The relationship of excess body weight and health-related quality of life: evidence from a population study in Taiwan

Increasing BMI is associated with a progressive reduction in physical quality of life among overweight middle-aged men

We assessed whether increasing body mass index (BMI) affects health-related quality of life in a group of 38 overweight (BMI 25–30 kg/m²) middle-aged (45.9 ± 5.4 years) men, recruited in Auckland (New Zealand). Health-related quality of life was assessed with SF-36v2 at 0, 12, and 30 weeks. Increasing BMI was associated with a progressive reduction in physical component summary score (p = 0.008), as well as lower general health (p = 0.036), physical functioning (p = 0.024), and bodily pain (p = 0.030) scores. Stratified analyses confirmed these findings: participants who were more overweight (n = 19; BMI 27.5–30 kg/m²) had poorer physical component summary (p = 0.005), physical functioning (p = 0.040), bodily pain (p = 0.044), and general health (p = 0.073) scores than the less overweight (n = 19; BMI 25–27.5 kg/m²). Increasing BMI is associated with a progressive reduction in physical quality of life, even within a relatively narrow BMI range encompassing only overweight middle-aged men.

Gender and age differences in the impact of overweight on obesity-related quality of life among Korean adults

SUMMARY

OBJECTIVE

To investigate gender and age difference in impact of overweight on health-related quality of life (HRQOL) among Korean adults.

METHODS

Cross-sectional obesity-related quality of life (QOL) scores were measured by a Korean obesity-related QOL scale (KOQOL) from 448 Korean adults aged 20-80 years. A body mass index (BMI) was categorized with normal-weight as BMI < 23 kg/m(2), overweight as BMI ≥ 23 kg/m(2) based on the alternative cutoff points for Asians. Each gender was respectively stratified by median age, 45 years for men and 50 years for women, to examine the obesity-related QOL by age groups.

RESULTS

Women had a poorer obesity-related QOL compared to men (p < 0.001). In the younger age group, overweight women had a poorer obesity-related QOL compared with normal-weight women (p < 0.001), however normal-weight and overweight men showed no difference in obesity-related QOL. In the older age group, overweight men showed better QOL on the domains of work-related and psychosocial health than those for normal-weight men, but overweight women still suffered from work-related and routine life QOL.

CONCLUSIONS

This study showed the impact of overweight on obesity-related QOL was different for gender and age group. We should consider the results to manage weight in overweight persons.

Body mass index and health-related quality of life among young Swiss men

BACKGROUND

Studies about the association between body mass index (BMI) and health-related quality of life (HRQOL) are often limited, because they 1) did not include a broad range of health-risk behaviors as covariates; 2) relied on clinical samples, which might lead to biased results; and 3) did not incorporate underweight individuals. Hence, this study aims to examine associations between BMI (from being underweight through obesity) and HRQOL in a population-based sample, while considering multiple health-risk behaviors (low physical activity, risky alcohol consumption, daily cigarette smoking, frequent cannabis use) as well as socio-demographic characteristics.

METHODS

A total of 5 387 young Swiss men (mean age = 19.99; standard deviation = 1.24) of a cross-sectional population-based study were included. BMI was calculated (kg/m²) based on self-reported height and weight and divided into 'underweight' (<18.5), 'normal weight' (18.5-24.9), 'overweight' (25.0-29.9) and 'obese' (≥30.0). Mental and physical HRQOL was assessed via the SF-12v2. Self-reported information on physical activity, substance use (alcohol, cigarettes, and cannabis) and socio-demographic characteristics also was collected. Logistic regression analyses were conducted to study the associations between BMI categories and below average mental or physical HRQOL. Substance use variables and socio-demographic variables were used as covariates.

RESULTS

Altogether, 76.3% were normal weight, whereas 3.3% were underweight, 16.5% overweight and 3.9% obese. Being overweight or obese was associated with reduced physical HRQOL (adjusted OR [95% CI] = 1.58 [1.18-2.13] and 2.45 [1.57-3.83], respectively), whereas being underweight predicted reduced mental HRQOL (adjusted OR [95% CI] = 1.49 [1.08-2.05]). Surprisingly, obesity decreased the likelihood of experiencing below average mental HRQOL (adjusted OR [95% CI] = 0.66 [0.46-0.94]). Besides BMI, expressed as a categorical variable, all health-risk behaviors and socio-demographic variables were associated with reduced physical and/or mental HRQOL.

CONCLUSIONS

Deviations from normal weight are, even after controlling for important health-risk behaviors and socio-demographic characteristics, associated with compromised physical or mental HRQOL among young men. Hence, preventive programs should aim to preserve or re-establish normal weight. The self-appraised positive mental well-being of obese men noted here, which possibly reflects a response shift, might complicate such efforts.

The longitudinal association between weight change and health-related quality of life: the KORA S4/F4 cohort study

OBJECTIVES

Despite the increasing importance of patient-centered perspectives, the impact of weight change on the health-related quality of life (HRQL) has remained unclear. This work aims to investigate this longitudinal relationship.

METHODS

Data was collected from a population-based cohort study of 3,080 Germans. Anthropometrics and HRQL were assessed at baseline and after a 7-year follow-up period. Using linear regression the average change in HRQL scores was calculated among 5 mutually exclusive weight change groups. Multilevel growth modeling was conducted to differentiate between interpersonal (cross-sectional) and intrapersonal (longitudinal) associations between body mass index (BMI)/BMI change and HRQL.

RESULTS

Heavy weight gain (≥10 % body weight) was associated with impairments in physical health among women (-2.82 points, CI: -4.29, -1.34) and obese men (-4.33 points, CI: -7.62, -1.04) and with improvements in mental health among women (+3.20 points, CI: +1.37, +5.02). Results from the multilevel models were consistent, showing negative associations between BMI change and physical health, positive associations between BMI change and mental health and a high degree of similarity between interpersonal and intrapersonal associations.

CONCLUSIONS

Weight gain leads to clinically relevant impairments in physical health. More research is needed to clarify the antipodal effects of weight change on physical and mental health components.

Body mass index and health-related quality of life in apparently healthy individuals

PURPOSE

Obesity is known to be associated with a range of chronic medical comorbidities, but little is known about the impact of overweight and obesity on health-related quality of life (HRQoL) in persons without chronic diseases. The aim of this study was to assess HRQoL, body mass index (BMI) and health behavior patterns in a community sample of subjects who had no long-lasting medical comorbidities

METHODS

We assessed HRQoL in 1,187 apparently healthy individuals (mean age 57 ± 7 years), of whom 24 % were classified as normal weight, 49 % as overweight, 20 % as obese and 7 % as very obese. Two different instruments of HRQoL were used: the generic Short-Form Health Survey (SF-36) questionnaire and the preference-based instrument EuroQol (EQ-5D).

RESULTS

All physical components of the SF-36 decreased linearly according to BMI categories in women. In men, only poorer physical functioning scale showed linearity with rising BMI. Scores on the mental components of the SF-36 did not differ by BMI categories in either gender. The EQ-5D index and EuroQol visual analogue scale scores decreased linearly with rising BMI only in women.

CONCLUSIONS

In apparently healthy middle-aged subjects, physical HRQoL decreases with increasing level of BMI and more so in women than in men. Mental components of HRQoL do not differ between the categories of BMI in either gender.

