Edmonton Obesity Staging System Prevalence and Association with Weight Loss in a Publicly Funded Referral-Based Obesity Clinic

Karissa L Canning, Ruth E Brown, Sean Wharton, Arya M Sharma, Jennifer L Kuk, Karissa L Canning, Ruth E Brown, Sean Wharton, Arya M Sharma, Jennifer L Kuk

Abstract

Objectives: To determine the distribution of EOSS stages and differences in weight loss achieved according to EOSS stage, in patients attending a referral-based publically funded multisite weight management clinic.

Subjects/methods: 5,787 obese patients were categorized using EOSS staging using metabolic risk factors, medication use, and severity of doctor diagnosis of obesity-related physiological, functional, and psychological comorbidities from electronic patient files.

Results: The prevalence of EOSS stages 0 (no risk factors or comorbidities), 1 (mild conditions), 2 (moderate conditions), and 3 (severe conditions) was 1.7%, 10.4%, 84.0%, and 3.9%, respectively. Prehypertension (63%), hypertension (76%), and knee replacement (33%) were the most common obesity-related comorbidities for stages 1, 2, and 3, respectively. In the models including age, sex, initial BMI, EOSS stage, and treatment time, lower EOSS stage and longer treatment times were independently associated with greater absolute (kg) and percentage of weight loss relative to initial body weight (P < 0.05).

Conclusions: Patients attending this publicly funded, referral-based weight management clinic were more likely to be classified in the higher stages of EOSS. Patients in higher EOSS stages required longer treatment times to achieve similar weight outcomes as those in lower EOSS stages.

Figures

Figure 1
Figure 1
Prevalent comorbidities for patients in EOSS stage 1 (a), stage 2 (b), and stage 3 (c). CHF = congestive heart failure; EOSS = Edmonton Obesity Staging System; MI = myocardial infarction; T2D = type 2 diabetes.
Figure 2
Figure 2
Achieved absolute (kg) and percentage of weight loss relative to initial body weight in patients attending a publicly funded multisite weight management clinic among EOSS stages 0 to 3. Treatment time is in months. EOSS = Edmonton Obesity Staging System; Ref = referent group. Analyses were adjusted for age, sex, initial BMI, and treatment time. ∗Significantly different from EOSS stage 0 for absolute weight loss (P < 0.05). †Significantly different from EOSS stage 0 for percentage of weight loss (P < 0.05).

