What ICOT does: combines anthropometry (0–2), organ dysfunction (0–3), and activity limitation (0–3) into a total score (0–8) to support staged clinical decision-making.

Organ dysfunction (0–3) — pragmatic examples:

• 0 (None): no obesity-related organ disease; no NAFLD/OSA symptoms; normal BP/glucose/lipids.
• 1 (Mild): IFG/IGT, mild dyslipidaemia, borderline HTN, mild NAFLD without fibrosis markers, mild OSA symptoms.
• 2 (Moderate): T2DM (treated), HTN on medication, moderate confirmed OSA, NAFLD/NASH with fibrosis risk, symptomatic OA affecting function.
• 3 (Severe): established CVD, CKD ≥ stage 3, diabetes complications, severe OSA, advanced liver disease/cirrhosis.

Activity limitation (0–3) — WHO ICF-aligned examples:

• 0 (None): usual work + daily activities without restriction.
• 1 (Mild): stairs/long walking cause breathlessness or joint pain; ADLs ok but extra effort; avoids some activities.
• 2 (Moderate): difficulty with work tasks/household chores; walking >5–10 min hard; rest breaks; some self-care difficulty.
• 3 (Severe): marked mobility limitation (aid/housebound) or significant self-care limitation; cannot perform usual activities independently.

Decision support only — apply clinical judgement and local pathways.