Condições de saúde e variáveis sociodemográficas associadas à qualidade de vida em idosas de um programa de atividade física de Curitiba, Paraná, Sul do Brasil

O presente estudo teve como objetivo analisar a associação entre variáveis sociodemográficas e condições de saúde com os domínios da qualidade de vida em idosas participantes do programa Idoso em Movimento. A amostra do estudo foi composta por 1.806 idosas, que foram avaliadas por meio de entrevista para os potenciais correlatos de qualidade de vida (WHOQOL-BREF e WHOQOL-OLD). O índice de massa corporal foi calculado após aferição do peso e da estatura. Os domínios da qualidade de vida foram classificados em tercis. Para análise dos dados, foi utilizada a regressão logística ordinal. Após ajustes para variáveis de confusão, a faixa etária, classe econômica, escolaridade, situação ocupacional e estado civil estiveram associados a alguns domínios da qualidade de vida (p < 0,05). Além disso, idosas obesas ou com problemas de saúde apresentaram menor razão de chance de estar nos escores mais elevados de qualidade de vida, e as idosas que usavam um ou dois medicamentos apresentaram maior razão de chance de estar nos escores mais elevados do domínio físico. Como conclusão, os fatores sociodemográficos e as condições de saúde estão associados com a qualidade de vida em idosas.

Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36

OBJECTIVE

Obesity is associated with impaired overall health-related quality of life but individual studies suggest the relationship may differ for mental and physical quality of life. A systematic review using Medline, Embase, PsycINFO and ISI Web of Knowledge, and random effects meta-analysis was undertaken.

DESIGN AND METHODS

Studies were included in the meta-analysis if they were conducted on adults (defined as age >16 years), reported an overall physical and mental component score of the SF-36, and, or both. Heterogeneity was assessed using I(2) statistics and publication and small study biases using funnel plots and Egger's test. Between-study heterogeneity was explored using meta-regression.

RESULTS

Eight eligible studies provided 42 estimates of effect size, based on 43,086 study participants. Adults with higher than normal body mass index had significantly reduced physical quality of life with a clear dose-response relationship across all categories. Among class III obese adults, the score was reduced by 9.72 points (95% Confidence Interval 7.24, 12.20, P < 0.001). Mental quality of life was also significantly reduced among class III obese (-1.75, 95% confidence interval -3.33, -0.16, P = 0.031), but was not significantly different among obese (class I and class II) individuals, and was significantly increased among overweight adults (0.42, 95% confidence interval 0.17, 0.67, P = 0.001), compared to normal weight individuals. Heterogeneity was high in some categories, but there was no significant publication or small study bias.

CONCLUSIONS

Different patterns were observed for physical and mental HRQoL, but both were impaired in obese individuals. This meta-analysis provides further evidence on the impact of obesity on both aspects of health-related quality of life.

Body weight and health-related quality of life in Catalonia, Spain

Obesity poses important burdens not only on the individuals whose quality of life is reduced but on national welfare systems that have to face growing premature mortality rates, increase healthcare expenditures to treat obesity-related diseases, and earmark vast amounts of healthcare resources for prevention. The main goal of this paper is to analyze the relationship between excess body weight and different dimensions of health-related quality of life for people 16 years and older and to identify the health dimensions most affected by excess weight. We have drawn data from the Catalonia Health Survey (2006). Our results reveal a relationship between excess weight and health-related quality of life. Even after controlling for socio-economic status and objective health variables, excess weight is shown to have a significant negative effect on health-related quality of life. Subjects responses revealed that the negative effect of excess weight was felt the strongest in the health-related quality of life dimensions of mobility and pain/discomfort. Our results indicate there are important differences among gender and age groups. Women and older people are more likely to suffer from the negative consequences of excess weight.

BMI and psychological distress in 68,000 Swedish adults: a weak association when controlling for an age-gender combination

Background

Study results concerning associations between body mass index (BMI) and psychological distress are conflicting. The purpose of this study was to describe the shape of the association between BMI and psychological distress in a large sample of Swedish adults.

Methods

Data was measured with the General Health Questionnaire-12 (GHQ-12), in 68,311 adults aged 18–74. Self-reported data was derived from a merger of the 2000, 2004 and 2008 Life and Health (Liv och Hälsa) questionnaires focusing general perceived distress as well as living conditions. Logistic regression analysis was used to describe the association between BMI and psychological distress when controlled for age and gender in combination.

Results

Women reported an overall higher psychological distress than men. A significant pattern of decreasing psychological distress with increasing age emerged among women in all BMI categories. Trends of this same pattern showed for men. Small or no differences were seen in psychological distress between those in normal weight, overweight, and obesity I categories (among women: 20.4%, 18.4%, 20.5%; among men: 12.8%, 11.2%, 12.9%). For both genders, any notable increase in psychological distress appeared first in the obesity II category (among women: 27.2%. Among men: 17.8%).

Conclusions

Psychological distress decreases with increasing age regardless of BMI; a pattern more obvious for women. Being categorized with obesity II leads to a markedly higher psychological distress than being categorized with normal weight, overweight or obesity I. From this, we suggest that future obesity research focusing on psychological distress could investigate the role of stigma and norm susceptibility in relationships where people are evaluated through the eyes of the other.

Health and health-related quality of life among treatment-seeking overweight and obese adults: associations with internalized weight bias

BACKGROUND

Weight bias is widespread and has numerous harmful consequences. The internalization of weight bias has been associated with significant psychological impairment. Other forms of discrimination, such as racial and anti-gay bias, have been shown to be associated with physical health impairment. However, research has not yet examined whether internalized weight bias is associated with physical as well as psychological impairment in health-related quality of life.

METHODS

Participants included 120 treatment-seeking overweight and obese adults (mean body mass index = 35.09; mean age = 48.31; 68% female; 59% mixed or Asian ethnicity). Participants were administered measures of internalized weight bias and physical and mental health-related quality of life, and they were assessed for the presence of chronic medical conditions, use of prescription and non-prescription medications, and current exercise.

RESULTS

Internalized weight bias was significantly correlated with health impairment in both physical (r = -.25) and mental (r = -.48) domains. In multivariate analyses controlling for body mass index, age, and other physical health indicators, internalized weight bias significantly and independently predicted impairment in both physical (β = -.31) and mental (β = -.47) health.

CONCLUSIONS

Internalized weight bias was associated with greater impairment in both the physical and mental domains of health-related quality of life. Internalized weight bias also contributed significantly to the variance in physical and mental health impairment over and above the contributions of BMI, age, and medical comorbidity. Consistent with the association between prejudice and physical health in other minority groups, these findings suggest a link between the effects of internalized weight-based discrimination and physical health. Research is needed on strategies to prevent weight bias and its internalization on both a societal and individual level.

The relationship between body mass index and quality of life in community-living older adults living in the United States

BACKGROUND

Carrying excess weight is associated with various chronic conditions especially in older adults, and can have a negative influence on the quality of life of this population.

OBJECTIVE

The objective of this study was to estimate the independent (i.e. adjusted for demographic, socioeconomic and health status differences) impact of Body Mass Index (BMI) on health-related quality of life.

DESIGN

A mail survey was sent to 60,000 older adults living in 10 states.

METHODS

The survey assessed quality of life using the average physical component scores (PCS) and mental component scores (MCS) obtained from the Veterans Rand 12-item (VR-12) health status tool embedded in the survey. Ordinary least squares (OLS) regression techniques were used to estimate the independent impact of each BMI category on quality of life, compared to the impact of other chronic conditions.

