Abstract
We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018–March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.
Highlights
Obesity is associated with significantly increased mortality [1,2] and is often defined in clinical practice by a body mass index (BMI) greater than or equal to 30 in a White European population [3,4,5]
The Edmonton Obesity Staging System (EOSS) is a widely used and validated staging system based on weight-related health impairments among individuals with obesity
Given the small numbers in other EOSS groups with EOSS-0 (1.1%), EOSS-1 (0.6%) and EOSS-4 (1.7%), subsequent analysis was limited to the 172 patients who were initially EOSS-2 or EOSS-3 at baseline (Figure 1)
Summary
Obesity is associated with significantly increased mortality [1,2] and is often defined in clinical practice by a body mass index (BMI) greater than or equal to 30 in a White European population [3,4,5]. The Edmonton Obesity Staging System (EOSS) is a widely used and validated staging system based on weight-related health impairments among individuals with obesity. The EOSS categorises obesity severity based on the impact of obesity-related complications on medical, physical and psychological health [11]. Increasing EOSS severity has been shown to correlate with mortality better than BMI [5,9,13], and has been linked to increased health service use, polypharmacy and less weight loss [6,13]. A previous technology assessment by the Institute for Clinical and Economic Review in 2015 recommended that health systems should use obesity classification systems, such as EOSS instead of BMI, to more effectively target treatment resources [14]
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