The relationship between health-related quality of life and weight loss

Impact of eating disorders and psychological distress on the quality of life of obese people

OBJECTIVE

Quality of life (QoL) is impaired in obesity, but the roles of eating behavior and psychological distress need to be more documented.

METHODS

One hundred thirty consecutive obese patients seeking medical care filled out questionnaires evaluating QoL, the presence of an eating disorder (ED), levels of anxiety and depression, and perception of body image.

RESULTS

Global QoL was poor in 16.4% and intermediate in 61.8% of the patients. EDs were present in 58% of patients who were more (P = 0.05) overweight; 24.2% of patients had binging. EDs impaired significantly the global and specific dimensions of QoL; binging impaired physical and sexual QoLs (both P < 0.02). Anxiety and depression were found in 73.6% and 50.4% of patients, respectively; depression was more frequent in women (P = 0.007) and in patients with EDs. Anxiety and/or depression impaired global (P < 0.001) and specific dimensions of QoL. Body shape concern was marked in 86.4% of women and associated with poor global (P < 0.001) and specific QoL, and with anxiety and depression.

CONCLUSION

The impairment of QoL in obese patients is increased by the presence of an ED, anxiety, and/or depression and marked body shape concern. These psychological factors should be assessed more carefully and taken into account in global strategies aiming to improve the well-being of obese patients.

Interdisciplinary lifestyle therapy improves binge eating symptoms and body image dissatisfaction in Brazilian obese adults

INTRODUCTION: Obesity is related to numerous negative consequences for physical and mental health. It is often associated with the presence of binge eating disorder, body image dissatisfaction, and general psychopathology. OBJECTIVE: To assess the effects of an interdisciplinary lifestyle therapy on binge eating symptoms, depression, anxiety, body dissatisfaction, and quality of life in obese adults. METHODS: A total of 49 obese adults (body mass index = 37.35±5.82 kg/m²; age = 44.14±10.00 years) participated in a weight-loss program for 6 months. Symptoms suggestive of binge eating, body dissatisfaction, depression, anxiety, and quality of life were measured using self-reported questionnaires. Food intake was assessed using a 3-day dietary record. Data were analyzed using analysis of variance (ANOVA). RESULTS: ANOVA results showed a reduction in binge eating symptoms and in body dissatisfaction results. Depression and anxiety symptoms also decreased, and an increase was observed in quality of life scores. After therapy, a significant improvement was observed in dietary patterns, as well as significant weight loss. A positive correlation was found between variation of anxiety symptoms and lipid intake. Binge eating symptoms were associated with anxiety symptoms and body image dissatisfaction, and body image dissatisfaction correlated positively with anxiety symptoms in males only. In females, a positive correlation was observed between depression and binge eating symptoms. CONCLUSION: The interdisciplinary therapy was effective in promoting positive physical and psychological changes and in improving the quality of life of obese adults.

Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates

Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO(2)), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO(2) at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.

Efficacy of a weight-loss website based on positive deviance. A randomized trial

BACKGROUND

Web-based interventions for weight control could promote more-widespread dissemination of weight-loss opportunities; however, they remain limited in effectiveness. Incorporating weight-control practices used by individuals with long-term weight-loss success ("positive deviants") may improve the efficacy of web-based weight control interventions.

PURPOSE

To evaluate the efficacy of AchieveTogether, a web-based weight-loss intervention for adults based on user-generated weight-loss strategies from successful weight losers.

DESIGN

In 2009-2010, participants were randomized to either a 12-week web-based intervention, AchieveTogether, or a wait-list control condition.

SETTING/PARTICIPANTS

100 overweight or obese adults participated in the study.

INTERVENTION

AchieveTogether was designed to help individuals implement weight control practices used by others who successfully lost and maintained weight.

MAIN OUTCOME MEASURES

The primary outcome was change in weight. Secondary outcomes included blood pressure, daily caloric intake, quality of life, and use of weight control practices. ANCOVA, with adjustment for baseline values on outcome measures, was used to assess differences between groups in primary and secondary outcomes. Statistical analyses were conducted in 2010-2011.

RESULTS

Most participants were women (69.7%) and white (90.8%), with a mean age of 50.3 years and baseline BMI of 33.2; 88% completed post-program assessments. Mean weight loss among intervention participants was -1.4 kg (95% CI= -2.2, -0.5), compared with a mean weight gain of 0.6 kg (95% CI= -0.3, 1.4) in control participants (p<0.01).

CONCLUSIONS

User-generated weight-loss practices from "positive deviants" could promote weight control in web-based interventions; however, further research is needed to improve program efficacy.

TRIAL REGISTRATION

This study is registered at ClinicalTrials.govNCT00709501.

Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis

OBJECTIVE

Obesity is related to increased risk of several health complications, including depression. Many studies have reported improvements in mood with weight loss, but results have been equivocal. The present meta-analysis examined changes in symptoms of depression that were reported in trials of weight loss interventions. Between-groups comparisons of different weight loss methods (for example, lifestyle modification, diet-alone and pharmacotherapy) were examined, as were within-group changes for each treatment type.

METHOD

MEDLINE was searched for articles published between 1950 and January 2009. Several obesity-related terms were intersected with terms related to depression. Results were filtered to return only studies of human subjects, published in English. Of 5971 articles, 394 were randomized controlled trials. Articles were excluded if they did not report mean changes in weight or symptoms of depression, included children or persons with psychiatric disorders (other than depression), or provided insufficient data for analysis. Thirty-one studies (n=7937) were included. Two authors independently extracted a description of each study treatment, sample characteristics, assessment methods and changes in weight and symptoms of depression. Treatments were categorized as lifestyle modification, non-dieting, dietary counseling, diet-alone, exercise-alone, pharmacotherapy, placebo or control interventions.