References

    1. Sharma A. M., Kushner R. F. A proposed clinical staging system for obesity. International Journal of Obesity. 2009;33(3):289–295. doi: 10.1038/ijo.2009.2.
    1. Kuk J. L., Ardern C. I., Church T. S., et al. Edmonton obesity staging system: association with weight history and mortality risk. Applied Physiology, Nutrition and Metabolism. 2011;36(4):570–576. doi: 10.1139/h11-058.
    1. Ball K., Crawford D., Owen N. Too fat to exercise? Obesity as a barrier to physical activity. Australian and New Zealand Journal of Public Health. 2000;24:1999–2001.
    1. Wills M. Orthopedic complications of childhood obesity. Pediatric Physical Therapy. 2004;16(4):230–235. doi: 10.1097/01.PEP.0000145911.83738.C6.
    1. Janssen I., Katzmarzyk P. T., Ross R. Waist circumference and not body mass index explains obesity-related health risk. American Journal of Clinical Nutrition. 2004;79(3):379–384.
    1. Ardern C. I., Katzmarzyk P. T., Janssen I., Ross R. Discrimination of health risk by combined body mass index and waist circumference. Obesity Research. 2003;11(1):135–142. doi: 10.1038/oby.2003.22.
    1. Padwal R. S., Pajewski N. M., Allison D. B., Sharma A. M. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. Canadian Medical Association Journal. 2011;183(14):E1059–E1066. doi: 10.1503/cmaj.110387.
    1. Yost T. J., Jensen D. R., Eckel R. H. Weight regain following sustained weight reduction is predicted by relative insulin sensitivity. Obesity research. 1995;3(6):583–587. doi: 10.1002/j.1550-8528.1995.tb00193.x.
    1. Gower B. A., Alvarez J. A., Bush N. C., Hunter G. R. Insulin sensitivity affects propensity to obesity in an ethnic-specific manner: results from two controlled weight loss intervention studies. Nutrition and Metabolism. 2013;10(1, article 3) doi: 10.1186/1743-7075-10-3.
    1. Pagoto S., Bodenlos J. S., Kantor L., Gitkind M., Curtin C., Ma Y. Association of major depression and binge eating disorder with weight loss in a clinical setting. Obesity. 2007;15(11):2557–2559. doi: 10.1038/oby.2007.307.
    1. Bidgood J., Buckroyd J. An exploration of obese adults' experience of attempting to lose weight and to maintain a reduced weight. Counselling and Psychotherapy Research. 2005;5(3):221–229. doi: 10.1080/17441690500310395.
    1. Lopresti A. L., Drummond P. D. Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2013;45:92–99. doi: 10.1016/j.pnpbp.2013.05.005.
    1. McElroy S. L. Obesity in patients with severe mental illness: overview and management. Journal of Clinical Psychiatry. 2009;70(supplement 3):12–21. doi: 10.4088/jcp.7075su1c.03.
    1. Ostrovsky N. W., Swencionis C., Wylie-Rosett J., Isasi C. R. Social anxiety and disordered overeating: an association among overweight and obese individuals. Eating Behaviors. 2013;14(2):145–148. doi: 10.1016/j.eatbeh.2013.01.009.
    1. Lau D. C. W., Douketis J. D., Morrison K. M., Hramiak I. M., Sharma A. M., Ur E. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children (summary) Canadian Medical Association journal. 2007;176(8):S1–S13.
    1. National Institutes of Health. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Rockville, Md, USA: NHLBI; 2000.
    1. Mifflin M. D., St Jeor S. T., Hill L. A., Scott B. J., Daugherty S. A., Koh Y. O. A new predictive equation for resting energy expenditure in healthy individuals. American Journal of Clinical Nutrition. 1990;51(2):241–247.
    1. Frankenfield D., Roth-Yousey L., Compher C. Comparison of predictive equations for resting metabolic rate in healthy nonobese and obese adults: a systematic review. Journal of the American Dietetic Association. 2005;105(5):775–789. doi: 10.1016/j.jada.2005.02.005.
    1. Wharton S., VanderLelie S., Sharma A. M., Sharma S., Kuk J. L. Feasibility of an interdisciplinary program for obesity management in Canada. Canadian Family Physician. 2012;58(1):e32–e38.
    1. Health Canada. Canadian Guidelines for Body Weight Classification in Adults. Health Canada; 2003.
    1. Gill R. S., Karmali S., Sharma A. M. The potential role of the Edmonton obesity staging system in determining indications for bariatric surgery. Obesity Surgery. 2011;21(12):1947–1949. doi: 10.1007/s11695-011-0533-8.
    1. Gómez-Ambrosi J., Silva C., Galofré J. C., et al. Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. International Journal of Obesity. 2012;36(2):286–294. doi: 10.1038/ijo.2011.100.
    1. Pouliot M.-C., Després J.-P., Nadeau A., et al. Visceral obesity in men: associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes. 1992;41(7):826–834. doi: 10.2337/diab.41.7.826.
    1. National Center for Chronic Disease Prevention and Health Promotion. Heart Disease and Stroke Prevention: Addressing the Nation's Leading Killers at a Glance. National Center for Chronic Disease Prevention and Health Promotion; 2011.
    1. Wing R. R., Blair E. H., Bononi P., Marcus M. D., Watanabe R., Bergman R. N. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care. 1994;17(1):30–36. doi: 10.2337/diacare.17.1.30.
    1. Unick J. L., Beavers D., Bond D. S., et al. The long-term effectiveness of a lifestyle intervention in severely obese individuals. The American Journal of Medicine. 2013;126(3):236–242. doi: 10.1016/j.amjmed.2012.10.010.
    1. National Heart-Lung and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, Md, USA: National Heart, Lung, and Blood Institute; 1998. (NIH Publication no. 98-4083).
    1. Shin M.-J., Hyun Y. J., Kim O. Y., Kim J. Y., Jang Y., Lee J. H. Weight loss effect on inflammation and LDL oxidation in metabolically healthy but obese (MHO) individuals: low inflammation and LDL oxidation in MHO women. International Journal of Obesity. 2006;30(10):1529–1534. doi: 10.1038/sj.ijo.0803304.
    1. Arsenault B. J., Côté M., Cartier A., et al. Effect of exercise training on cardiometabolic risk markers among sedentary, but metabolically healthy overweight or obese post-menopausal women with elevated blood pressure. Atherosclerosis. 2009;207(2):530–533. doi: 10.1016/j.atherosclerosis.2009.05.009.
    1. Wildman R. P., Muntner P., Reynolds K., et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering. Archives of Internal Medicine. 2008;168(15):1617–1624. doi: 10.1001/archinte.168.15.1617.
    1. Brochu M., Tchernof A., Dionne I. J., et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? Journal of Clinical Endocrinology and Metabolism. 2001;86(3):1020–1025. doi: 10.1210/jc.86.3.1020.
    1. Sims E. A. H. Are there persons who are obese, but metabolically healthy? Metabolism: Clinical and Experimental. 2001;50(12):1499–1504. doi: 10.1053/meta.2001.27213.
    1. Karelis A. D., Brochu M., Rabasa-Lhoret R. Can we identify metabolically healthy but obese individuals (MHO)? Diabetes and Metabolism. 2004;30(6):569–572. doi: 10.1016/S1262-3636(07)70156-8.

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