RESULTS

A total of 22,827 (38%) eligible sample members responded to the survey. Of those, 2.2% were underweight, 38.5% had a normal BMI, 37.0% were overweight, 18.5% were obese and 1.9% were morbidly obese. Following OLS regression techniques, respondents' PCS values were statistically significantly lower for the underweight, overweight, obese and morbidly obese BMI categories, compared to the normal BMI group. Compared with all other chronic conditions, being morbidly obese (-6.0 points) had the largest negative impact on the PCS. Underweight was the only BMI category with a statistically significantly lower MCS value.

CONCLUSIONS

The greatest negative impacts of the various BMI categories on quality of life were on physical rather than mental aspects, especially for those in the underweight, obese and morbidly obese categories, more so than many other chronic conditions.

Associations of lifestyle factors, disease history and awareness with health-related quality of life in a Thai population

Background

The impact of the presence and awareness of individual health states on quality of life (HRQoL) is often documented. However, the impacts of different health states have rarely been compared amongst each other, whilst quality of life data from Asia are relatively sparse. We examined and compared the effects of different health states on quality of life in a Thai population.

Methods

In 2008–2009, 5,915 corporate employees were invited to participate in a survey where HRQoL was measured by the Short Form 36 (SF-36) questionnaire. The adjusted mean SF-36 scores were calculated for each self-reported illness, number of chronic conditions, lifestyle factors and awareness of diabetes and hypertension. The effect sizes (ES) were compared using Cohen's d.

Results

The response rate was 82% and 4,683 (79.1%) had complete data available for analysis. Physical and Mental Component Summary (PCS and MCS) scores decreased as the number of chronic conditions increased monotonically (p<0.0001). Diabetes and hypertension negatively influenced PCS (mean score differences −0.6 and −1.5, p<0.001 respectively) but not MCS, whereas awareness of diabetes and hypertension negatively influenced MCS (−2.9 and −1.6, p<0.005 respectively) but not PCS. Arthritis had the largest ES on PCS (−0.37), while awareness of diabetes had the largest ES on MCS (−0.36). CVD moderately affected PCS and MCS (ES −0.34 and −0.27 respectively). Obesity had a negative effect on PCS (ES −0.27). Exercise positively affected PCS and MCS (ES +0.08 and +0.21 (p<0.01) respectively).

Conclusion

Health promotion to reduce the prevalence of chronic diseases is important to improve the quality of life in Asian populations. Physical activity is an important part of such programs. Awareness of diseases may have greater impacts on mental health than having the disease itself. This has implications for the evaluation of the cost-benefit of screening and labeling of individuals with pre-disease states.

Relationship Between Morbidly Obese Subjects' Attributions of Low General Well-being, Expectations and Health-Related Quality of Life: Five-year Follow-up After Gastric Banding

Low health-related quality of life among morbidly obese subjects is well-known. However, the relationship may not be simple. We aim to examine the association between pre-operative expectations and health-related quality of life and long-term changes in health-related quality of life after gastric banding. The questionnaires were answered twice: before and five years after gastric banding. Short Form-36 assessed health-related quality of life. Obesity specific questions were used to assess the subjects' attribution of impairment to morbid obesity and their expectations to changes as a result of weight loss. The subjects attribute morbid obesity as a major reason for their impairments in state of health, physical activity, pain and work capacity. As a result of weight loss, the subjects expect improvements even within fields which they did not consider to be impaired due to morbid obesity. We found an inverse association between high expectations and mental component summary score at baseline. At follow-up having expectations fully fulfilled was associated with a higher mental component summary score than having expectations fulfilled only to a fair extension and not having expectations fulfilled. Physical component summary was statistically significant improved at follow-up Morbidly obese subjects' attributions of low general well-being combined with their expectations may be a central part of understanding the mechanisms involved in the association between morbid obesity and low health-related quality of life. Furthermore the impact of morbid obesity on health-related quality of life may be reduced if healthprofessionals bridge the gap between morbidly obese subjects' expectations and their experience.

CD3Z genetic polymorphism in immune response to hepatitis B vaccination in two independent Chinese populations

Vaccination against hepatitis B virus is an effective and routine practice that can prevent infection. However, vaccine-induced immunity to hepatitis B varies among individuals. CD4⁺ T helper cells, which play an important role in both cellular and humoral immunity, are involved in the immune response elicited by vaccination. Polymorphisms in the genes involved in stimulating the activation and proliferation of CD4⁺ T helper cells may influence the immune response to hepatitis B vaccination. In the first stage of the present study, a total of 111 single nucleotide polymorphisms (SNPs) in 17 genes were analyzed, using the iPLEX MassARRAY system, among 214 high responders and 107 low responders to hepatitis B vaccination. Three SNPs (rs12133337 and rs10918706 in CD3Z, rs10912564 in OX40L) were associated significantly with the immune response to hepatitis B vaccination (P = 0.008, 0.041, and 0.019, respectively). The three SNPs were analyzed further with the TaqMan-MGB or TaqMan-BHQ probe-based real-time polymerase chain reaction in another independent population, which included 1090 high responders and 636 low responders. The minor allele ‘C’ of rs12133337 continued to show an association with a lower response to hepatitis B vaccination (P = 0.033, odds radio = 1.28, 95% confidence interval = 1.01–1.61). Furthermore, in the stratified analysis for both the first and second populations, the association of the minor allele ‘C’ of rs12133337 with a lower response to hepatitis B vaccination was more prominent after individuals who were overweight or obese (body mass index ≥25 kg/m²) were excluded (1^st stage: P = 0.003, 2^nd stage: P = 0.002, P-combined = 9.47e-5). These findings suggest that the rs12133337 polymorphism in the CD3Z gene might affect the immune response to hepatitis B vaccination, and that a lower BMI might increase the contribution of the polymorphism to immunity to hepatitis B vaccination.

The impact of the metabolic syndrome on health-related quality of life: a cross-sectional study in Greece

BACKGROUND

Metabolic syndrome [MetS] is a chronic, progressive and multi-complex health problem that can trigger physical, emotional and psychosocial problems. The aim of this study is to investigate the association between MetS and health-related quality of life (HRQoL) as well as depressive and anxiety disorders.

METHODS

New consecutive patients who attended an outpatient lipid clinic for evaluation for MetS were eligible for inclusion in the study. The MetS was defined according to the new definition of International Diabetes Federation (IDF). The medical outcomes study, short form-36 (SF-36) was used to assess HRQoL. Anxiety and depressive symptoms were assessed by a validated Greek version of the hospital anxiety and depression scale (HADS).

RESULTS

Three hundred and fifty-nine subjects were involved of whom 206 [57.4%] met the diagnostic criteria for the MetS (cases) and 153 [42.6%] were free of MetS criteria (comparator group). MetS was associated with lower scores of all subscales of the SF-36 except of bodily pain. The physical component summary score of SF-36 was independently associated with gender (β = 2.41, P = .01), married or living together (β = 5.18, P = .001) and satisfactory household income (β = 5.77, P < .0001). The mental component summary score of SF-36 was independently associated with gender (β = 3.20, P = .003) and satisfactory household income (β = 3.94, P = .02). A predominance of anxiety and depressive symptoms was observed among subjects with MetS.

CONCLUSIONS

Our study demonstrated that subjects with MetS have significantly more impaired HRQoL than those without MetS. These findings suggest that HRQoL should be considered in the management of subjects with MetS.