RESULTS

Random effects models found that lifestyle modification was superior to control and non-dieting interventions for reducing symptoms of depression, and marginally better than dietary counseling and exercise-alone programs. Exercise-alone programs were superior to controls. No differences were found for comparisons of pharmacologic agents and placebos. Within-group analyses found significant reductions in symptoms of depression for nearly all active interventions. A meta-regression found no relationship between changes in weight and changes in symptoms of depression in lifestyle modification interventions.

CONCLUSIONS

On average, obese individuals in weight loss trials experienced reductions in symptoms of depression. Future studies should examine incidence and resolution of clinically significant depressive disorders with weight loss interventions.

Effect of exercise combined with phytoestrogens on quality of life in postmenopausal women

BACKGROUND

Postmenopausal women seem to favor alternative therapies such as exercise and phytoestrogens as a substitute for potentially harmful hormone replacement therapy. Based on previous research, we hypothesized that phytoestrogens combined with exercise could have a synergic effect on women's health.

OBJECTIVE

To verify whether phytoestrogens enhance the response to mixed training regarding menopausal symptoms and quality of life in postmenopausal women.

METHODS

From a pool of women participating in a 6-month randomized, controlled exercise study, 21 received a placebo (mean age 58.3 ± 5.4 years, body mass index 29.8 ± 5.1 kg/m(2)) and 19 received phytoestrogen supplements (mean age 60.1 ± 3.4 years; body mass index 30.3 ± 4.6 kg/m(2)). Body weight, fat mass and lean body mass (dual-energy X-ray absorptiometry) were assessed. Quality of life was estimated by the Short Form-36 (SF-36) and Perceived Stress Scale-10 (PSS-10) questionnaires, and menopausal symptoms by the Kupperman index. All measurements were performed before and after the intervention.

RESULTS

Although the Kupperman index and PSS-10 remained unchanged in both groups, the SF-36 Physical Component Summary and almost all the SF-36 subscales (except for role-emotional and mental health) increased only in the exercise group taking phytoestrogens (0.001 < p < 0.04).

CONCLUSION

While phytoestrogens combined with mixed exercise were not sufficient to improve menopausal symptoms, it seemed to be a better strategy than exercise alone to improve the general quality of life in postmenopausal women.

Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery

PURPOSE

To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation.

METHODS

Patients were evaluated before and six months after surgery. The patients were mainly female (75%), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05.

RESULTS

The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre- and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF25-75 (Forced Expiratory Flow between 25 and 75% FVC) and FEV1/FVC% (Forced Expiratory Volume in the 1st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables.

CONCLUSIONS

There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation.

Sleep apnea, reproductive hormones and quality of sexual life in severely obese men

The effect of sleep apnea on the reproductive function of obese men is not entirely elucidated. The objective of this study was to define the effect of sleep apnea on the reproductive hormones and sexual function in obese men. This study included 89 severely obese men with BMI ≥35 kg/m2 considering gastric bypass surgery. Anthropometrics (weight, and BMI), reproductive hormones, and sleep studies were measured. The sexual quality of life was assessed using the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite). The mean age of our patients was 46.9 ± 11.0 years, the mean BMI was 47.8 ± 8.7 kg/m2 and the mean weight was 337.7 ± 62.4 lb. After correction for age and BMI, means of free testosterone per severity group of sleep apnea were as follows: no or mild sleep apnea 74.4 ± 3.8 pg/ml, moderate sleep apnea 68.6 ± 4.2 pg/ml, and severe sleep apnea 60.2 ± 2.92 pg/ml, P = 0.014. All other parameters of sleep apnea including hypopnea index, percent time below a SpO2 of 90%, and percent time below a SpO2 of 80% were also negatively correlated with testosterone levels after correction for age and BMI. BMI and presence of coronary artery disease decreased the sexual quality of life. Sleep apnea was associated with reduced sexual quality of life. In summary, sleep apnea negatively affects testosterone levels independent of BMI. Severely obese men had decreased sexual quality of life.

Does pain predict interference with daily functioning and weight loss in an obese residential treatment-seeking population?

BACKGROUND

Pain may interfere with daily functioning in obese persons and also with outcomes during weight loss. We examined the relationship between pain and (1) interference with daily functioning (DFi) and (2) outcomes in an obese treatment-seeking population.

METHOD

Participants were 386 patients entering a residential weight loss program (body mass index, 40.7 +/- 10.12 kg/m(2)). We examined the relationships of demographic factors, pain types, and emotional status with both baseline DFi and short-term weight loss.

RESULTS

Regression analysis showed that overall, total pain scores significantly predicted DFi even after controlling for other confounders (p < .05). Leg pain, joint pain, and headache predicted DFi (p's < .05) among women. Among both men and women, depression severity predicted DFi (p's < .01). For the entire sample, there was an inverse bivariate relationship between total pain score and weight loss (p < .001). Joint pain and depression (among women) and age and depression (among men) predicted reduced weight loss (p's < .05).

CONCLUSION

These results highlight the value of assessing both pain and emotional status for individuals undergoing weight loss treatment since these may interfere recommendations to increase activity.

