Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing
Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective mea...
Uložené v:
| Vydané v: | International Journal of Obesity Ročník 45; číslo 9; s. 1949 - 1957 |
|---|---|
| Hlavní autori: | , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
England
Nature Publishing Group
01.09.2021
|
| Predmet: | |
| ISSN: | 0307-0565, 1476-5497, 1476-5497 |
| On-line prístup: | Získať plný text |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO
peak/kg).
This observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO
peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry.
VO
peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF.
The integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO
peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity. |
|---|---|
| AbstractList | Background/ObjectivesDifferent approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO2peak/kg).Subjects/MethodsThis observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO2peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry.ResultsVO2peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF.ConclusionsThe integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO2peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity. Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO peak/kg). This observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry. VO peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF. The integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity. Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO2peak/kg).BACKGROUND/OBJECTIVESDifferent approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO2peak/kg).This observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO2peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry.SUBJECTS/METHODSThis observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO2peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry.VO2peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF.RESULTSVO2peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF.The integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO2peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity.CONCLUSIONSThe integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO2peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity. |
| Author | Ermolao, Andrea Neunhaeuserer, Daniel Gasperetti, Andrea Bettini, Silvia Belligoli, Anna Quinto, Giulia Battista, Francesca Busetto, Luca Milan, Gabriella Vettor, Roberto |
| Author_xml | – sequence: 1 givenname: Silvia orcidid: 0000-0001-8596-8237 surname: Bettini fullname: Bettini, Silvia organization: Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy – sequence: 2 givenname: Giulia orcidid: 0000-0001-5653-275X surname: Quinto fullname: Quinto, Giulia email: giulia.quinto9@gmail.com organization: Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy. giulia.quinto9@gmail.com – sequence: 3 givenname: Daniel surname: Neunhaeuserer fullname: Neunhaeuserer, Daniel organization: Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy – sequence: 4 givenname: Francesca surname: Battista fullname: Battista, Francesca organization: Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy – sequence: 5 givenname: Anna surname: Belligoli fullname: Belligoli, Anna organization: Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy – sequence: 6 givenname: Gabriella orcidid: 0000-0001-8987-5310 surname: Milan fullname: Milan, Gabriella organization: Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy – sequence: 7 givenname: Andrea surname: Gasperetti fullname: Gasperetti, Andrea organization: Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy – sequence: 8 givenname: Roberto surname: Vettor fullname: Vettor, Roberto organization: Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy – sequence: 9 givenname: Andrea surname: Ermolao fullname: Ermolao, Andrea organization: Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy – sequence: 10 givenname: Luca surname: Busetto fullname: Busetto, Luca organization: Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33990701$$D View this record in MEDLINE/PubMed |
