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.

1. 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

2. www.drsharma.ca

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

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

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

6. www.drsharma.ca

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

8. EOSS Predicts Mortality at Every Level of BMI
NHANES III
Overweight
www.drsharma.ca Padwal R, Sharma AM et al. CMAJ 2011

9. www.drsharma.ca

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

11. EOSS Distribution Across BMI Categories
NHANES 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 2
www.drsharma.ca Padwal R, Sharma AM et al. CMAJ 2011

12. 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
www.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

13. 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
www.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

14. 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
www.drsharma.ca Sharma AM & Kushner RF, Int J Obes 2009

16. www.drsharma.ca

17. www.drsharma.ca

18. www.drsharma.ca

19. 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

20. www.DrSharma.ca