Exenatide bid observational study (ExOS): baseline population characteristics of a prospective research study to evaluate the clinical effectiveness of exenatide bid use in patients with type 2 diabetes in a real-world setting

OBJECTIVES

To describe the Exenatide Observational Study (ExOS) and patients initiating exenatide therapy in a real-world clinical practice setting.

METHODS

ExOS is a prospective, single-arm, multicenter, observational study to assess the effectiveness of up to 24 months of exenatide therapy in patients with type 2 diabetes (T2D). Patients with T2D ≥18 years of age, who initiated exenatide therapy, were eligible. The primary effectiveness endpoint is achieving or maintaining hemoglobin A1C of ≤7.0%, or an absolute drop of 0.5% from baseline. Secondary objective measures evaluate the absolute and percentage changes from baseline for a variety of clinical measures (lipid markers, weight, BMI, etc.) and quality of life (QOL) is assessed using the Impact of Weight on Quality of Life (IWQOL)-Lite.

RESULTS

On average, the baseline population (n = 531) was aged 55 years, predominantly female (62%), white (79%), educated, obese (mean BMI 39 kg/m(2)), with mean HbA(1c), blood pressure, total cholesterol, and triglyceride values of 8.0%, 129/76 mmHg, 174 mg/dL, and 197 mg/dL, respectively. A total of 28% entered the study with HbA(1c) ≤7.0% and 67% were being treated with oral antihyperglycemic drug(s) (OAD) only [1 (28.4%), 2 (28.4%), >2 (10.2%)], or some form of insulin ±OADs (19%), and ≥50% were on a cholesterol-lowering drug(s) ± antihypertensive medication(s). The single-arm design of this study is a limitation; however, the overall objective of the ongoing study is to observe patients on exenatide therapy over time, comparing their status at endpoint to baseline, rather than to make comparisons among different drug therapies.

CONCLUSIONS

Patients treated with exenatide tended to be obese, middle-aged women on various combinations of OADs and/or insulin who often had hypertension and/or dyslipidemia. Further planned analyses will provide the largest sample of prospective data on outcomes of exenatide therapy for up to 24 months in this usual-care population.

Predictors of Psychological Well-Being during Behavioral Obesity Treatment in Women

This study examined the association of autonomy-related variables, including exercise motivation, with psychological well-being and quality of life, during obesity treatment. Middle-aged overweight/obese women (n = 239) participated in a 1-year behavioral program and completed questionnaires measuring need support, general self-determination, and exercise and treatment motivation. General and obesity-specific health-related quality of life (HRQOL), self-esteem, depression, and anxiety were also assessed. Results showed positive correlations of self-determination and perceived need support with HRQOL and self-esteem, and negative associations with depression and anxiety (P < .001). Treatment autonomous motivation correlated positively with physical (P = .004) and weight-related HRQOL (P < .001), and negatively with depression (P = .025) and anxiety (P = .001). Exercise autonomous motivation was positively correlated with physical HRQOL (P < .001), mental HRQOL (P = .003), weight-related HRQOL (P < .001), and self-esteem (P = .003), and negatively with anxiety (P = .016). Findings confirm that self-determination theory's predictions apply to this population and setting, showing that self-determination, perceived need support, and autonomous self-regulation positively predict HRQOL and psychological well-being.

The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES) study: background, design and rationale

Background

Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective) economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery.

Methods/design

Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada), with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference-based quality of life assessment, patient satisfaction, patient utilities, anthropometric indices, cardiovascular risk factors, health care utilization and direct and indirect costs.

Discussion

The results will identify the spectrum of potential risks associated with protracted wait times for bariatric care and will quantify the economic, humanistic and clinical impact of surgery from the Canadian perspective. Such information is urgently needed by health-service providers and policy makers to better allocate use of finite resources. Furthermore, our findings should be widely-applicable to other publically-funded jurisdictions providing similar care to the extremely obese.

Trial Registration

Clinicaltrials.gov NCT00850356

Association between actual weight status, perceived weight and depressive, anxious symptoms in Chinese adolescents: a cross-sectional study

Backgroud

The purpose of this study was to describe actual measured weight and perceived weight and to explore associations with depressive, anxiety symptoms in school adolescents in China.

Methods

A sample of 1144 Chinese adolescents was randomly selected from four schools in Wuhan, China, including 665 boys and 479 girls with ages ranging between 10 and 17 years. Actual measured weight and height and perceived weight status were compared to anxiety and depressive symptoms measured using the revised Self-Rating Anxiety Scale and Children's Depression Inventory. A general linear model was used to compare differences in psychological symptoms among the teenagers with different measured and perceived weights.

Results

When compared with standardized weight tables (WHO age- and gender-specific body mass index (BMI) cutoffs (2007 reference)), girls were more likely to misperceive themselves as overweight, whereas more boys misclassified their weight status as underweight. The adolescents who perceived themselves as overweight were more likely to experience depressive and anxiety symptoms (except girls) than those who perceived themselves as normal and/or underweight. However, no significant association was found between depressive and anxiety symptoms actual measured weight status.

Conclusions

Perceived weight status, but not the actual weight status, was associated with psychological symptoms.

