Oral Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

Evaluating the severity of obesity in adolescents presenting to an intensive behavioural weight management intervention (128101)

Natalie B Lister 1 , Natalie C Perri 2 , Hannah Melville 1 , Hiba Jebeile 1 , Megan Gow 3 , Eve House 1 4 , on behalf of the Fast Track to Health study team 1
  1. University of Sydney, Westmead, NSW, Australia
  2. Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
  3. The George Institute for Global Health, Sydney, NSW, Australia
  4. Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Westmead, NSW, Australia

 This study aimed to determine clinical obesity diagnosis(1) and Edmonton Obesity Staging System for Paediatrics (EOSS_P)(2) severity in treatment-seeking adolescents with obesity.

A cross-sectional secondary analysis was conducted using baseline data from the ‘Fast Track to Health’ study (2018-2023), which recruited 141 adolescents (13-17years) with obesity and ≥1 cardiometabolic complication from two paediatric hospitals in Sydney and Melbourne. Comprehensive clinical assessments including anthropometry, blood tests, psychosocial questionnaires and paediatrician reviews were used to classify participants according to diagnostic (Lancet) and staging criteria (EOSS_P Stage 0 to 3). Descriptive statistics determined obesity severity and Chi-square tests examined subgroup differences by sex, study site and completion status.

Most participants met the Lancet Commission diagnostic criteria for clinical obesity (n=97, 68.8%) followed by pre-clinical obesity (n=42, 29.8%), and no obesity (n=2, 1.4%). Significant differences were observed by sex, with males more likely to present with clinical obesity (p=0.021). There were no differences by site or completion status. EOSS-P showed most participants were classified as Stage 2 (n=67, 47.5%) or 3 (n=43, 30.5%), indicating the presence of clinically significant health complications. Mental health (Stage 2, n=71, 50.4%) and social domains (Stage 3, n=33, 23.4%) mostly contributed to higher staging. Subgroup differences by sex demonstrated females more likely to be Stage 1 (p=0.011) in metabolic domain. In the mental domain, Pearson’s Chi-square was not statistically significant (p=0.52), suggesting no association, however the Likelihood Ratio was significant (p=0.05), indicating a potential association with females more likely to be Stage 2.

The Lancet Commission and EOSS-P frameworks provide clinical insight beyond BMI alone. All participants had cardiometabolic complications associated with weight, yet some did not meet the diagnostic criteria for clinical obesity. There may be unintended bias with females less likely to meet Lancet diagnostic criteria despite no differences in overall severity according to EOSS-P.

  1. Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JP, Brown WA, et al. Definition and diagnostic criteria of clinical obesity. The Lancet Diabetes & Endocrinology. 2025;13(3):221-262.
  2. Hadjiyannakis S, Buchholz A, Chanoine J-P, Jetha MM, Gaboury L, Hamilton J, et al. The Edmonton Obesity Staging System for Pediatrics: a proposed clinical staging system for paediatric obesity. Paediatrics & Child Health. 2016;21(1):21-6.