More than just body mass index: Using the Edmonton obesity staging system for pediatrics to define obesity severity in a multi‐ethnic Australian pediatric clinical cohort

Abstract

Background Despite advancements in the use of body mass index (BMI) to categorize obesity severity in pediatrics, its utility in guiding individual clinical decision making remains limited. The Edmonton Obesity Staging System for Pediatrics (EOSS‐P) provides a way to categorize the medical and functional impacts of obesity according to the severity of impairment. The aim of this study was to describe the severity of obesity among a sample of multicultural Australian children using both BMI and EOSS‐P tools. Methods This cross‐sectional study included children aged 2–17 years receiving obesity treatment through the Growing Health Kids (GHK) multi‐disciplinary weight management service in Australia between January to December 2021. BMI severity was determined using the 95th percentile for BMI on age and gender standardized Centre for Disease Control and Prevention (CDC) growth charts. The EOSS‐P staging system was applied across the four health domains (metabolic, mechanical, mental health and social milieu) using clinical information. Results Complete data was obtained for 338 children (age 10.0 ± 3.66 years), of whom 69.5% were affected by severe obesity. An EOSS‐P stage 3 (most severe) was assigned to 49.7% of children, the remaining 48.5% were assigned stage 2 and 1.5% were assigned stage 1 (least severe). BMI predicted health risk as defined by EOSS‐P overall score. BMI class did not predict poor mental health. Conclusion Used in combination, BMI and EOSS‐P provide improved risk stratification of pediatric obesity. This additional tool can help focus resources and develop comprehensive multidisciplinary treatment plans.

Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity

“…Considering additional factors beyond numerical thresholds is crucial for accurately evaluating health risks and guiding healthcare interventions in older adults [ 31 ]. BMI and z-scores in children are more complex and are not reviewed here [ 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…Obesity status can be subcategorized further to capture more or less severe BMI variance [ 3 ]. BMI is relatively simple to measure in adults [ 4 , 5 , 6 , 7 , 8 , 9 ] and functionally sums a variety of complex body indicators. (Interpreting BMI in children is more complex and is not reviewed here.)…”

Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways

“…It is important to acknowledge the limitations of this article. Firstly, there is limited literature on the implementation of the new EOSS-P approach [ 30 , 86 , 87 , 88 ]. Given its recent initiation in Belgium, feedback on its efficacy and potential pitfalls is currently unavailable.…”

“…Southcombe et al implemented the EOSS-P system in Australia in a paediatric clinical cohort of 338 patients aged 2–17 years [ 30 ] and demonstrated superior risk stratification of paediatric obesity when combining EOSS-P with BMI compared to BMI alone and proposed early tailored treatment.…”