Change in body image and psychological well-being during behavioral obesity treatment: Associations with weight loss and maintenance

This study reports on outcomes from a behavioral obesity treatment program, evaluating if treatment-related changes in body image and psychological well-being are predictors of weight change during treatment and after follow-up. Participants were 142 overweight/obese women (BMI=30.2+/-3.7kg/m(2); age=38.3+/-5.8 years) participants in a behavioral treatment program consisting of a 4-month treatment period and a 12-month follow-up. Psychosocial variables improved during treatment and these changes were correlated with 4-month weight reduction. Short-term changes in body size dissatisfaction (p=.002) and mood (p=.003) predicted long-term weight loss. Additional results suggest that there might be a predictive role of short-term changes in body size dissatisfaction and self-esteem on long-term weight loss after accounting for initial weight change (p<.028). We conclude that, along with weight changes, cognitive and affect-related processes influenced during obesity treatment may be related long-term success, in some cases independently of initial weight loss.

Estimating importance weights for the IWQOL-Lite using conjoint analysis

PURPOSE

Our objective was to estimate preference-based weights for the IWQOL-Lite that reflect the relative importance overweight and obese people place on the domains included in the instrument.

METHODS

US residents, 18 years of age or older, who are overweight (BMI=25.0-29.9) or obese (BMI>or=30) completed an online survey instrument consisting of 12 choice questions. The survey included eight attributes: problems doing usual daily activities, physical symptoms, worry about health, low self-esteem, sexual problems, problems moving around or sitting in public places, teasing or discrimination, and problems at work. Ordered probit was used to estimate importance weights for the attributes and levels.

RESULTS

Five hundred and two subjects completed the survey. Sexual problem was the most important attribute. The remaining attributes can be ranked on the order of importance as follows: low self-esteem, physical symptoms, daily activities, teasing or discrimination, moving around or sitting, problems at work, and worry about health.

CONCLUSIONS

Our results confirm previous findings that weighting the individual items in the IWQOL-Lite by the importance of outcomes to overweight and obese subjects may provide a more meaningful evaluation of the effect of changes in weight on patient well-being than a nonpreference-based measure of HRQOL.

A systematic review of the quality of psychometric evidence supporting the use of an obesity-specific quality of life measure for use with persons who have class III obesity

With global obesity rates at 42%, there is a need for high-quality outcome measures that capture important aspects of quality of life for persons with obesity. The aim of this paper was to systematically review and critique the psychometric properties and utility of the impact of weight on quality of life-lite (IWQOL-Lite) for use with persons who have class III obesity. Databases were searched for articles that addressed obesity-specific quality of life. A critical appraisal of the psychometric properties of the IWQOL-Lite and connection to a quality of life conceptual framework was completed. Raters used a standardized data extraction and quality appraisal form to guide evidence extraction. Two articles that reviewed obesity-specific quality of life measures were found; none were based on a systematic review. Six articles on the IWQOL-Lite met the criteria for critical appraisal using guidelines. The mean quality score for these articles was 59.2%. Concepts measured were consistent with the biopsychosocial concept of health defined by the World Health Organization. There is limited but consistent evidence that the IWQOL-Lite is a reliable, valid and responsive outcome measure that can be used to assess disease-specific quality of life in persons with class III obesity.

Effects of aquajogging in obese adults: a pilot study

Aim and Method. To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life, and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. Results. Total fat mass and waist circumference decreased 1.4 kg (P = .03) and 3.1 cm (P = .005), respectively. The distance in the Six-Minute Walk Test increased 41 meters (P = .001). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (P = .008), self-esteem (P = .004), and public distress (P = .04). Increased perceived exercise benefits (P = .02) and decreased embarrassment (P = .03) were observed. Conclusions. Aquajogging was associated with reduced body fat and waist circumference and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.

Self-Reported Psychosocial Health in Obese Patients before and after Weight Loss

Psychosocial profiles were examined in 255 morbidly obese patients attending a hospital service offering access to standard weight loss therapies. 129 patients were reassessed after at least 6-month follow-up. At baseline, 51.8% and 32.7% of patients, respectively, had evidence of anxiety and depressive disorders, 24% had severe impairments in self esteem, and 29.7% had an increased risk of eating disorders. At follow-up, weight loss from baseline was significant in all 3 therapies: diet only is 0.74 +/- 1.8 kg; pharmacotherapy is 6.7 +/- 4.2 kg; and surgery is 20.1 +/- 13.6 kg. Anxiety scores improved in all three groups (P < .05). Patients having pharmacotherapy or surgery had significant improvements in physical and work function and public distress compared to those having dietary treatment only (P < .05). Our observational data suggest that weight management services can lead to psychosocial benefit in morbidly obese patients. Well-designed studies are necessary to examine the link between weight loss and emotional health.

Impact of obesity and type 2 diabetes on health-related quality of life in the general population in England

BACKGROUND

Weight gain can contribute towards the development of type 2 diabetes (T2D), and some treatments for T2D can lead to weight gain. The aim of this study was to determine whether having T2D and also being obese had a greater or lesser impact on health-related quality of life (HRQoL) than having either of the two conditions alone.

METHODS

The 2003 dataset of the Health Survey for England (HSE) was analyzed using multiple regression analyses to examine the influence of obesity and T2D on HRQoL, and to determine whether there was any interaction between these two disutilities.

RESULTS

T2D reduced HRQoL by 0.029 points, and obesity reduced HRQoL by 0.027 points. There was no significant interaction effect between T2D and obesity, suggesting that the effect of having both T2D and being obese is simply additive and results in a reduction in HRQoL of 0.056.

CONCLUSIONS

Based on analysis of HSE 2003 data, people with either T2D or obesity experience significant reduction in HRQoL and people with both conditions have a reduction in HRQoL equal to the sum of the two independent effects. The effect of obesity on HRQoL in people with T2D should be considered when selecting a therapy.

