Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing

Area of Science:

• Cardiology
• Metabolic Disorders
• Exercise Physiology

Background:

• Obesity severity classification traditionally relies on anthropometric measurements.
• The Edmonton Obesity Staging System (EOSS) incorporates clinical, physical, and psychological factors but lacks objective physical impairment measures.
• Cardiopulmonary exercise testing (CPET) offers objective functional assessment.

Purpose of the Study:

• To introduce a novel obesity staging system, EOSS-CRF, by integrating cardiorespiratory fitness (CRF) into the EOSS.
• To address the limitations of the standard EOSS in objectively quantifying physical impairment.
• To enhance the prognostic value of obesity staging through objective functional parameters.

Main Methods:

• An observational, cross-sectional study involving 500 obese patients who underwent clinical, anthropometric, biochemical assessments, and CPET.
• Patients were initially classified using the standard EOSS.
• A modified EOSS (EOSS-CRF) was developed using age- and gender-appropriate VO2peak/kg percentiles from the FRIEND registry.

Main Results:

• VO2peak/kg demonstrated significant differences between EOSS classes 1 and 2, and 1 and 3, but not between classes 2 and 3.
• The EOSS-CRF classification resulted in a redistribution of patients across stages compared to the standard EOSS, notably shifting patients from class 2 to class 3.
• CRF revealed that the standard EOSS underestimates physical impairment compared to the EOSS-CRF.

Conclusions:

• Integrating CRF (VO2peak/kg) into the EOSS provides a quantitative measure of functional impairment, improving obesity severity assessment.
• The EOSS-CRF system offers a more comprehensive approach to risk stratification for patients with obesity.
• This enhanced staging system can aid in identifying individuals at higher risk of mortality, facilitating targeted therapeutic strategies.