The relationship between quality of life, binge-eating disorder, and obesity status in an ethnically diverse sample

This study examined the relationship between obesity status, binge-eating disorder (BED), and quality of life (QOL) in a large, ethnically diverse community sample of adult men and women. Using data from the Collaborative Psychiatric Epidemiological Surveys (N = 20,013), individuals were categorized into four groups: nonobese with BED (n = 142), nonobese without BED (n = 14,301), obese with BED (n = 136), and obese without BED (n = 4,863). Results indicated obese individuals with BED consistently reported the poorest QOL. Findings suggested that obesity status was more strongly related to physical health-related QOL variables (e.g., number of physical conditions, mobility impairment) whereas diagnostic status was more predictive of mental health and social functioning QOL variables (e.g., cognitive impairment, social interaction impairment, time out of role). The degree to which lifetime BED diagnosis was associated with impairment in social interaction differed across ethnic groups. For black individuals, the number of physical health conditions was associated with BED presence moreso than weight status.

Health-related quality of life and awareness of hypertension

BACKGROUND

It has been shown that individuals with hypertension have poorer health-related quality of life (HRQoL) than normotensive individuals. However, little is known about the impact of high blood pressure and the awareness to have hypertension on HRQoL.

METHODS

In this cross-sectional population-based study, we evaluated 901 cardiovascular risk patients aged 45 to 70 years without serious comorbidities. Hypertension was detected in 497 (55%) of the patients, in whom 137 (28%) had previously undiagnosed hypertension confirmed with home blood pressure measurement. Before the diagnosis of hypertension was made, the patients filled Short-Form Health Survey (SF-36) to assess their HRQoL. Glucose homeostasis was assessed with 2  h oral glucose tolerance test.

RESULTS

Patients who were aware of their hypertension had lower scores in physical functioning and general health than patients without hypertension and patients who were unaware of hypertension. There were no differences for mental components of SF-36 between these study groups. The prevalence of obesity and newly diagnosed type 2 diabetes was higher in patients with known hypertension than among other study groups.

CONCLUSION

Impaired HRQoL in hypertensive patients might be secondary to the awareness of hypertension, adverse drug effects, newly diagnosed type 2 diabetes or obesity, not high blood pressure per se.

Association between obesity and depression: evidence from a longitudinal sample of the elderly in Taiwan

OBJECTIVES

Obesity has been identified as an epidemic worldwide. In Taiwan, the highest prevalence of obesity is observed in adults age ≥65. This article investigates the effects of body weight status on the likelihood of depression among the elderly in Taiwan.

METHOD

A longitudinal sample of the elderly (1351 males and 1165 females) interviewed in both the 1999 and 2003 Surveys of Health and Living Status of the Elderly in Taiwan is used. A random effect logit model is estimated to examine the effects of body weight status, lifestyle, and socio-demographic characteristics on the likelihood of depression.

RESULTS

About 10.4% of the elderly men are overweight and 13.4% are obese in 2003. A higher prevalence of obesity is found among elderly women, with 19.3% being overweight and 26.4% obese. Elderly men who are underweight are more likely to be depressed (odds ratio; OR = 2.36) than those from other weight categories, while overweight and obese women are less likely to be depressed (ORs = 0.72 and 0.61) than elderly women of the normal weight category.

CONCLUSIONS

In contrast to most findings for the Western countries, a negative association between obesity and depression of the elderly is evident in Taiwan. The different findings between Western and Asian countries may be due to the cultural differences. Unlike the Western countries that stigmata are attached to excessive overweight, being overweight is not a symbol of unhealthiness because only the wealthy can afford to eat more and put on more weight in the Chinese society.

The effect of urinary incontinence on health utility and health-related quality of life in men following prostate surgery

AIMS

The impact of urinary incontinence (UI) on health-related quality of life (HRQoL) has been less well researched in men than women and the general population. This study aims to assess the association between UI and HRQoL in men 1 year after prostate surgery.

METHODS

Planned secondary analysis of data from two parallel randomized controlled trials of active conservative treatment for UI in 853 men following radical prostatectomy (RP) and transurethral resection of the prostate (TURP). Men of any age were eligible for trial inclusion if they were experiencing UI 6 weeks after undergoing RP or TURP at 34 centers in the United Kingdom. Univariate and multivariate analysis considered associations between health status (SF-12 and EQ-5D) and self-reported UI. Multivariate analysis controlled for age, obesity, UI prior to surgery, and concomitant fecal incontinence.

RESULTS

Mean age of 411 men in the RP trial was 62.3 years (SD 5.7) and 442 men in the TURP trial was 68.0 (SD 7.9). Of men with UI at 6 weeks after surgery, 76.7% in the RP group and 63.2% in the TURP group still had UI at 12 months. Any UI at 12 months was significantly associated with reduced HRQoL in the RP group and lower EQ-5D and SF-12 Mental Component Scores in the TURP group.

CONCLUSION

Any UI is a significant factor in reduced HRQoL in men following prostate surgery, particularly younger men who undergo RP. Its importance to patients as an adverse outcome should not be underestimated.

Physical function mitigates the adverse effects of being thin on mortality in a free-living older Taiwanese cohort

OBJECTIVES

To examine the significance of underweight and physical function as well as their interaction on mortality in the aged.

DESIGN

Prospective cohort.

SETTING

The Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

Total of 1435 representative free-living elders (739 men and 696 women).

MEASUREMENTS

Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0-100) was derived from the SF-36(®). Death by December 31, 2006 was the outcome measure.

RESULTS

After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20-5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was combined with the lowest-PF after covariate adjustments (HR = 8.67, 95% CI = 3.77-20.0). Similarly, the lowest arm muscle circumference (MAMC)-PF had a HR of 5.22 compared to mid-MAMC-highest-PF. However, percent and absolute body fat, estimated by bioelectrical impedance, was comparable to non-sarcopenic individuals.

CONCLUSION

Thin elderly Taiwanese with sarcopenia, and less skeleton, are at the most risk of death, especially if physical function is limited.

Improvement of health-related quality of life in adult women with 21-hydroxylase deficiency over a seven-year period

Health related quality of life (HRQoL) is impaired in adult patients with 21-hydroxylase deficiency (21-OHD). Up to now, only cross-sectional and no longitudinal studies are available. It is not known if HRQoL can be improved in adult 21-OHD patients. We performed a longitudinal, prospective, single centre, follow-up study over seven years including 15 adult female 21-OHD patients. Two standardized questionnaires (Short Form 12 (SF-12); Hospital Anxiety and Depression Scale (HADS)) were completed in 2003, 2006 and 2010. Adjustment for age and sex was performed by transformation of score values into age- and sex-adjusted Z-scores using data sets from respective normative groups. Data regarding glucocorticoid therapy, clinical and hormonal parameters were assessed. We found that two of eight scales of SF-12 showed a significant improvement and four of eight scales a positive trend to better scores. No significant changes were seen in scores for HADS or for steroid hormone levels. Daily hydrocortisone equivalent dose per body surface significantly decreased over the study period. No changes in BMI were observed over the study period. We conclude that improvement of HRQoL in adult female 21-OHD patients is possible. Several factors might be involved in this improvement including reduced daily hydrocortisone equivalent dose per body surface.

The relation between self-reported body weight and health-related quality of life: a cross-sectional study in Japan

BACKGROUND

Whilst being obese is associated with increased mortality, less is known about the relationship between body weight and health-related quality of life (HRQOL). We aimed to examine this relationship in the general Japanese population, focusing on both underweight and overweight individuals.

METHODS

We cross sectionally analyzed data from the Health Diary Study, which surveyed health-related behavior in a nationally quasi-representative sample from 2003. HRQOL was measured using the Short Form-8 Health Survey. Body mass index (BMI) was calculated from self-reported height and weight values. We compared differences in HRQOL in people with normal BMI (18.5-24.9) with those with underweight (<18.5), overweight (25-29.9) or obese (≥30) BMIs.