Health-related quality of life and physical activity in persons at high risk for type 2 diabetes

PURPOSE

The aim of this study was to compare the health-related quality of life (HRQOL) of persons at risk for type 2 diabetes to that of the Finnish general population. In addition, the associations between physical activity and HRQOL at-risk persons were studied.

METHODS

One hundred thirty-two at-risk persons were recruited from health care centres in Central Finland. Participants filled out questionnaires including demographic characteristics, HRQOL (SF-36), frequency of vigorous physical activity (< or =2 times a week, once a week, less than once a week) and comorbidities.

RESULTS

HRQOL of at-risk persons differed significantly from that of the Finnish population in four of the eight dimensions of SF-36. Compared with reference values of the general population, the values of at-risk persons were worse for general health and pain, but better for mental health and role limitation (emotional) dimensions. Among at-risk persons those physically more active had less depressiveness and lower body weight. HRQOL decreased linearly with decreasing physical activity in all dimensions.

CONCLUSIONS

People with elevated risk for type 2 DM have reduced HRQOL in general health and body pain dimensions, but mental health and emotional role dimensions were better compared with that of the population. Among at-risk persons, the benefits of physical activity on HRQOL were seen in all HRQOL dimensions. Regular exercise and body weight control may improve subjective health and reduce risk for type 2 DM and its consequences.

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy

Background

Obesity has adverse physical, social, and economic consequences that can negatively affect quality of life (QOL). Thus the aim of this study was to verify the effects of a long-term multidisciplinary lifestyle intervention on QOL, body image, anxiety, depression and binge eating in obese adolescents.

Methods

Sixty-six obese adolescents (41 girls and 25 boys; BMI: 35.62 ± 4.18 kg/m²) were recruited from the Multidisciplinary Obesity Intervention Program outpatient clinic, and were submitted to a multidisciplinary lifestyle therapy (short-term = 12 weeks and long-term = 24 weeks), composed of medical, dietary, exercise and psychological programs. Validated self-report questionnaires were used to assess symptoms of anxiety Trait/State (STAI); depression (BDI); binge eating (BES), body image dissatisfaction (BSQ) and QOL (SF-36). Data were analyzed by means of scores; comparisons were made by ANOVA for repeated measures, and Tukey's test as post-hoc and Students T test.

Results

Long-term therapy decreased depression and binge eating symptoms, body image dissatisfaction, and improved QOL in girls, whereas, for boys, 24 weeks, were effective to reduce anxiety trait/state and symptoms of binge eating, and to improve means of dimensions of QOL (p < .05).

Conclusion

A long-term multidisciplinary lifestyle therapy is effective to control psychological aspects and to improve QOL in obese adolescents.

One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures

BACKGROUND

The literature on changes in health-related quality of life (HRQOL) in weight loss studies is inconsistent, and few studies use more than one type of measure. The purpose of the current study was to compare one-year changes in HRQOL as a function of weight change using three different measures: a weight-related measure (Impact of Weight on Quality of Life-Lite [IWQOL-Lite)]) and two generic measures (SF-36; EQ-5D).

METHODS

Data were obtained from 926 participants (mean Body Mass Index (BMI) (kg/m(2)) = 35.4; 84% female; mean age = 49.5 years) in a placebo-controlled randomized trial for weight loss. At baseline and one-year, participants completed all three HRQOL measures. HRQOL was compared across weight change categories (> or = 5% and 0-4.9% gain, 0-4.9%, 5.0-9.9% and > or = 10% loss), using effect sizes.

RESULTS

The weight-related measure of HRQOL exhibited greater improvements with one-year weight loss than either of the generic instruments, with effect sizes ranging from 0.24 to 0.62 for 5-9.9% weight reductions and 0.44 to 0.95 for > or = 10% reductions. IWQOL-Lite Self-Esteem also showed a small improvement with weight gain. Changes in the two generic measures of HRQOL were inconsistent with each other, and in the case of the SF-36, variable across domains. For participants gaining > or = 5% of weight, the greatest reductions in HRQOL occurred with respect to SF-36 Mental Health, MCS, and Vitality, with effect sizes of -0.82, -0.70, and -0.63 respectively.

CONCLUSION

This study found differences between weight-related and generic measures of health-related quality of life in a one-year weight loss trial, reflecting the potential value of using more than one measure in a trial. Although weight loss was generally associated with improved IWQOL-Lite, physical SF-36 subscale and EQ-5D scores, a small amount of weight gain was associated with a slight improvement on weight-specific HRQOL and almost no change on the EQ-5D, suggesting the need for further research to more fully study these relationships. We believe our findings have relevance for weight loss patients and obesity clinicians/researchers in informing them of likely HRQOL outcomes associated with varying amounts of weight loss or gain.

The future of obesity reduction: beyond weight loss

Obesity increases the risk of morbidity and mortality and reduces quality of life independent of age, sex or ethnicity. Leading health authorities recommend weight loss as a primary treatment strategy for obesity reduction--weight loss goals range from 5% to 10% of initial body weight. Intentional weight loss in most adults is associated with a reduction in many of the health complications of obesity. Nonetheless, emerging evidence supports the notion that a lifestyle-modification program characterized by an increase in physical activity and a balanced diet can reduce obesity and the risk of obesity-related comorbid conditions despite minimal or no weight loss. The benefits of such an approach include appreciable reductions in abdominal obesity, visceral fat and cardiometabolic risk factors, and increases in both skeletal muscle mass and cardiorespiratory fitness. Individuals with obesity face a serious challenge if they are to attain even modest weight loss in today's obesogenic environment. Clinicians could encourage positive lifestyle changes in their patients by counseling them that obesity and its associated health risks can be reduced in response to an increase in physical activity with or without weight loss.

Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis

BACKGROUND

Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment.

METHODS

Participants (BMI = 31.1 +/- 4.1 kg/m2; age = 38.4 +/- 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables.

RESULTS

At 12 months, the intervention group had greater weight loss (-5.6 +/- 6.8% vs. -1.2 +/- 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed.

CONCLUSION

Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.

Who copes well? Obesity-related coping and its associations with shame, guilt, and weight loss

The relationship among weight-related coping, guilt, and shame was investigated in a sample of 98 obese German individuals over a 6-month period. In terms of the objectives, the study explored the kind and frequency of typical coping situations in which obese individuals become aware of being obese. Furthermore, the study sought to determine the predictive utility of weight-related shame and guilt concerning coping responses, and to establish whether there is an association between coping responses and weight change. A longitudinal examination over a 6-month period was chosen with two measurement points. As typical distressing coping situations, individuals reported mostly negative evaluations through others/self, physical exercise situations, or environmental hazards (mainly shopping for clothes). Weight-related shame at baseline was a significant negative predictor for problem-focused engagement coping, whereas weight-related guilt was a significant positive predictor for problem-focused engagement strategies and dietary restraint at follow-up. Although Body Mass Index showed no substantial association with the coping measures, weight loss was accompanied by a substantial drop in problem-focused disengagement coping (wishful thinking, problem avoidance). Discussion of these findings focuses on the issue of possible effects of weight-related feelings of guilt and shame on coping behavior, the link between weight loss and disengaging coping strategies, and the possible use of the findings for cognitive-behavioral therapy for obesity.

Depression and anxiety among US adults: associations with body mass index

BACKGROUND

Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors.

METHODS

We analyzed the data collected from 177,047 participants (aged>or=18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software.

RESULTS

The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m(2)), in women who were overweight (BMI: 25-<30 kg/m(2)) or obese (BMI>or=30 kg/m(2)), and in men who had class III obesity (BMI>or=40 kg/m(2)) than in those with a normal BMI (18.5-<25 kg/m(2)). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI>or=40 kg/m(2) were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m(2) were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders.

CONCLUSIONS

Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

Validation of the adapted Bariatric Quality of Life Index (BQL) in a prospective study in 446 bariatric patients as one-factor model

BACKGROUND

The Bariatric Quality of Life Index (BQL) was created and validated as a nine-factor model in 2005 for the measurement of quality of life (QoL) in patients before and after bariatric surgery.Even though the results were acceptable, the statistical structure of the test was very unclear.

METHODS

A total of 466 patients were enrolled in an ongoing prospective longitudinal German study. The assessment took place preoperatively and at 1, 3,6, 9, and 12 months postoperatively. After that period, reevaluations were done on a yearly basis. In addition to demographic and clinical data, QoL data were collected using the BQL, the Short Form 12 (SF-12v2), the Gastrointestinal Quality of Life Index(GIQLI), and the Bariatric Analysis and Reporting Outcome System(BAROS; old version since the study started in 2001). Statistical parameters for contingency (Cronbach's a), construct and criterion validity (Pearson's r), and responsiveness (standardized effect sizes) were calculated. The data of the assessments conducted preoperatively and after 6 and 12 months were used for the validation.

RESULTS

The factor analysis and the screeplot showed that a one-factor solution explained 45.37% of variance. The selectivity of the items ranged between 0.61 and 0.85, and Cronbach's a was 0.898. The measurements showed similar excellent results with the analysis of all measurement points. Pearson's test showed a good retest reliability (r = 0.9). The correlations with the SF-12 and the Moorehead-Ardelt I questionnaire(MA-I) were significant, while the correlation with the GIQLI was low. The results of the correlation with the excess weight loss(EWL) (0.45 and 0.49) and the BMI (-0.38 and -0.47) were good.

CONCLUSION

The BQL is a valid instrument and should be preferred over generic questionnaires as it provides better responsiveness.

Impact of weight reduction on eating behaviors and quality of life: Influence of the obesity degree

BACKGROUND

To examine the effects of a short-term weight reducing program on body composition, eating behaviors, and health-related quality of life (HRQL) of sedentary obese women characterized by different obesity degrees.

METHODS

44 women with a BMI under 34.9 kg/m(2) and 39 women with a BMI above 35 kg/m(2) were studied. Fat mass and lean mass (electrical bioimpedance), eating behaviors (Three-Factor Eating Questionnaire), and HRQL (36-item short form, SF-36, questionnaire) were determined before and after weight loss.

RESULTS

Disinhibition and hunger scores and their subscales decreased after weight loss in both groups (0.0001 < p < 0.04). Restriction increased after weight reduction in all women (p = 0.02). Among the five restriction subscales, flexible restriction increased in women with a BMI above 35 kg/m(2) (p = 0.008), whereas rigid restraint and avoidance of fattening foods increased in both groups (0.006 < p < 0.02). SF-36 Mental Component Score increased after weight loss in all women (p < 0.0001).

