Beyond BMI: Can the Edmonton Obesity Staging System Improve Obesity Care in Pregnancy?

Dr Bharti Kalra, Consultant Gynecologist, Bharti Hospital, Karnal, India

EOSS offers a more holistic approach to assessing obesity in pregnancy, but evidence remains insufficient to replace BMI in routine care.

Emerging evidence suggests that body mass index (BMI) alone may not fully capture the health risks of obesity, particularly during pregnancy. A new scoping review published in Clinical Obesity examines whether the Edmonton Obesity Staging System (EOSS) could offer a more patient-centred approach to assessing obesity-related risk in pregnant individuals.

The EOSS goes beyond body size, incorporating physical, metabolic, mental, and functional health to stage obesity severity. While widely studied in adult and paediatric populations, its use in pregnancy remains largely unexplored. Reviewing the available literature, researchers identified only three cohort studies that applied EOSS in pregnant populations, highlighting a significant evidence gap.

Across these studies, both higher BMI and advanced EOSS stages, particularly stages 3 and 4, were associated with increased risks of prenatal complications such as preeclampsia, venous thromboembolism, wound complications, and caesarean delivery. However, current data do not demonstrate a clear superiority of EOSS over BMI in predicting outcomes.

The authors note that reliance on BMI alone may contribute to stigma and anxiety during pregnancy, underscoring the need for more nuanced assessment tools. While EOSS shows promise as a holistic and potentially less stigmatizing framework, the review concludes that more prospective research is needed before it can be integrated into routine prenatal care.

(Source: Nagpal TS, Cox JM, Salas XR, Adamo KB. Measuring and Managing Obesity in Pregnancy Using the Edmonton Obesity Staging System: A Scoping Review. Clinical Obesity. 2025 Aug 28:e70043.)