters squared) [25,26,[28][29][30][31][32]. In terms of life years measurement, Stevens et al [27], Peeters et al [11], Fontaine et al [14], and, recently, Finkelstein et al [33] attempted to calculate life years lost to obesity, but did not estimate the change in the life years associated with ORDs.…”

The Potential Role of the Edmonton Obesity Staging System in Determining Indications for Bariatric Surgery

“…1). In the second study by Kuk et al, individuals with EOSS stage 2 or 3 had an increased risk of mortality (HR 1.6-1.7) from all causes compared to normal weight individuals [8]. However, neither stage 0 nor 1 was associated with increased mortality risk.…”

“…Determining the urgency for surgical intervention allows for improved prioritization of obese patients. This is highlighted in the study by Kuk et al, which found that a substantial number of patients with class III obesity had minimal mortality risk [8]. With BMI alone used for determining priority for bariatric surgical intervention, many patients with EOSS scores of 2 or 3 may have been overlooked.…”

A critical analysis of obesity prevention policies and strategies

“…The WHO recognizes obesity as a chronic disease and there is evidence that obesity affects morbidity and mortality at the population level. 1,64 Adopting a chronic disease framework for obesity means that both prevention and management strategies need to be implemented. Within this chronic disease context, public health needs to ensure that strategies do not have unintended consequences for individuals and populations.…”