CONCLUSION

A 3week weight reducing program changes selected eating behaviors and components of HRQL, irrespective of women's obesity degree. Data suggest that women with a BMI above 35 kg/m(2) could have a better weight control in the long term because of their higher flexible restriction after weight loss when compared to those whose BMI was under 34.9 kg/m(2).

Setting overweight adults in motion: the role of health beliefs

OBJECTIVE

Health beliefs of overweight adults who did and did not enter an exercise program were compared to identify possible factors that hamper people to enter such a program.

METHOD

Participants (n = 116, 78 women and 38 men) were overweight adults without comorbidities. Self-report instruments examined the burden of suffering, beliefs related to physical exercise and obesity, somatic complaints, and obesity-related quality of life of new participants of exercise programs versus sedentary non-exercisers.

RESULTS

The mean BMI of exercisers and non-exercisers was 34.6 +/- 7.0 and 32.8 +/- 5.8 kg/m2, respectively. Fear of injury was higher and perceived health benefits of exercise were lower in the non-exercisers who also more often believed their overweight to be irreversible and attributed overweight to physical causes. The burden of suffering, somatic complaints, and quality of life of the groups were not significantly different. Fear of injury remained a significant predictor of belonging to the non-exercise group after controlling for other variables and multiple testing.

CONCLUSION

Research is needed to examine whether the inflow of overweight people in exercise groups increases when health beliefs are recognized, considered, and discussed both in interventions and in public health campaigns promoting physical exercise in sedentary, overweight people.

Improvements in sexual quality of life after moderate weight loss

We evaluated changes in sexual quality of life as they relate to weight loss over a 2-year period in individuals undergoing weight loss treatment. Six dimensions of sexual quality of life were measured using items from the Impact of Weight on Quality of Life questionnaire (feeling sexually unattractive, lacking sexual desire, reluctance to be seen undressed, difficulty with sexual performance, avoidance of sexual encounters and lack of enjoyment of sexual activity). At baseline women were more likely than men to report lack of sexual enjoyment and reluctance to be seen undressed in spite of lower body mass index (BMI). Weight loss averaged 13.1% and was significantly associated with improvements in all sexual quality of life dimensions. A 3-4% regain did not appear to negatively affect sexual quality of life. The greatest improvements for women had occurred by 3 months and were observed in all dimensions, whereas for men only 'not feeling sexually attractive' showed marked improvement in this short time frame.

Health and health-related quality of life: differences between men and women who seek gastric bypass surgery

BACKGROUND

The aim of this study was to examine the differences between male and female bariatric surgery candidates with respect to health-related quality of life (HRQOL), health, sociodemographic variables, and interactions among these variables in a bariatric surgery practice in the United States. Women seek bariatric surgery 5 times more often than men. Research on gender differences in HRQOL is limited, and the results are conflicting.

METHODS

A total of 794 surgery candidates (mean age 42.2 y; body mass index 46.9 kg/m2; 84.8% women) completed both a weight-related (Impact of Weight on Quality of Life-Lite questionnaire) and a generic (Medical Outcomes Study Short-Form-36) measure of HRQOL. Health was evaluated by questionnaire and clinical interviews.

RESULTS

Compared to men, women reported reduced HRQOL on 3 of the 5 scales assessing obesity-specific HRQOL and also the physical aspects of general HRQOL. Women also had double the rate of depression (48.5% versus 22.5%), and men had double the rate of sleep apnea (80.3% versus 40.2%). Women were younger, less obese, and were less likely to be married. No gender differences were found in the association between HRQOL and co-morbidities. However, an increasing number of co-morbidities was associated with decreasing physical and mental HRQOL. Additionally, depression was associated with decreased mental HRQOL, and coronary heart disease was associated with decreased physical HRQOL.

CONCLUSION

Women's reduced HRQOL, particularly in self-esteem, sexual life, and physical functioning, and their greater rates of depression, might play a role in their decision to seek bariatric surgery. Although we could not determine causality, this study is a first step toward understanding why women seek surgery 5 times more often than men.

Determinants of quality of life for patients with kidney stones

PURPOSE

We evaluated various factors relating to quality of life in a population of patients with stones.

MATERIALS AND METHODS

A total of 155 patients seen at our urology clinic for stones between January and May 2007 were prospectively questioned regarding stone history and were administered the SF-36 questionnaire to assess quality of life. Age, body mass index, American Society of Anesthesiologists score, number of stone episodes, interval from the last stone episode, number of surgical procedures for stones and associated complications, missed days of work and long-term medical treatment were elicited from the patients. Individual SF-36 domains and composite scores were compared to those of the American general population. Univariate and multivariate regression analyses were performed to assess the impact of all covariates on quality of life scores.

RESULTS

Patients with stones scored lower than the average American population in 5 of the 8 domains of the SF-36 as well as in the physical composite score. Multivariate regression modeling showed that increasing body mass index and age were the strongest predictors of decreased physical well-being. The number of stone episodes did not influence SF-36 scores, although the number of surgical procedures impacted physical and mental components. The number of ureteroscopy procedures and stent placements primarily impacted mental well-being. Medical therapy, particularly the use of potassium citrate, was associated with more favorable quality of life.

CONCLUSIONS

Various factors impact quality of life in patients with urolithiasis but the most important are body mass index, age and the number of surgical procedures. Prospective longitudinal studies may further elucidate the determinants of quality of life and they might be used to optimize patient care.