| BookMark | eNpdkEtPwzAQhC1URB_wBzggS1y4BNZeP2JuqCoPqVIPhXPkJE6VqnFKnCDy77FEuXCayzezszMnE996R8g1g3sGmD4EwVCpBDhLAFKpEnNGZkxolUhh9ITMAEEnIJWcknkIewCQEvgFmSIaAxrYjGxXZdP6vvV0k7tQ9yPd9nZX-x3djqF3zSO1ntbNsWu_XON8T_ORFrYr6_Y4HKLTdiN1364r6uBo70IfrZfkvLKH4K5OuiAfz6v35Wuy3ry8LZ_WSSE09omsSsmUtLwAY0qwSnAUAEYLU5qc56gFU0KXoipB5pY7zFE6jilToNFWuCB3v7mx3ecQb2dNHQp3OFjv2iFkXPKUaa2QR_T2H7pvh87HdpFSiEqCEJG6OVFD3rgyO3Z1Ex_M_ubCH-V7bX8 |
| CitedBy_id | crossref_primary_10_1007_s40519_022_01402_w crossref_primary_10_3390_biomedicines11051319 crossref_primary_10_3390_jcm12227183 crossref_primary_10_1111_cob_12514 crossref_primary_10_26633_RPSP_2025_62 crossref_primary_10_3389_fendo_2023_1147171 crossref_primary_10_1007_s13679_024_00576_x |
| ContentType | Journal Article |
| Copyright | 2021. The Author(s), under exclusive licence to Springer Nature Limited. The Author(s), under exclusive licence to Springer Nature Limited 2021. |
| Copyright_xml | – notice: 2021. The Author(s), under exclusive licence to Springer Nature Limited. – notice: The Author(s), under exclusive licence to Springer Nature Limited 2021. |
| DBID | CGR CUY CVF ECM EIF NPM 3V. 7T2 7TK 7TS 7X2 7X7 7XB 88E 88G 8AO 8C1 8FE 8FH 8FI 8FJ 8FK ABUWG AEUYN AFKRA ATCPS AZQEC BBNVY BENPR BHPHI C1K CCPQU DWQXO FYUFA GHDGH GNUQQ HCIFZ K9. LK8 M0K M0S M1P M2M M7P PHGZM PHGZT PJZUB PKEHL PPXIY PQEST PQGLB PQQKQ PQUKI PRINS PSYQQ Q9U 7X8 |
| DOI | 10.1038/s41366-021-00856-9 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed ProQuest Central (Corporate) Health and Safety Science Abstracts (Full archive) Neurosciences Abstracts Physical Education Index Agricultural Science Collection Health & Medical Collection ProQuest Central (purchase pre-March 2016) Medical Database (Alumni Edition) Psychology Database (Alumni) ProQuest Pharma Collection ProQuest Public Health Database ProQuest SciTech Collection ProQuest Natural Science Collection ProQuest Hospital Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest One Sustainability (subscription) ProQuest Central UK/Ireland Agricultural & Environmental Science Database ProQuest Central Essentials Biological Science Database ProQuest Central Natural Science Collection Environmental Sciences and Pollution Management ProQuest One ProQuest Central Proquest Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Central Student SciTech Premium Collection ProQuest Health & Medical Complete (Alumni) Biological Sciences Agriculture Science Database ProQuest Health & Medical Collection Medical Database Psychology Database Biological Science Database ProQuest Central Premium ProQuest One Academic (New) ProQuest Health & Medical Research Collection ProQuest One Academic Middle East (New) ProQuest One Health & Nursing ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Applied & Life Sciences ProQuest One Academic (retired) ProQuest One Academic UKI Edition ProQuest Central China ProQuest One Psychology ProQuest Central Basic MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) Agricultural Science Database ProQuest One Psychology ProQuest Central Student ProQuest One Academic Middle East (New) ProQuest Central Essentials ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) SciTech Premium Collection ProQuest One Community College ProQuest One Health & Nursing ProQuest Natural Science Collection ProQuest Pharma Collection ProQuest Central China Physical Education Index Environmental Sciences and Pollution Management ProQuest Central ProQuest One Applied & Life Sciences ProQuest One Sustainability ProQuest Health & Medical Research Collection Health Research Premium Collection Health and