RESULTS

Among a population-weighted random sample (5387 households), 1857 households (34.5%) agreed to participate. Of the targeted sample population (3658 people), 3477 responded (95.1%). Of 2453 people (age ≥18 years), we analyzed data from 2399 people. After adjusting for age, sex and status of chronic conditions, we found that being overweight was correlated with impaired physical HRQOL [coefficient:-0.96 (95% confidence interval (CI): -1.73, -0.20)] but not with mental HRQOL [coefficient: -0.17 (95% CI: -0.50, 0.95)].

CONCLUSIONS

Although the differences were small, being overweight was correlated with impaired physical HRQOL but not with mental HRQOL.

Sex differences in the association of youth body mass index to adult health-related quality of life: the physical activity longitudinal study

OBJECTIVE

The long-term consequences of youth overweight on adult health-related quality of life (HRQL) have not been documented. This study examines sex differences in the association between youth body mass index (BMI) and adult HRQL.

METHODS

Subjects included 139 male and 142 female participants aged 7-18 in the 1981 Canada Fitness Survey, followed up in 2002-04. The associations of youth BMI to adult HRQL (SF-36) were examined with bivariate correlations, differences in means and multivariate linear regression analyses.

RESULTS

Bivariate analyses revealed positive associations between youth overweight and mental aspects of adult HRQL in females, and weak negative associations with physical aspects, but no significant associations in males. All overweight male and female youth scored the maximum (100) on Role Emotional (RE). In females, compared to healthy weight youth, overweight youth scored 16.0, 13.4, 12.7, and 10.9 points higher on general health (GH), vitality (VT), mental health (MH), and the mental component score (MCS) in adulthood, respectively; a 1 unit increase in youth BMI led to 1.7, 1.5, and 1.4 point increases in adult VT, MH and MCS scores, respectively. Associations were attenuated with the removal of adult BMI from the models, but remained strong for MH and MCS.

CONCLUSIONS

Overweight in youth did not have a significant negative impact on HRQL two decades later; rather, a positive association was found with mental aspects of adult HRQL in females.

The benefits of body weight loss on health-related quality of life

BACKGROUND

Obesity is a worldwide public health issue, and the prevalence of obesity is also increasing steadily in Taiwan. Obesity leads to several chronic diseases. Often, impaired quality of life is a consequence of obesity. The aim of this study was to determine if body weight-loss could improve health-related quality of life (HRQOL) in Taiwan.

METHODS

The cutoff for obesity is body mass index (BMI) = 27 as compared with 30 in US and Europe. We enrolled 67 participants with BMI ≥ 27 and more than one criterion of the metabolic syndrome, who underwent 3 months of body weight-loss intervention by diet control and regular exercise. We performed anthropometric measurements and blood tests, and administered the WHOQOL-BREF questionnaire Taiwanese version to assess HRQOL before and after the weight loss intervention. This is the first study using the WHOQOL-BREF to examine HRQOL in Taiwan. The questionnaire included D1 physical, D2 psychological, D3 social relationships and D4 environmental domains; each was scored from 4 to 20.

RESULTS

Obese subjects had lower D1 and D2 scores as compared with the Taiwan healthy population reference group at baseline. In this study, 38 participants completed the 3-month intervention program and 29 participants dropped out. Twenty-five participants reached the 5% of initial BMI goal. Among them, significant statistical improvements were found both in medical comorbidities and in the four domains of the HRQOL questionnaire.

CONCLUSION

Obesity can cause impaired HRQOL, which can be improved through BMI intervention. In addition to the benefits of biomedical aspect, this could be an incentive goal for keeping body weight control.

Measuring health-related quality of life in non-complicated diabetes patients may be an effective parameter to assess patients at risk of a more serious disease course: a cross-sectional study of two diabetes outpatient groups

AIM

To describe health-related quality of life in diabetes outpatients and investigate the impact of diabetic foot ulcers, by comparing a group of patients with and without diabetic foot ulcers complications. Secondary to study the impact of sociodemographic and clinical variables in the two groups.

DESIGN

Cross-sectional study.

METHODS

The study involved 130 diabetes outpatients and 127 diabetic foot ulcers patients. Health-related quality of life was measured with the generic questionnaire Short Form-36, consisting of eight dimensional scores. All scores were adjusted for differences in age and gender (estimated marginal means). Differences were compared with anova calculations, by the use of Predictive Analytics Software, PASW (version 17.0).

RESULTS

This study confirms that health-related quality of life differs significantly between disease subgroups when measured with Short Form-36. Diabetic foot ulcers had a major negative impact on 7/8 subscales on the Short Form-36 compared to the diabetes outpatients group. health-related quality of life decreased with increasing amount of complications and comorbidity in the diabetes outpatients group, with cardiovascular complications being the most pronounced predictor of lower health-related quality of life scores.

CONCLUSION

Patients who have developed diabetic foot ulcers reports much poorer health-related quality of life than compared to diabetes outpatients. Factors linked to the development of late complications were not detected in the diabetic foot ulcers group, such as cardiovascular comorbidity and neuropathy.

RELEVANCE TO CLINICAL PRACTICE

Health-related quality of life measurement in early stages of disease may detect patients at risk of a more serious disease course and who consequently are in need of a more intensive follow-up.

Self-assessed disability and self-rated health among rural villagers in Peru: a brief report

CONTEXT

Risks for poor self-rated overall health in rural areas of developing nations have not been thoroughly investigated.

PURPOSE

The objective of this study was to assess potential risk factors for poor self-rated health among rural villagers in Peru.

METHODS

A door-to-door survey of villagers residing in the Pampas Grande region in Peru, which is in the Andes Mountains, yielded complete data for 337 adults.

FINDINGS

Adjusting for age and gender using multiple logistic regression analysis revealed that having self-reported disabilities was inversely and independently related to good self-rated health (OR 0.48 [95% CI, 0.26-0.88]). Joint pain also was related to self-rated health (OR 0.23 [95% CI, 0.13-0.41]).

CONCLUSIONS

Increasing access to affordable, effective analgesics may reduce this disparity. Health agencies should consider these actions as possible planning priorities for the region.

Modeling factors that influence exercise and dietary change among midlife Australian women: results from the Healthy Aging of Women Study

The objective of this study was to investigate the factors that influence midlife women to make positive exercise and dietary changes. In late 2005 questionnaires were mailed to 866 women aged 51-66 years from rural and urban locations in Queensland, Australia and participating in Stage 2 of the Healthy Aging of Women Study. The questionnaires sought data on socio-demographics, body mass index (BMI), chronic health conditions, self-efficacy, exercise and dietary behavior change since age 40, and health-related quality of life. Five hundred and sixty four (69%) were completed and returned by early 2006. Data analysis comprised descriptive and bivariate statistics and structural equation modeling. The results showed that midlife is a significant time for women to make positive health behavior changes. Approximately one-third of the sample (34.6%) indicated that they had increased their exercise and around 60% had made an effort to eat more healthily since age 40. Modeling showed self-efficacy to be important in making both exercise (βˆ(Z)=0.099;βˆ=0.006;95%CI:0.001,0.011) and dietary (βˆ(Z)=-0.187;βˆ=-0.009;95%CI:-0.013,-0.005) changes. Although education appeared to influence self-efficacy (βˆ(Z)=0.148;βˆ=2.448;95%CI:1.136,3.76) in relation to exercise change, this was not the case for dietary change. The study has application for programs promoting healthy aging among women, and implies that those with low education, high BMI and poor mental health may need considerable support to improve their lifestyles.

