Edmonton Obesity Staging System for Pediatrics, quality of life and fitness in adolescents with obesity

Background: Body mass index (BMI) is often used to diagnose obesity in childhood and adolescence but has limitations as an index of obesity-related morbidity. The Edmonton Obesity Staging System for Pediatrics (EOSS-P) is a clinical staging system that uses weight-related comorbidities to determine health risk in paediatric populations. The purpose of this study was to investigate the associations of EOSS-P and BMI percentile with quality of life (QOL), cardiorespiratory fitness (CRF) and muscular strength in adolescents with obesity. Methods: Participants were enrolled at baseline in the Healthy Eating, Aerobic and Resistance Training in Youth trial (BMI = 34.6 ± 4.5 kg m⁻², age = 15.6 ± 1.4 years, N = 299). QOL, CRF (peak oxygen uptake, VO_2peak) and muscular strength were assessed by the Pediatric QOL Inventory (PedsQL), indirect calorimetry during a maximal treadmill test and eight-repetition maximum bench and leg press tests, respectively. Participants were staged from 0 to 3 (absent to severe health risk) according to EOSS-P. Associations were assessed using age-adjusted and sex-adjusted general linear models. Results: Quality of life decreased with increasing EOSS-P stages (p < 0.001). QOL was 75.7 ± 11.4 in stage 0/1, 69.1 ± 13.1 in stage 2 and 55.4 ± 13.0 in stage 3. BMI percentile was associated with VO_2peak (β = –0.044 mlO₂ kg⁻¹ min⁻¹ per unit increase in BMI percentile, p < 0.001), bench press (β = 0.832 kg per unit increase in BMI percentile, p = 0.029) and leg press (β = 3.992 kg, p = 0.003). There were no significant differences in treadmill time or VO_2peak between EOSS-P stages (p > 0.05). Conclusion: As EOSS-P stages increase, QOL decreases. BMI percentile was negatively associated with CRF and positively associated with muscular strength.