The Edmonton Obesity Staging Classification

演讲者1：此简短视频提供了埃德蒙顿肥胖舞台或EOSS的摘要。从历史上看，在临床实践中，在体重指数或肥胖类别的背景下考虑了肥胖症。这是一种基于世界卫生组织设定的预定正常值的人体测量指标，从体重不足，正常体重，超重开始，然后是肥胖I类，II，II和III。但是，体重指数不能直接评估体内脂肪，因此这不是对体内脂肪的真实度量，也不是对个人整体健康的真正衡量。此外，年龄在20岁或以上的年龄，体重指数包括身高和体重，但不考虑年龄或性别。

而且我们知道，一个女人比拥有相同BMI的男人往往具有更多的体内脂肪。同样，老年人比具有相等BMI的年轻人往往具有更多的体内脂肪。

因此，有必要在更广泛的健康背景下考虑肥胖。这就是肥胖阶段进入的地方 - 埃德蒙顿肥胖阶段系统。这是基于与体重相关的问题而不是大小的问题的临床评估来对肥胖的严重程度进行排名。这是一个五阶段的分类系统，它考虑了与肥胖有关的代谢，身体和心理因素，以及这些因素如何影响患者的整体健康状况。在第0阶段，一个人可能被归类为肥胖。但是，他们没有其他疾病的健康问题或危险因素。在第1阶段，一个人可能会出现一些临床前危险因素，例如血压或胆固醇在较高的正常范围内。

第2阶段是个人被认为对既定的合并症（例如糖尿病，高血压或骨关节炎）的健康问题。条件发展到发生器官损伤的地步的患者在第3阶段，而发展为不可逆转的终阶段器官损伤的患者被认为具有4阶段的肥胖症。因此，从本质上讲，肥胖症分期系统被认为是衡量个体健康状况的量度，而肥胖类是衡量身体大小的量度。重要的是要考虑肥胖阶段，因为体重过高，超重或按体重指数肥胖并不一定会导致个人的健康状况不佳，也不预测死亡率或发病率。

在肥胖阶段捕获的是与肥胖相关的健康问题更加相关。

The advantage of the obesity staging system in predicting health outcomes is shown by a large study conducted in the United States, involving close to 8,000 individuals who were overweight or obese as defined by body mass index, and who were followed over 16 years. This graph is a survival curve showing the proportion of people still alive over time according to different levels of body mass index– so a lower proportion surviving meaning a higher mortality rate. The black line represents overweight or a BMI greater than 25, and the red, green, and blue lines represent obesity classes I, 2, and 3.

You can see that there is little difference between mortality rates or the proportion of people surviving over time in people with different degrees of overweight and obesity defined by body mass index. In fact, at 200 months, the proportion of people surviving is actually higher in those with class 3 obesity than in those who are overweight. However, when this same cohort was categorised according to obesity stage, you can see that this categorization was a much better predictor or discriminator of mortality rates than when categorised by body mass index. By 200 months, the proportion of people surviving in stage 3 was much lower than the proportion who were in stage 0.

So it appears that obesity stage is much more relevant for mortality than obesity class, or looking solely at someone’s body mass index.

So the Edmonton Obesity Staging System considers medical, mental, and functional impairments associated with obesity when considering the profile of an individual, and considers these to vary through five stages. And you can imagine that the amount of body weight or an individual’s body size will vary between individuals in the same stage, as it’s not necessarily body weight that’s relevant in obesity stages, but the effect of that weight on the body systems and the individual.

与膝关节骨关节炎相关，在一项对5500多名患者的研究中，这些患者按体重指数分类为肥胖，并按肥胖阶段，终末期膝关节骨关节炎进行分类，如总关节置换所示，是与肥胖相关的第三大普遍性。1阶段至第三阶段肥胖的个体的合并症，在高血压和超血前的背后。

So the Edmonton Obesity Staging System Staging Tool is useful clinically to help place individuals into one of the stages, and then this can help direct management.

总而言之，埃德蒙顿肥胖症分期系统考虑了肥胖对个人的医学，心理和功能影响。基于对个体体重相关的健康问题的临床评估，考虑了肥胖的严重程度或阶段，这比体重指数更好地指标了死亡率和发病率。这与我们如何管理患者有关。

这是本演讲中使用的一些参考文献的列表。