Calidad de vida, según percepción y comportamientos de control del peso por género, en estudiantes universitarios adolescentes en México

El objetivo de este estudio fue analizar la calidad de vida (CV), según auto percepción del peso corporal y comportamientos de control de peso, por género, en 2.401 estudiantes de 17 a 19 años de primer ingreso en un centro universitario en México del 2007 al 2009; 61,9% mujeres, 80,6% no trabajaban y 99,2% solteros. Se auto administró en línea un cuestionario genérico de CV (YQOL-R) módulo perceptual, y siete ítems acerca del peso adaptados del YRBS 2007. Se observó que un 52% de mujeres y un 31,7% de hombres trataba de bajar de peso. CV más alta para peso cercano al correcto, quienes trataban de mantenerse en su peso y los que hacían ejercicio; CV más baja para quienes reportaron mucho sobrepeso, mujeres que trataban de bajar de peso, comían menos, dejaban de comer, hacían dieta sin supervisión, vomitaban o tomaban laxantes. En mujeres la CV fue diferente si trataban de mantenerse, subir o bajar de peso; en hombres sólo al tratar de subir. Esta información puede ser de utilidad para procesos educativos, programas de prevención y para evaluar las intervenciones.

Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls

PURPOSE

We explored covariates of the quality of life (QOL) in non-small-cell lung cancer (NSCLC) patients and made a comparison with healthy controls.

METHODS

We assessed the QOL of 220 consecutive NSCLC patients at a university hospital. The QOL data were measured by the brief version of the World Health Organization's Quality of Life and by utility using the standard gamble method. We selected demographically matched healthy controls from the 2001 National Health Interview Survey for comparison. Multiple linear regression models were constructed to explore significant factors of QOL after controlling for covariates.

RESULTS

Patients with more advanced stages of NSCLC had poorer scores than did the healthy controls in the physical and psychological domains. Patients with disease duration of longer than 1 year tended to report higher physical and environment QOL than did those with NSCLC diagnosed for less than 1 year. Insight into one's own illness was associated with a higher utility, better social support, and improved financial resources.

CONCLUSIONS

QOL was significantly associated with staging and duration of NSCLC. Disease insight appears to be a positive factor for operable NSCLC patients of the Taiwanese culture, which implies that clinicians should respect patient autonomy in diagnosis disclosure.

Psychological Symptoms in People Presenting for Weight Management

Introduction: Elevated levels of psychopathology have been described in various groups of obese patients. This study aimed to describe the presence of depressive and binge eating symptoms in patients presented for clinical weight management at a general hospital in Singapore, as well as their health-related quality of life (HRQOL). Correlations between these symptoms and other demographic and clinical variables were also sought. Materials and Methods: Patients presented at a clinical weight management programme were asked to complete the Beck Depression Inventory (BDI), Binge Eating Scale (BES) and the Short Form-36 (SF-36). Clinical and demographic data were also collected. Results: Of the group, 17.1% reported moderate or severe binge eating symptoms and 9.7% reported moderate or severe depressive symptoms. HRQOL, mostly in physical health domains, was lower in this sample compared to local norms. Within the group, binge eating and depressive symptoms, but not increasing obesity, predicted poorer HRQOL. Conclusions: Psychological symptoms are significantly present in patients presented for clinical weight management and these contribute to poorer quality of life. Addressing these symptoms will improve the overall well-beings of these patients and the total benefits gained will exceed the benefits of weight loss per se. Key words: Binge eating, Depression, Obesity, Quality of life

Are youth BMI and physical activity associated with better or worse than expected health-related quality of life in adulthood? The Physical Activity Longitudinal Study

PURPOSE

Body mass index (BMI) and physical activity (PA) affect health-related quality of life (HRQL); however, the long-term impact of youth BMI and PA on adult HRQL is unknown. We investigated the relationship of youth BMI and PA to adult HRQL 22 years later.

METHODS

Subjects included 310 participants aged 7 to 18 in the 1981 Canada Fitness Survey, followed up in 2002-2004. The associations of youth BMI and leisure time PA to adult HRQL were examined, comparing to age- and sex-adjusted Canadian SF-36 norms.

RESULTS

Bivariate analyses revealed positive associations between youth overweight and mental aspects of adult HRQL, but little association with physical aspects. In logistic regression adjusting for adult BMI and other covariates, overweight youth were 7 times more likely than healthy weight youth to score at/above the norm on both mental health (MH) and bodily pain, and almost 18 times more likely on the mental component score (MCS). Youth BMI was also positively associated with general health (GH), social functioning, and role emotional. Removing adult BMI from the models led to attenuated associations with mental HRQL and no association with GH. Longitudinal BMI status change was explored, and findings supported the main regression results. Youth PA was not associated with adult HRQL.

CONCLUSIONS

Youth overweight conveyed a long-term positive impact on several aspects of adult HRQL, and this impact may be both direct and indirect through BMI change and the effect on adult BMI. Youth PA had no long-term impact on adult HRQL.

Associations between body mass index and health-related quality of life among Australian adults

OBJECTIVES

To assess the relationship between body mass index (BMI) and health-related quality of life (HQoL), as measured by the Short Form Health Survey (SF-36) within a sample with broad population coverage.

SUBJECTS AND METHODS

Survey data incorporating the SF-36 questionnaire, height and weight were obtained from a nationally representative sample of 9,771 Australians aged 21 or older (4,649 men and 5,122 women). Linear multiple regression methods were employed to estimate the magnitude of association between BMI classes and HQoL variables, adjusting for disability and other covariates.

RESULTS

Less than 1% of men and just 3.5% of women were classified as underweight while 52.2% of women and 65.9% of men were classified as overweight or obese. For all SF-36 health dimensions, people with BMI scores in the healthy range reported, on average, higher health-related HQoL scores than underweight and obese people, and HQoL scores decreased with the degree of obesity. Although overweight and obesity were associated with decreasing levels of both physical and emotional well-being, the deterioration in health status was significantly more evident in the physical than in the mental, social or emotional dimensions.

CONCLUSIONS

Low and high BMIs were associated with decreasing levels of both physical and emotional well-being, but the deterioration in health status was more consistent in the physical than in other dimensions.

Association of body mass index with Short-Form 36 physical and mental component summary scores in a multiethnic Asian population

OBJECTIVES

To investigate the association between body mass index (BMI) and physical and mental health-related quality of life (HRQoL) in a multiethnic Asian population in Singapore, and explore whether there were gender and ethnic differences in this association.

METHODS

We conducted cross-sectional analyses using data from 5027 Chinese, Malay and Indian participants (2403 men and 2624 women) aged 24-95 years. These subjects were from four previous cross-sectional surveys carried out in Singapore (from 1982 to 1998) who attended a follow-up examination (including both a questionnaire and a clinic examination) between 2004 and 2007, during which HRQoL was assessed. Participants were classified as underweight (<18.5 kg m(-2)), normal weight (18.5 to <23 kg m(-2)), overweight (23 to <25 kg m(-2)), moderate obese (25 to <30 kg m(-2)) and severe obese (>or=30 kg m(-2)). HRQoL was measured using the Short-Form 36-item questionnaire (SF-36) physical component summary score (PCS) and mental component summary score (MCS). Linear regressions with and without adjusting for other covariates were used to evaluate the association between BMI and SF-36 PCS and MCS.

