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Clinical Research

Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing

International Journal of Obesity volume 45, pages 1949–1957 (2021)Cite this article

Subjects

Abstract

Background/Objectives

Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO2peak/kg).

Subjects/Methods

This observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO2peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry.

Results

VO2peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF.

Conclusions

The integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO2peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity.

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Fig. 1: Distribution of patients among the two different classifications, Edmonton Obesity Staging System (EOSS) and modified EOSS (EOSS-CRF).
Fig. 2: Weight-adjusted peak oxygen consumption (VO2peak/kg) (ml/kg/min) in the three groups of patients with obesity, classified according to the standard Edmonton Obesity Staging System (EOSS).
Fig. 3: Prevalence of the most important obesity-related comorbidities (type 2 diabetes mellitus, T2DM; prediabetes, pre-DM; hypertension, HYPT; dyslipidaemia, DLP; obstructive sleep apnoea, OSA; non-alcoholic fatty liver disease, NAFLD) grouped by both Edmonton Obesity Staging System (EOSS) and modified EOSS (EOSS-CRF) classifications.
Fig. 4: Severity of functional impairment according to the two different classifications, Edmonton Obesity Staging System (EOSS) and modified EOSS (EOSS-CRF).
Fig. 5: Impact of Edmonton Obesity Staging System (EOSS) in assigning patients to a specific group.

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Author notes

  1. These authors contributed equally: Silvia Bettini, Giulia Quinto

Authors and Affiliations

  1. Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy

    Silvia Bettini, Anna Belligoli, Gabriella Milan, Roberto Vettor & Luca Busetto

  2. Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy

    Giulia Quinto, Daniel Neunhaeuserer, Francesca Battista, Andrea Gasperetti & Andrea Ermolao

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  1. Silvia Bettini
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Correspondence to Giulia Quinto.

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Bettini, S., Quinto, G., Neunhaeuserer, D. et al. Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing. Int J Obes 45, 1949–1957 (2021). https://doi.org/10.1038/s41366-021-00856-9

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