Understanding Clinical Assessment Using The Edmonton Obesity Staging System

Transcription

1 Understanding Clinical Assessment Using The Edmonton Obesity Staging System Arya M Sharma, MD. PhD, FRCPC Research Chair for Obesity Research & Management University of Alberta Medical Director Alberta Provincial Obesity Program Edmonton, AB, Canada P [ ]-V1.0C

2 BMI is a useful operational definition for obesity but should not be used as the defining characteristic of the disease.in the case of individuals who are very obese, issues of definition and measurement are not relevant.

3 Anatomical Terms Used to Describe Obesity (historical) Cellular hyperplastic hypertrophic) Sharma AM & Kushner RF, IJO 2009;33, 289

4 Anatomical Terms Used to Describe Obesity (historical) Cellular hyperplastic hypertrophic) Somatotypes ectomorphic, mesomorphic endomorphic Sharma AM & Kushner RF, IJO 2009;33, 289

5 Anatomical Terms Used to Describe Obesity (historical) Cellular hyperplastic hypertrophic) Somatotypes ectomorphic, mesomorphic endomorphic Body segment central peripheral Sharma AM & Kushner RF, IJO 2009;33, 289

6 Anatomical Terms Used to Describe Obesity (historical) Cellular hyperplastic hypertrophic) Somatotypes ectomorphic, mesomorphic endomorphic Body segment central peripheral Distribution pattern android gynoid Sharma AM & Kushner RF, IJO 2009;33, 289

7 Anatomical Terms Used to Describe Obesity (historical) Cellular hyperplastic hypertrophic) Somatotypes ectomorphic, mesomorphic endomorphic Body segment central peripheral Distribution pattern android gynoid Depot visceral subcutaneous ectopic (visceral, subcutaneous, ectopic) Sharma AM & Kushner RF, IJO 2009;33, 289

8 Quetelet Index (1832) body weight (Kg) height (m) 2 Renamed Body Mass Index by Ancel Keys in 1972 Adolphe Quetelet ( )

9 BMI and Body Fat European South Asian Yajnik CS, Lancet Jan 10;363(9403):163. DXA scan of two individuals with the same BMI but markedly different percent body fat Yudkin & Yainik, Lancet 2004

10 Relationship Between BMI and Percent Body Fat in Men and Women Body Fat (%) Women Men Body Mass Index (kg/m 2 ) Adapted from: Gallagher et al. Am J Clin Nutr 2000;72:694.

11 INTERHEART Study Yusuf S et al. Lancet 2005;366:

12 Association of Waist-to-Hip Ratio Within BMI Categories with Myocardial Infarction Risk OR (95% CI) < >30 BMI (kg/m 2 ) Yusuf S et al. Lancet 2005;366:

13 the surgical treatment benefit with respect to cardiovascular events was not related to baseline BMI or waist circumference no significant relationships between weight change and cardiovascular events could be demonstrated

14 Although weight loss in general is desirable for obese patients, the overweight condition by itself is not informative. Physicians need to know an individual patient s risk factor profile before initiating therapy.

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

17 Edmonton Obesity Staging System (EOSS) Hypertension Stage 2 Hypertension Stage 1 Prehypertension LVH CHD Stage 3 Stage 0 Normal blood pressure Heart Failure Stage 4 Sharma AM & Kushner RF, Int J Obes 2009

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

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20 EOSS Predicts Mortality in NHANES III Padwal R, Sharma AM et al. CMAJ 2011

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

22 EOSS Predicts Mortality even in Overweight

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

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29 EOSS Case 1 24 year-old physically active female, BMI of 32 Kg/m 2 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 Sharma AM & Kushner RF, Int J Obes 2009

30 EOSS Case 2 32 year-old male BMI of 36 Kg/m 2 hypertension, sleep apnea, depression Class 2, Stage 2 Obesity - Clear benefits of obesity treatment Sharma AM & Kushner RF, Int J Obes 2009

31 EOSS Case 3 63 year-old male BMI of 74 Kg/m 2 disabling osteoarthritis (wheel chair) severe hypoventilation, fibromyalgia, generalized anxiety disorder Class 3, Stage 4 Obesity - Aggressive obesity treatment unless deemed palliative Sharma AM & Kushner RF, Int J Obes 2009

32 EOSS Predicts Surgical Risk

33 EOSS Predicts Surgical Risk Chiappetta S et al. SOARD (in press)

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35 EOSS is a better predictor of pregnancy with fertility treatment than BMI: A prospective study (n=101) Paterson N, et al. Clin Obesity (in press)

36 EOSS is a better predictor of pregnancy with fertility treatment than BMI: A prospective study (n=101) Paterson N, et al. Clin Obesity (in press)

37 Paediatr Child Health Vol 21 No 1 January/February 2016

38 EOSS-P Pediatric Staging Tool Hadjiyannakis S et al. Paediatr Child Health 2016

39 Key Points 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 EOSS provides a rational framework for clinical prioritization and management

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