RESULTS

Compared with participants with normal weight, moderate or severe obesity was associated with 0.8 points (95% confidence interval (CI): -1.5 to -0.1, P=0.03) and 2.1 points lower PCS (95% CI: -3.1 to -0.1, P<0.001), respectively, after adjustment for sociodemographic variables, family functioning measure scores and the presence of chronic diseases. These associations were greater in women than in men. In contrast, being underweight was associated with 1.3 points lower MCS (95% CI: -2.3 to -0.3, P=0.014).

CONCLUSIONS

In this study (one of few studies in the Asia-Pacific region), obesity was associated with lower PCS and the effect was modified by gender but not ethnicity, such that the association was greater in women than in men. However, obesity was not associated with MCS. Underweight was associated with reduced MCS but not PCS.

The association of body mass index and health-related quality of life in the general population: data from the 2003 Health Survey of England

OBJECTIVES

The link between obesity/overweight and life-threatening illnesses is well established. The objective of this study was to investigate the relationship between body mass index (BMI) and health-related quality of life (HRQoL), and any differences between men and women, in the general population of England.

METHODS

HRQoL data (from EQ-5D responses of 14,416 individuals aged >or=18 in the 2003 Health Survey for England) were used, and linear regression analyses were conducted to examine the relationship between BMI and HRQoL.

RESULTS

A significant association between BMI and HRQoL was found after controlling for factors such as gender, age, and obesity-related comorbidities. The maximum HRQoL was reached at a BMI of 26.0 in men and 24.5 in women, demonstrating that BMI is negatively associated with HRQoL for both underweight and obese individuals. At higher BMI values, men reported higher HRQoL than women; at lower BMI values, HRQoL was lower in men than women.

CONCLUSIONS

There is a significant association between BMI and HRQoL in men and women in the general population. Nearly all aspects of HRQoL are adversely affected by elevated BMI.

Obesity and mental health

Mental health factors contribute to the onset and maintenance of overweight and obese status in children, adolescents, and adults. Binge eating disorder (BED), body image, self-esteem, mood disorders, and social and family factors affect individuals in different ways and contribute to weight gain and failure in weight loss management. Assessment of these mental health factors and treatment by 1 of several mental health treatment models may not only improve self-worth but also weight loss and maintenance.

Overweight, medical comorbidity and health-related quality of life in a community sample of women and men

Associations among gender, overweight and obesity, medical comorbidity, and health-related quality of life (HRQoL) were examined in a general population sample of 4,181 women and men aged 18-65 years. Anthropometric measurements and medical comorbidity were assessed as part of a computer-assisted physician interview. HRQoL was assessed with the Physical and Mental Component Summary scales of the Medical Outcomes Study Short Form (SF-36 PCS, MCS). General linear models were used to examine the associations among gender, weight status, medical comorbidity, and HRQoL. Controlling for age, social status, the occurrence of specific medical conditions, and the total number of medical conditions, mild obesity was associated with impairment in physical health functioning, as measured by the PCS, among women, whereas impairment in men's physical health was apparent only for moderate obesity. There was no association between weight status and psycho-social functioning, as measured by the MCS, in women, whereas overweight was associated with better perceived psycho-social functioning in men. The findings are consistent with the hypothesis that women suffer a disproportionately large share of the disease burden of overweight and obesity that is not due solely to differences in medical comorbidity. The possibility that aspects of emotional well-being may mediate the association between obesity and physical health functioning warrants further attention in this regard. The findings also indicate the need to stratify data by gender and to include more sensitive measures of psycho-social functioning in future studies.

The effect of age on weight-related quality of life in overweight and obese individuals

The objective of the current study was to investigate the association between age and weight-related quality of life in a broad range of overweight/obese individuals. Participants included 9,991 overweight and obese adults from a cross sectional database (mean age = 44.9, mean BMI = 38.3, 75.3% women, 73% white). Participants completed the Impact of Weight on Quality of Life-Lite (IWQOL-Lite), a measure of weight-related quality of life. For the total sample, weight-related quality of life was more impaired with increasing age for physical function, sexual life, and work. However, increasing age was associated with less impairment for self-esteem and public distress. On the sexual life domain there was an interaction between age and gender. Men showed a steady decline in sexual life with increasing age, whereas women showed reduced scores on sexual life in all age groups beyond age 18-24.9. Of note, women's scores on all IWQOL-Lite domains were significantly lower (more impaired) than men's. Thus, there are both positive as well as negative consequences of increasing age with respect to the impact of weight on quality of life in overweight and obese persons.

Metabolic syndrome and quality of life (QOL) using generalised and obesity-specific QOL scales

OBJECTIVES

We investigated the association between metabolic syndrome (MS) and health-related quality of life (HRQOL) assessed using generalised and obesity-specific QOL instruments.

METHODS

We recruited 456 outpatients [age: 19-81 years, body mass index (BMI): 16.3-36.7 kg/m2] in the primary care division from 12 general hospitals in Korea. HRQOL was measured using EuroQol comprising the health states descriptive system (EQ-5D) and visual analogue scale (EQ-VAS) as a general instrument. The Korean Obesity-related QOL scale (KOQOL) composed of six domains was used as a disease-specific QOL instrument. MS was defined on the basis of International Diabetes Federation (IDF) criteria with Korean-specific waist circumference cutoffs (men: 90 cm, women: 85 cm).

RESULTS

Subjects with MS displayed significantly higher impairment of EQ-5D and KOQOL. Binary logistic regression analysis of MS patients with controls for age, gender, smoking, alcohol, exercise, education, income, marital status and medication history disclosed odds ratio (OR) values of 2.13 (1.33-3.41) for impaired total KOQOL, 2.07 (1.31-3.27) for impaired physical health, 1.63 (1.03-2.60) for impaired work-related health, 2.42 (1.45-4.04) for impaired routine life, 2.08 (1.27-3.40) for impaired sexual life and 2.56 (1.59-4.11) for diet distress. Among the EQ-5D dimensions, only pain/discomfort displayed a significantly increased OR of 1.60 (1.01-2.56) in MS group.

CONCLUSIONS

Subjects with MS displayed a significantly impaired HRQOL compared with those without MS. MS and HRQOL were more strongly associated in obesity-specific QOL than in generalised QOL.

Validity of overall self-rated health as an outcome measure in small samples: a pilot study involving a case series

OBJECTIVE

A single-item measure of overall self-rated health (SRH) commonly is used in population surveys, but has not been used in small pilot projects. The purpose of this study was to assess the validity of SRH in small samples.

DESIGN

We used data from a prospective, observational weight-loss project to compare change in SRH with change in body weight and physical activity (PA) (minutes) over 30 days (n = 34). Body mass index at baseline ranged from 25.5 to 50.4 (mean = 36.1, median = 34.6). SRH was self-assessed using the following question: How would you rate your health overall? Results An increase in weight was associated with a reduction in SRH (r = 0.37, P = 0.03). An increase in PA was associated with improved SRH (r = 0.39, P = 0.02).

CONCLUSIONS

A single-item SRH measure may be an efficient method for measuring programme outcomes, and may also be useful for comparing the relative effectiveness of different programmes in pilot projects and quality improvement studies.

Obesity and health related quality of life in the general adult population of the Canary Islands

PURPOSE

To explore the relationship between excess weight and health related quality of life (HRQL) in the general population by means of the EuroQol-5D questionnaire.

METHODS

The relationship between excess weight and HRQL was explored by the 2004 Canary Islands Health Survey. Survey participants from 16 years of age and older were classified according to their body mass index (BMI). The relationship between excess weight and the dichotomized EuroQol-5D was examined by multiple logistic regression analysis, adjusting by socio-demographic variables, smoking status, alcohol consumption, and self-reported disease status.

