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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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Edmonton Obesity Staging System (EOSS) Stage 2 co-morbidity moderate Stage 1 Stage 3 moderateStage 0 Stage 4 Obesitywww.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

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Edmonton Obesity Staging System (EOSS) Hypertension Stage 2 Hypertension Stage 1 Pre- LVH Stage 3 hypertension CHDStage 0 Normal Heart Stage 4 blood pressure Failurewww.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

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Edmonton Obesity Staging System (EOSS) Type 2 Diabetes Stage 2 Type 2 Diabetes Stage 1 IFT/ Micro-/macro- Stage 3 IGT vascular diseaseStage 0 Normal blood glucose Blindness Stage 4 ESRDwww.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

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EOSS Predicts Mortality in NHANES IIIwww.drsharma.ca Padwal R, Sharma AM et al. CMAJ 2011

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EOSS Predicts Mortality at Every Level of BMINHANES III Overweightwww.drsharma.ca Padwal R, Sharma AM et al. CMAJ 2011

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Association Between EOSS and Mortality Risk inAerobics Center Longitudinal Study (n = 29 533)www.drsharma.ca Kuk JL, et al. Appl. Physiol. Nutr. Metab. 2011;36: 570

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EOSS Distribution Across BMI CategoriesNHANES III (1988-1994) 14% 8% 19% 10% 15% Class I 59% 5% 14% Overweight 17% 23 million 28% Class II 47% 64% 5% EOSS Stage 14% 14% 0 10 million Class EOSS Stage III 1 50 million 67% EOSS Stage 6 million 2www.drsharma.ca Padwal R, Sharma AM et al. CMAJ 2011

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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 marginalwww.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

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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 treatmentwww.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

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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 palliativewww.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

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www.drsharma.ca

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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 stagewww.drsharma.ca

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www.DrSharma.ca