Medicine Complete (Alumni Edition) Natural Science Collection ProQuest Central Korea Health & Medical Research Collection Agricultural & Environmental Science Collection Biological Science Collection Health & Safety Science Abstracts ProQuest Central (New) ProQuest Medical Library (Alumni) ProQuest Public Health ProQuest Biological Science Collection ProQuest Central Basic ProQuest One Academic Eastern Edition Agricultural Science Collection ProQuest Hospital Collection Health Research Premium Collection (Alumni) ProQuest Psychology Journals (Alumni) Biological Science Database ProQuest SciTech Collection Neurosciences Abstracts ProQuest Hospital Collection (Alumni) ProQuest Health & Medical Complete ProQuest Medical Library ProQuest Psychology Journals ProQuest One Academic UKI Edition ProQuest One Academic ProQuest One Academic (New) ProQuest Central (Alumni) MEDLINE - Academic |
| DatabaseTitleList | Agricultural Science Database MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: BENPR name: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine Diet & Clinical Nutrition Recreation & Sports |
| EISSN | 1476-5497 |
| EndPage | 1957 |
| ExternalDocumentID | 33990701 |
| Genre | Journal Article Observational Study |
| GeographicLocations | Italy |
| GeographicLocations_xml | – name: Italy |
| GroupedDBID | --- -Q- ..I .GJ .L3 .XZ 0R~ 1CY 29J 2FS 2WC 36B 39C 4.4 406 53G 5GY 5RE 70F 7X2 7X7 88E 8AO 8C1 8FE 8FH 8FI 8FJ 8R4 8R5 A8Z AACDK AAHBH AANZL AASML AATNV AAWTL AAYZH ABAKF ABAWZ ABBRH ABCQX ABDBE ABDBF ABFSG ABIVO ABJNI ABLJU ABOCM ABRTQ ABUWG ABZZP ACAOD ACGFS ACKTT ACPRK ACRQY ACSTC ACUHS ACZOJ ADBBV ADHUB ADXHL AEFQL AEJRE AEMSY AENEX AEUYN AEVLU AEXYK AEZWR AFBBN AFDZB AFFNX AFHIU AFKRA AFRAH AFSHS AGAYW AGHAI AGQEE AHMBA AHSBF AHWEU AI. AIGIU AILAN AIXLP AJRNO ALFFA ALIPV ALMA_UNASSIGNED_HOLDINGS AMYLF APEBS ATCPS ATHPR AXYYD AYFIA AZQEC B0M BBNVY BENPR BHPHI BKKNO BPHCQ BVXVI CCPQU CGR CS3 CUY CVF DIK DNIVK DPUIP DU5 DWQXO E3Z EAD EAP EBC EBD EBLON EBS ECM EE. EIF EIOEI EJD EMB EMK EMOBN EPL ESX F5P FDQFY FERAY FIGPU FIZPM FSGXE FYUFA GNUQQ HCIFZ HMCUK HZ~ IAO IHR IHW INH INR IPY ITC IWAJR JSO JZLTJ KQ8 L7B M0K M1P M2M M7P MVM NPM NQJWS O9- OK1 OVD P2P P6G PHGZM PHGZT PJZUB PPXIY PQGLB PQQKQ PROAC PSQYO PSYQQ Q2X RNS RNT RNTTT ROL SNX SNYQT SOHCF SOJ SRMVM SV3 SWTZT TAOOD TBHMF TDRGL TEORI TR2 TSG TUS UKHRP VH1 WH7 ZGI ZXP ~8M ~KM 3V. 7T2 7TK 7TS 7XB 8FK C1K K9. LK8 PKEHL PQEST PQUKI PRINS Q9U 7X8 PUEGO |
| ID | FETCH-LOGICAL-c473t-5fd5165a2c099d0a64234009749d9b2b3741647d4fd05ba2e3b35e23816073af3 |
| IEDL.DBID | M7P |
| ISICitedReferencesCount | 8 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000652529400001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 0307-0565 1476-5497 |
| IngestDate | Thu Oct 02 10:13:18 EDT 2025 Mon Oct 06 18:14:28 EDT 2025 Mon Jul 21 06:03:57 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 9 |
| Language | English |
| License | 2021. The Author(s), under exclusive licence to Springer Nature Limited. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c473t-5fd5165a2c099d0a64234009749d9b2b3741647d4fd05ba2e3b35e23816073af3 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 |
| ORCID | 0000-0001-8596-8237 0000-0001-5653-275X 0000-0001-8987-5310 |
| PMID | 33990701 |
| PQID | 2563365044 |
| PQPubID | 38864 |
| PageCount | 9 |
| ParticipantIDs | proquest_miscellaneous_2528177632 proquest_journals_2563365044 pubmed_primary_33990701 |
| PublicationCentury | 2000 |
| PublicationDate | 2021-09-01 |
| PublicationDateYYYYMMDD | 2021-09-01 |
| PublicationDate_xml | – month: 09 year: 2021 text: 2021-09-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | England |
| PublicationPlace_xml | – name: England – name: London |
| PublicationTitle | International Journal of Obesity |
| PublicationTitleAlternate | Int J Obes (Lond) |
| PublicationYear | 2021 |
| Publisher | Nature Publishing Group |
