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“Obesity Staging System”

March 2, 2009

Dr. Sharma, a Canadian physician who specializes in and blogs about obesity, weight and health (and who I keep meaning to put on my blog roll), felt that BMI and waist circumference were not very helpful parameters when dealing with the realities of individual patients. So he and another doctor put on their thinking caps and came up with what they’re calling the Edmonton Obesity Staging System.


If the type is too small to read, basically this is a five stage system that outlines five levels or grades of obesity and which treatments might be pursued at each level. However, the levels are not determined by weight, but by whether or not certain weight-related conditions are present and the severity of those conditions. Seriously, though, click on that link above to read the actual post.

So I think this system is pretty great and I hope it’s adopted by clinicians everywhere. I love that it focuses on actual health problems and not just on weight. I love that it suggests looking for ‘non-weight related contributors to risk factors’ instead of assuming any problem is caused by weight.

Personally, I would feel much better about seeing a doctor who used this type of system. Even though I currently have some symptoms which would be considered obesity-related, having a doctor who didn’t consider having a certain BMI as being a disease in and of itself would be great.

I know this system will have plenty of critics. Much of society hates the idea of just “letting” people be fat no matter how healthy they may be. For others, any hint of implicating fatness as a cause/contributor to some conditions will make this system unacceptable.

I’m curious as to how my readers feel about it.

14 Comments leave one →
  1. vesta44 permalink
    March 2, 2009 2:16 pm

    The main problem I have with that system is that there will be people like me who don’t fit in any of those categories. I’m fat, but I don’t have high blood pressure, high blood sugars, or high cholesterol, but I do have severe mobility issues due to degenerative joint disease, fibromyalgia, and spinal stenosis. None of these are caused by my weight, but the arthritis is aggravated by it. So where do I fit? Looks to me like I fit parts of 2 or 3 of those categories, and I already have 35 years of dieting behind me, not to mention a failed WLS, and I refuse to even consider ever dieting again, and no way in heaven or hell would I consider another WLS. I’ve maintained my weight, within a variance of 15 lbs, for the last 10 years. Other than aggressive treatment of my chronic pain issues, I don’t think there’s a whole lot that can be done to make me thinner (and being thinner isn’t going to do much for the spinal stenosis, from what I understand).

    • March 3, 2009 11:16 am

      While you, and probably a lot of people, might not fall completely into any category, I think it would still be helpful in terms of encouraging doctors to look outside the fat box when diagnosing fat patients. Acknowledging, like in your case, that there can exist conditions which would be present in some form no matter how much someone weighs is not perfect, but a good start, imo.

      Honestly, while this may sound cynical of me, just pointing out to some doctors that a healthy fat person doesn’t need any sort of intensive treatment or intervention would be a revolution in how they treat people.

  2. March 2, 2009 3:49 pm

    I agree that it’s better than a BMI-based approach, but in reality, this will penalize people as they age. I’ve been fat since I was 11 and chubby before that. At 40, my numbers are still fairly good, though I may be moving toward stage 1. By the time I’m 60 (given my family history), I’ll probably have high blood pressure and type 2 diabetes. Does that mean that it will all of a sudden be a good idea for me to diet or take poorly tested drugs? Why not just live with those conditions? I’ll continue to try to eat a nutritionally sound diet and stay as active as is practical for me. I’m probably not going to die early. So, seriously, why can’t I just age normally, without taking up a battle with my body? Thin people have the same conditions as they age.

    • March 3, 2009 11:21 am

      Age should definitely be a consideration when it comes to treating a lot of conditions. Mobility problems in one’s 20’s are a lot more worrisome than having some mobility issues in one’s 70s or 80s. I wonder what kind of training doctors currently get in that area? I mean, just in people I know, I’ve seen doctors treat diabetes management differently in a 22 year old than an 80 year old – which makes sense, but I wonder if it would be good to include some kind of age information in this.

  3. March 2, 2009 5:15 pm

    It seems that this system makes more sense if you believe that weight by itself isn’t unhealthy. It’s true that bodies can take a lot at 25, but what about carrying that extra weight for the next 25 or 40 years? Possibly fat isn’t as inert as it was thought to be, but is hormonally active? I know I have knee problems when I get to be around 200 pounds that I don’t have now. It’s hard to know how bad extra weight really is, when I read news stories they constantly interchange “obesity” with “poor diet and exercise habits”. I know skinny folks with awful habits, and chubby folks with healthy ones. Overall, I think it makes a lot more sense than this annoying BMI, with its somewhat arbitrary cutoff points. I also think that this culture, the only one I really know, is more obsessed with looks than health, no matter what anybody says.

