The Edmonton Staging System: Post 1, Basics.
Some of you may have heard of the Edmonton Obesity Staging System. It’s gotten nods from size acceptance activists on social media sites because with its Stage 0 classification, it acknowledges that it’s possible to be fat and healthy and at a point where losing weight my any means necessary may not be advisable.
This is actually not a new idea. American guidelines dating back to the 1990s say the same thing. The National Institutes of Health Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity In Adults, The Evidence Report, published in 1998, only advises weight loss counselling for people who have a Body Mass Index (BMI) greater than 30, two other risk factors, and a desire to lose weight (chart, page 20). I can remember how happy I was when it first came out. It gave me something I could cite when doctors tried to push weight loss programs on me, when I had no risk factors other than a high BMI and no interest in dieting.
What is the Edmonton Staging System?
The Edmonton Staging System is chiefly intended to be a tool for rationing health care services in Alberta’s Health Care Insurance Plan. That’s Alberta’s single payer public health care system established under the Canadian Health Act.
What kind of health care services will be rationed? That's the big question. The most obvious are expensive weight loss treatments that may have a high net cost to the health care system; weight loss surgery in particular. However, this is a question that I'll revisit.
Who Designed it?
The Edmonton Staging System was developed by Dr. Arya Sharma and his colleagues at The University of Alberta. Steven Blair has also been involved in the research for the Edmonton Staging System. Dr. Blair is well known in fat acceptance circles for having done groundbreaking research for the Cooper Institute for Aerobics Research in Dallas in the 1990s; research that strongly indicates that activity level is a more important variable in health and fitness than BMI.
Dr. Sharma is a bariatric specialist and the founder and Scientific Director of the Canadian Obesity Network. On his blog, he questions the common beliefs about eating, activity level and weight, referring to the ubiquitous advice to lose weight by "eating less, moving more" as "the Nightmare on ELMM Street." He acknowledges that weight loss dieting is usually ineffective and sometimes counterproductive, long-term. However, it's important to remember that his career and livelihood are based on the idea that fatness is a disease that needs a medical cure.
Dr. Sharma and Dr. Blair may be more rational and compassionate than most people in the anti-obesity establishment, but they are not fat acceptance advocates.
So Without Further Ado, Here It Is
Stage 0: Patient has no apparent obesity-related risk factors (e.g., blood pressure, serum lipids, fasting glucose, etc. within normal range), no physical symptoms, no psychopathology, no functional limitations or impairment of well-being.
Stage 1: Patient has one or more obesity-related sub-clinical risk factors (e.g., elevated blood pressure, impaired fasting glucose, elevated liver enzymes, etc.), mild physical symptoms (e.g., dyspnea on moderate exertion, occasional aches and pains, fatigue, etc.), mild psychopathology, mild functional limitations and/or mild impairment of well-being.
Stage 2: Patient has one or more established obesity-related chronic diseases requiring medical treatment (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.), moderate functional limitations and/or moderate impairment of well-being.
Stage 3: Patient has clinically significant end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitations and/or significant impairment of well-being.
Stage 4: Patient has severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being
A Few Thoughts
I'm not going to be one of the people cheerleading for this system. I have some serious reservations about the Edmonton Staging System's weight-centric view of health. It could easily be (mis)used to ration care for any type of condition that can be linked to weight, for anyone with a high BMI.
I think its use should be limited to weight loss treatments, and I think that Dr. Sharma and Dr. Blair are capable of much more insightful work. It's just a new format for a way of thinking that's been around for decades, and it reinforces the weight centred paradigm that's (ready?) epidemic in the medical establishment right now.
Next week, I'l post links to some studies that explain the reasoning behind the Edmonton Staging System and links to some posts that discuss how it can or should be used. I'll also look around for media coverage.