| Publisher_xml | – name: Nature Publishing Group |
| SSID | ssj0005502 ssj0033214 |
| Score | 2.4101315 |
| Snippet | Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers... Background/ObjectivesDifferent approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1949 |
| SubjectTerms | Adult Age Anthropometry Body Mass Index Cardiorespiratory fitness Cross-Sectional Studies Disease management Exercise Test - methods Exercise Test - standards Exercise Test - statistics & numerical data Female Humans Impairment Italy - epidemiology Male Middle Aged Mortality risk Obesity Obesity - classification Obesity - complications Obesity - epidemiology Oxygen consumption Oxygen Consumption - physiology Parameters Patients Population studies Prognosis Risk Factors Severity of Illness Index Weight |
| Title | Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/33990701 https://www.proquest.com/docview/2563365044 https://www.proquest.com/docview/2528177632 |
| Volume | 45 |
| WOSCitedRecordID | wos000652529400001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1Li9swEB66u6XspY_0lXYbVCi9ibUl2ZJ7Ke02S6HEhD4gt2DZoxLYOtnYKey_70iRN7e99DJgLBsjj0afRqPvA3iHGmVjjOOuMjlX1hlunbYcsRAZamswdUFsQpelWSyKeUy4dbGscoiJIVA369rnyM9papaS4IRSHzfX3KtG-d3VKKFxBCeeJUGG0r35ocQjS265pKRX5BlYEWnWz-IJmkSa844iee5rcWllTRAk53fgzTDvXD763y9-DA8j4mSf9i7yBO5hO4LxlxX27D2LtKBXrBxY-UfwYBb320cwOqBKahwU0bun8GPa_PG0By2LsgKMIKsXO2J7_vMPrGrZKmQrQvKR2RtWh7rXze6Knqy2N2yQemK9p_lofz-DX5fTnxdfeRRn4LXSsueZa7I0zypRE8ZskorWMVL5UyGqaAorrPRQT-lGuSbJbCVQWpmhBwg5RZXKyedw3K5bfAnMFmhpVeqEQaHIOQwSKMNC5cZSwDFyDGdDBy_jCOuWh94dw9vb2zQ2_IZH1eJ659sIk2qKoGIML_Y_cbnZk3gsJSEzCnfpq7tf_hpORfALX1V2Bsf9dodv4H79t1912wkc6YUO1pA1F-kETj5Py_l3upol37wVs0lwSrLlfPYPrwDiIQ |
| linkProvider | ProQuest |
| linkToHtml | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1NT9wwEB0BrWgvtN1-LV81Eu3NYtd2EgcJVVUBgWBXSFCJW4iTcbUSzW432aL9U_xGxk7C3rhx6DmOD_bzzBt7Zh7ALkYoc60tt6kOuTJWc2MjwxFjEWBkNPatF5uIhkN9fR1fLMF9Wwvj0ipbm-gNdT7O3B35HrlmKYlOKPV98pc71Sj3utpKaNSwOMP5HYVs5cHpIe3vVyGOj65-nvBGVYBnKpIVD2we9MMgFRmRo7yXEgGXypUzqDiPjTDScRQV5crmvcCkAqWRATrPFtJxSK2keZfhhaJIyElFDMRgkVIS9B57V0mnANR2YSSWETQVOz2p90ryHKHL_aVInihPyJ_gt97PHb_531boLaw1jJr9qI_AO1jCogPdwxFW7Btr2p7esmGrOtCB1UGTT9CBzoI102Cv-F6-h8uj_I9r61CwRjaBESV3Yk6s7u--z9KCjfxtjL9cZWbOMp_XO5nd0p_pdM5aKStWuTYmxe8P8OtZFuEjrBTjAj8DMzEairqt0CgUgV8jkU6MVagNGVQtu7DZbmjSWJAyWexmF3YeP9PZdw86aYHjmRsjdD8iDyG68KkGTTKpm5QkkpgnIbS__vTkX-DVydXgPDk_HZ5twGvhMeky6DZhpZrOcAteZv-qUTnd9lBncPPcyHkAF6I0sw |
| linkToPdf | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1RT9swED4BQ2gvbBQ2ujEwEtub1dZ2EmfSNE2UCsRWITEk3rI4OU-VIC1Nuql_bb9uZyeBPfHGw57j-MH-7u6zfXcfwBFGKHOtLbepDrkyVnNjI8MRYxFgZDQOrBebiMZjfX0dX6zAn7YWxqVVtj7RO-p8mrk78h6FZimJTijVs01axMVw9Hl2x52ClHtpbeU0aoic4_I3Hd_KT2dD2uv3QoxOvh-f8kZhgGcqkhUPbB4MwiAVGRGlvJ8SGZfKlTaoOI-NMNLxFRXlyub9wKQCpZEBuigXkmmkVtK8q_AskoRiV6V-_E96SdC_72MlnRpQ25GRGEfQVO_0pe6VFEVClwdMp3qiPyF_hOv6mDd68T-v1kvYbJg2-1KbxhasYNGB7nCCFfvAmnaoN2zcqhF0YONbk2fQgc4Dm6bBXgm-3IbLk_zWtXsoWCOnwIiqO5EnVvd9_8jSgk38LY2_dGVmyTKf7ztb3NCf6XzJWokrVrn2JsXPHbh6kkV4BWvFtMBdYCZGQ6dxKzQKRUahkcgoxirUhhytll3Yazc3aTxLmTzsbBcO7z-TT3APPWmB04UbI_QgosghuvC6BlAyq5uXJJIYKbn5wZvHJz-ADQJM8vVsfP4WngsPT5dYtwdr1XyB72A9-1VNyvm-Rz2DH08NnL9C-z09 |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Edmonton+Obesity+Staging+System%3A+an+improvement+by+cardiopulmonary+exercise+testing&rft.jtitle=International+Journal+of+Obesity&rft.au=Bettini%2C+Silvia&rft.au=Quinto+Giulia&rft.au=Neunhaeuserer%2C+Daniel&rft.au=Battista%2C+Francesca&rft.date=2021-09-01&rft.pub=Nature+Publishing+Group&rft.issn=0307-0565&rft.eissn=1476-5497&rft.volume=45&rft.issue=9&rft.spage=1949&rft.epage=1957&rft_id=info:doi/10.1038%2Fs41366-021-00856-9&rft.externalDBID=HAS_PDF_LINK |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0307-0565&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0307-0565&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0307-0565&client=summon |