  4. wriggles permalink
    March 2, 2009 11:16 pm

    The problem with obesity, is the concept itself. It just doesn’t work. ‘Obesity related’, doesn’t mean that being fat causes these things it’s just as likely that fat can be itself just another symptom.

    Too many slim people get the same things. Another problem is that the treatments are not effective for the purpose, so advocating them is about belief.

    Being fat is part of the human condition, it can also be, like slimness, a sign of an underlying cause. Find out what they are and deal with them.

    That’s all these doctors have to do and they just can’t or won’t, they should get fired, that’s what happens to real people who won’t do what they get paid to do.

  5. Anna permalink
    March 3, 2009 2:11 pm

    Fat IS hormonally active–it is now viewed as an endocrine organ. That’s why I don’t see how it can be viewed as 100% benign. It doesn’t just sit there, it alters the hormonal flow in your whole body. Which is good when it’s doing it’s job (you need some!) and not so good if there is too much.

    That being said, a healthy diet and physical exercise go a long way to help your body stabilize its hormones, even if weight doesn’t change.

    • March 3, 2009 4:59 pm

      I have wondered that myself. My understanding of the way body fat acts..the different adipokines etc.. is very very elementary. It seems to me though that the effects must differ between individuals. I mean, in some ways I’m kind of a textbook example in terms of being apple-shaped and having many of the signs of metabolic syndrome. OTOH, I know people who are my weight and larger who do not have the same symptoms. Part of that may be genetic or some differences in where weight is carried. I just don’t know.

      I would love to read something really going into the idea of body fat as an endocrine organ, but that was more accessible than a lot of the studies I’ve tried to read.

    • March 4, 2009 2:51 am

      I would encourage people to read Sandy’s links, but also to go both to Dr. Sharma’s website and the website for CON (which stands for Canadian Obesity Network) and poke around a bit. Keep in mind that CON’s partnership with drug companies is part of the whole point. CON is funded by the Networks of Centres of Excellence. The NCE is a government-funded group whose mission is “To mobilize Canada’s research talent in the academic, private and public sectors, and apply it to the task of developing the economy and improving the quality of life of Canadians.” So yeah, I’m not a fan of drug companies for a lot of reasons, and anyone is free to see any nefarious thing they like in the partnering of private and public sectors (I definitely see the potential conflicts) but CON is just one group that is funded by the NCE and every group includes private interests.

      Dr. Sharma doesn’t seem to try and hide his work with CON nor his belief that surgery is a more effective treatment for obesity-related diseases than dieting. Also keep in mind that under his own staging system, people would not be in need of treatment unless they had an actual illness and even then, he encourages looking at causes other than fat.

      I don’t know Dr. Sharma and I am not particularly invested in his professional integrity. Honestly, I would think the staging system was a good idea if it was put out by Dr. McPharmacy-Shill. Nor do I need to share Dr. Sharma’s views on bariatric surgery to find merit in some of his ideas. Just like how I can agree with Sandy on the supplement industry while disagreeing with her on many other points.

      Also, Dr. Sharma allows comments on his blog so if you have any questions/concerns about what he writes, you are free to ask him yourself.

      CON’s website:

      A list of groups funded by the NCE:

  6. March 5, 2009 12:30 pm

    Wow, I’m amazed I’m only a stage 2. I think it is definitely going to be more helpful in a clinical setting than calculating a BMI. For people in my situation, its fairly obvious that I have an obesity problem so either way, I’m pretty sure a doctor can diagnose me correctly, but I like that this puts further emphasis on the co-morbidities.

    • March 9, 2009 10:34 am

      Definitely more helpful than BMI, I think. I know some people worry that by emphasizing treatment for co-morbidities, doctors may ‘encourage’ people not to try and lose weight, but, not only do I see it as ethically necessary, I hope that it would encourage healthier weight-loss behaviors in people who do want to try and lose weight.

      Which is the most run-on-sentence way of saying that I agree with you.

  7. March 10, 2009 5:46 pm

    I am curious about the * that says these stages correlate to BMI classifications.

    Before my WLS, I started at a 50.2 BMI, or “super morbidly obese.” However, I had none of the problems listed anywhere on the diagram.

    If the link to BMI is removed from the chart, I think the progression side of things is great. I think the treatments are too weight loss focused, and that focusing on managing the illness and effects is more important than the weight itself.

    Interesting fodder, thanks.


  1. A more complex view of obesity « Exceptionally Fat

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