Obesity ranking system

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An obesity classification system that distinguishes between fat and lean

tissue and takes into account functional status and the various comorbid

conditions that can be associated with obesity may be a more effective

mortality prediction tool than standard body mass index (BMI), according to

new research published

online<http://www.cmaj.ca/lookup/doi/10.1503/cmaj.110387>August 15 in

the

*Canadian Medical Association Journal*.

" Anthropometric-based classification schemes for excess adiposity do not

include direct assessment of obesity-related comorbidity and functional

status and thus have limited clinical utility, " the researchers, led by Raj

S. Padwal, MD, from the Department of Medicine, University of Alberta,

Edmonton, Canada, explain. The new tool, called the Edmonton obesity staging

system (EOSS), ranks obese and overweight people according to a 5-point

scale based on factors relating to an individual's underlying health status

and the presence or absence of underlying health conditions and, therefore,

may be a better predictor of mortality.

A 0 on the EOSS scale, for instance, represents " no apparent risk factors

(e.g., blood pressure, serum lipid and fasting glucose levels within normal

range), physical symptoms, psychopathology, functional limitations and/or

impairment of well-being related to obesity, " according to the study

authors.

A ranking of 2 indicates " the presence of established obesity-related

chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea,

osteoarthritis), moderate limitations in activities of daily living and/or

well-being, " and the highest ranking indicates " Severe (potentially

end-stage) disabilities from obesity-related chronic diseases, severe

disabling psychopathology, severe functional limitations and/or severe

impairment of well-being. "

In determining efficacy of the tool, researchers with the University of

Alberta applied it to data on 8143 people aged 20 years and older in the

1988–1994 and 1999–2004 US National Health and Human Nutrition Examination

Surveys (NHANES).

The results indicated that 77.2% of overweight or obese people in the

1988–1994 survey and 90.3% of those in the 1999–2004 survey were classified

as stage 1 or 2 in the EOSS, and their risk for death was significantly

lower than that of overweight or obese people classified as stage 3.

In the NHANES 1988–1994 data, scores of 2 and 3 each were associated with a

higher risk for dying (hazard ratio, 1.57; 95% confidence interval [CI],

1.16 - 2.13; hazard ratio, 2.69; 95% CI, 1.98 - 3.67, respectively) compared

with scores 0 or 1.

The higher risk was seen even after adjustment for BMI, metabolic syndrome,

and hypertriglyceridemic waist (ie, waist circumference ≥ 90 cm and a

triglyceride level ≥ 2 mmol/L for men or ≥ 85 cm and ≥ 1.5 mmol/L for

women), as well as in a cohort eligible for bariatric surgery.

Measurements of BMI and waist circumference are typically among key factors

in the assessment of appropriate treatments for obesity, such as bariatric

surgery or antiobesity therapies.

But BMI fails to directly distinguish between fat and lean tissue, and

neither measurement reflects underlying obesity-related functional status or

health conditions, which can include diabetes, hypertension, dyslipidemia,

osteoarthritis, liver disease or kidney disease, or metabolic syndrome.

In considering the broader range of factors, the EOSS is intended to provide

more clinically relevant prognostic information in a manner similar to that

of the tumor, node, metastasis system used in the staging of cancer, the

authors write.

" The major incremental contribution of this staging system to anthropometric

indices and cardiovascular risk equations is the direct measurement of the

presence and severity of underlying obesity-related comorbidities, which

enables a more comprehensive and individualized assessment of risk, " they

said.

" Such enhanced risk assessment may enable a greater understanding of

obesity-related prognosis and may also assist in determining the urgency of

intervention. "

The system could be particularly beneficial in prioritizing patients for

bariatric surgery according to ranking that reflects a broader assessment of

obesity and obesity-related comorbid conditions than simply a BMI ranking,

the authors added.

There are several study limitations, including, but not restricted to, the

following: Equal weighting applied to different comorbid conditions (eg,

osteoarthritis and diabetes), and the study design was retrospective, which

rendered certain information, such as psychological function, unavailable.

" We propose that this system be considered adjunctive to current

anthropometric classification systems in assessing obesity-related risk,

determining prognosis and guiding treatment, " they concluded. " Further

refinement of the staging system would assist in determining the best way of

incorporating it into clinical care. "

*The study was funded by the National Institutes of Health. Two study

authors are supported by an alternative funding plan from the government of

Alberta and the University of Alberta. Another author has received grants,

honoraria, donations, and consulting fees from numerous commercial and

nonprofit entities with interests in obesity. *

*CMAJ*. Published online August 15,

2011<http://www.cmaj.ca/lookup/doi/10.1503/cmaj.110387>

..

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--

Ortiz, MS, RD

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