Prognostic value of the Edmonton Obesity Staging System among people hospitalized with obesity

Obesity is a heterogeneous clinical condition whose severity is not adequately reflected by body mass index (BMI). We used the Edmonton Obesity Staging System (EOSS), which integrates obesity-related comorbidities and functional impairment, to assess the prognosis of hospitalized patients with obesity.

Prospective cohort study conducted in 26 Spanish hospitals. Hospitalised individuals with a BMI > 30 kg/m² were included. We evaluated sociodemographic and anthropometric variables, comorbidities, laboratory parameters, baseline treatment and treatment prescribed at discharge, EOSS stage, and outcomes at 90 days after discharge (readmissions and mortality).

Of 3,218 screened individuals, 496 (15.4%) were obese. The mean age was 75 years, and 50.1% were women. Most patients with obesity were classified into EOSS stages 2 (35.9%) and 3 (33.1%). Advanced stages were associated with higher comorbidity burden, worse laboratory profile (renal dysfunction, anaemia), and greater therapeutic complexity. As the EOSS stage increased, the trend analysis demonstrated a progressive increase in the risk of readmission (p = 0.026) and death (p = 0.023). In the discharge report, we recorded a significant relative increase in prescriptions of medications with cardiometabolic benefit and effect on body weight (relative increase of 33% for SGLT2 inhibitors and 11.8% for GLP-1/GLP1-GIP receptor agonists).

The EOSS classification system applied to hospitalized patients may identify subgroups of patients with worse prognosis helping physicians to initiate specific treatment to improve health outcomes.