RESULTS

People with excess weight were older, less educated, and had more associated diseases than the population without excess weight. Excess weight and HRQL are inversely correlated. Severely obese participants showed EuroQol-5D index scores significantly lower than those of normal weight participants (0.65 vs. 0.87). The adjusted odds ratio for the lower HRQL is 3.17 for severely obese people compared to normal weight people.

CONCLUSIONS

Excess weight has a negative impact on HRQL, even for people without chronic diseases. A better understanding of the relationships between excess weight, its associated comorbidities, and HRQL may have important implications for the design and assessment of prevention and treatment strategies.

The assessment of health-related quality of life in relation to the body mass index value in the urban population of Belgrade

Background

The association between excess body weight, impairment of health and different co-morbidities is well recognized; however, little is known on how excess body weight may affect the quality of life in the general population. Our study investigates the relationship between perceived health-related quality of life (HRQL) and body mass index (BMI) in the urban population of Belgrade.

Methods

The research was conducted during 2005 on a sample of 5,000 subjects, with a response of 63.38%. The study sample was randomly selected and included men and women over 18 years of age, who resided at the same address over a period of 10 years. Data were collected by means of a questionnaire and nutritional status was categorized using the WHO classification. HRQL was measured using the SF-36 generic score. Logistic regression analysis was used to compare HRQL between subjects with normal weight and those with different BMI values; we monitored subject characteristics and potential co-morbidity.

Results

The prevalence of overweight males and females was 46.6% and 22.1%, respectively. The prevalence of obesity was 7.5% in males and 8.5% in females.

All aspects of health, except mental, were impaired in males who were obese. The physical and mental wellbeing of overweight males was not significantly affected; all score values were similar to those in subjects with normal weight.

By contrast, obese and overweight females had lower HRQL in all aspects of physical functioning, as well as in vitality, social functioning and role-emotional.

Conclusion

The results of our study show that, in the urban population of Belgrade, increased BMI has a much greater impact on physical rather than on mental health, irrespective of subject gender; the effects were particularly pronounced in obese individuals.

The association of body mass index with health-related quality of life: an exploratory study in a multiethnic Asian population

OBJECTIVES

To evaluate the association between body mass index (BMI) and health-related quality of life (HRQoL) in a multiethnic Asian population in Singapore, and to explore if the World Health Organization (WHO) recommendation of alternative BMI cutoffs for Asians could be further strengthened by evidence of higher risk of impaired HRQoL using these criteria.

METHODS

Consenting English, Chinese, Malay and Tamil-speaking primary care patients (age >or= 21 years) were interviewed using English/their respective mother tongue versions of the EQ-5D/EQ-VAS, Health Utilities Index (HUI2 & HUI3) and the SF-6D. We first evaluated the relationship between BMI and HRQoL (overall and individual attributes for each instrument) using multiple linear/logistic regression (where appropriate) to adjust for factors known to affect HRQoL. We next reorganized BMI into five categories (reflecting the differences in cutoffs between International/Asian classifications) and evaluated if median HRQoL scores were significantly different across these categories.

RESULTS

Among 411 participants [response rate: 87%; median age: 51 years; obese: 19% (International); 33% (Asian)], after adjusting for sociodemographic and other factors, a tendency for underweight and obese subjects to report lower overall HRQoL scores was observed for most instruments. At the individual attribute level, obese subjects reported significantly lower HUI2 pain scores (regression coefficient: -0.035, P = 0.029) and greater odds of reporting problems for SF-6D role-limitations (odds ratio: 2.9, P = 0.005). Median overall HRQoL scores were not significantly different across the five BMI categories.

CONCLUSION

Consistent with available studies, obese subjects reported worse HRQoL than normal-weight subjects. That underweight subjects also reported worse HRQoL is interesting and requires confirmation. HRQoL was similar in Asians using either WHO criteria.

Obesity and its related diseases in Taiwan

Obesity is related to increased morbidity and mortality, and prevails worldwide. It has become an important health issue and requires urgent attention. In Taiwan, overweight and obesity are defined as body mass index > or = 24 and 27 kg m(-2), respectively. These cut-offs differ from Caucasian standards, as Asians have higher comorbidities and fat mass at lower BMI levels than Caucasians. The prevalence of obesity and overweight in Taiwan are 19.2% and 30.5% in men, 13.4% and 21.3% in women. This implies that a more profound increase in obesity prevalence is found in men than in women. A high-fat diet, sedentary lifestyle and betel nut chewing may increase substantially this obesity epidemic. Recently, type 2 diabetes mellitus has been found to be the most common type of diabetes, and obesity is significantly related to type 2 diabetes in children. In addition, obesity is associated with cardiovascular diseases risk factors and cannot be neglected in elderly. Therefore, a comprehensive prevention and management programme of obesity is urgently warranted for controlling the growing obesity trend and its related diseases in Taiwan.

The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment: a meta-analysis

Background

This meta-analysis examined differences in health-related quality of life (HRQoL) between seekers of surgical and non-surgical treatment, and non-treatment seekers, over and above differences that are explained by weight, age, and gender.

Methods

Our literature search focused on the ‘Impact of Weight on Quality of Life-Lite’ (IWQOL-Lite) and the ‘Short Form-36’ (SF-36) questionnaires. Included were studies published between 1980 and April 2006 providing pre-treatment descriptive statistics of adult overweight, obese or morbidly obese persons. Excluded were elderly and ill patient groups.

Results

54 articles, with a total number of nearly 100,000 participants, met the inclusion criteria. Persons seeking surgical treatment demonstrated the most severely reduced HRQoL. IWQOL-Lite scores showed larger differences between populations than SF-36 scores. After adjustment for weight, the population differences on the IWQOL disappeared. In contrast, the differences on the SF-36 between the surgical treatment seeking population and the other populations were maintained after adjustment for weight.

Conclusion

The IWQOL-Lite questionnaire predominantly reflects weight-related HRQoL, whereas the SF-36 mostly reflects generic HRQoL that is determined by both weight and other factors. Our metaanalysis provides reference values that are useful when explaining or evaluating obesity-specific (IWQOL-Lite) or generic (SF-36) HRQoL, weight, and demographic characteristics of obese persons seeking or not seeking surgical or non-surgical treatment.

The association between body mass index and health-related quality of life: data from CaMos, a stratified population study

BACKGROUND

Deviation from normal weight is associated with health risks, but less is known about the association between weight and health-related quality of life (HRQOL). We investigated this in the context of a population-based study, using a standard five-category weight classification system based on body mass index (BMI).

METHODS

The Canadian Multicentre Osteoporosis Study is a randomly selected sample of men and women over 25 years of age from nine centres across Canada. Data were obtained by interview, and height and weight were measured and used to calculate BMI. HRQOL was measured using the SF-36. Multivariable linear regression was used to identify the association between BMI category and SF-36 scores after controlling for potential confounders.

RESULTS

Complete data were available for 6,302 women and 2,792 men. Mean BMI for every age and gender group exceeded healthy weight guidelines. For women, being underweight, overweight or obese was associated with poorer HRQOL in most SF-36 outcomes while for men, this was associated with poorer HRQOL in some domains and with higher HRQOL in others.

CONCLUSIONS

A significant proportion of the population may be putting their health at risk due to excess weight, which may have a substantial negative effect on HRQOL, particularly in women. This underscores the need for continued public health efforts aimed at combating overweight and obesity.