Impact of obesity on health-related quality of life in schizophrenia and bipolar disorder

OBJECTIVE

Studies have reported that up to 60% of individuals with schizophrenia and 68% of those with bipolar disorder are overweight/obese. This paper explores the health-related quality of life (HRQOL) of individuals with schizophrenia or bipolar disorder as a function of obesity status.

METHODS AND PROCEDURES

Two hundred and eleven participants were recruited from four psychiatric programs (outpatient, day treatment, case management, and psychosocial rehabilitation). HRQOL was assessed using both a general measure (Medical Outcomes Study Short-Form-36 (SF-36)) and a weight-related measure (Impact of Weight on Quality of Life-Lite (IWQOL-Lite)). To interpret HRQOL scores obtained by the obese group, we compared scores to those obtained by reference groups from the weight-loss literature.

RESULTS

Sixty-three percent of participants with schizophrenia and 68% of those with bipolar disorder were obese. Obese participants were more likely to be women, on mood stabilizers, taking a greater number of psychiatric medications, and to have poorer weight-related and general HRQOL. Weight-related HRQOL in the obese psychiatric sample was more impaired than in outpatient and day treatment samples seeking weight loss but less impaired than in gastric-bypass patients. Several of the physical domains of general HRQOL were more impaired for the obese psychiatric sample than for the outpatient weight-loss sample. However, physical functioning was less impaired for the obese psychiatric sample than for gastric-bypass patients.

DISCUSSION

The presence of obesity among individuals with schizophrenia or bipolar disorder is associated with decreased HRQOL. These results have implications for prevention and management of weight gain in individuals with schizophrenia or bipolar disorder.

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.

Psychiatric considerations of the massive weight loss patient

As bariatric surgery for extreme obesity continues to grow in popularity, so does interest in postbariatric surgery body-contouring surgery. There is an extensive literature on the psychological characteristics of persons with extreme obesity who undergo bariatric surgery and the psychological changes that typically occur postoperatively. Far less, however, is known about the psychological aspects of body contouring following massive weight loss. This article reviews the psychosocial characteristics of individuals with extreme obesity who undergo bariatric surgery, as well as the changes in these traits that typically occur postoperatively. Because there have been few studies of the psychological aspects of patients who have lost massive amounts of weight, we use related literatures on the relationship between body image dissatisfaction and other plastic surgical procedures to identify the most relevant research and clinical issues for this unique patient population. Appropriate psychiatric screening and management of these patients is believed to play an important role in successful postoperative outcomes.

Pediatric obesity: parallels with addiction and treatment recommendations

Rates of pediatric obesity have increased dramatically over the past decade. This trend is especially alarming because obesity is associated with significant medical and psychosocial consequences. It may contribute to cardiovascular, metabolic, and hepatic complications, as well as to psychiatric difficulties. The development of obesity appears to be influenced by a complex array of genetic, metabolic, and neural frameworks, along with behavior, eating habits, and physical activity. Numerous parallels exist between obesity and addictive behaviors, including genetic predisposition, personality, environmental risk factors, and common neurobiological pathways in the brain. Typical treatments for pediatric obesity include behavioral interventions targeting diet or exercise. These treatments have yielded mixed results and typically have been examined in specialty clinic populations, limiting their generalizability. There are limited medication options for overweight children and adolescents, and no approved medical intervention in children younger than 16 years old. Bariatric surgery may be an option for some adolescents, but due to the risks of surgery, it is often seen as a last resort. The parallels between addiction and obesity aid in developing novel interventions for pediatric obesity. Motivational enhancement and cognitive-behavioral strategies used in addiction treatment may prove to be beneficial.

Psychological Outcome Two Years after Restrictive Bariatric Surgery

BACKGROUND

An essential outcome criterion of obesity surgery besides weight loss is the improvement of medical and psychological health status. Both dimensions influence quality of life. This study evaluates depressive symptoms, self-esteem and health-related quality of life 2 years after bariatric surgery.

METHODS

149 patients (47 males (32%), 102 females (68%), mean age 38.8 +/- 10.3 years) were assessed by standardized questionnaires before and 1 and 2 years after gastric restrictive surgery.

RESULTS

Mean BMI pre-surgery was 51.3 +/- 8.4 kg/m2. BMI decreased significantly to 38.6 +/- 6.8 kg/m2 at 1 year and to 37.9 +/- 7.4 kg/m2 at 2 years after surgery. Statistical analyses revealed a significant decrease in depressive symptoms and a significant improvement in self-esteem and the physical dimension of health-related quality of life. Pre-surgery, 40.5% (n=62) of the patients suffered from depressive symptoms of clinical relevance. These depressive symptoms persisted in 17.7% (n = 27) 1 year and in 16.4% (n = 25) 2 years after surgery.

CONCLUSION

Parallel with a considerable weight loss after bariatric surgery, important aspects of mental health such as depressive symptoms and self-esteem improved significantly. These effects appear 1 year after surgery, but do not seem to change considerably afterwards.

The prognostic significance of depressive symptoms for predicting quality of life 12 months after gastric bypass

OBJECTIVE

This study was conducted to examine the relative prognostic significance of weight and depressive symptoms for 12-month postoperative health-related quality of life (HRQL) in extremely obese gastric bypass patients.

METHODS

Participants comprised 137 extremely obese patients undergoing gastric bypass surgery. Presurgery and 12 months postsurgery participants completed the Medical Outcomes Study Short Form-36 Health Survey, a standard measure of HRQL, and the Beck Depression Inventory (BDI). Regression analyses were performed to predict HRQL, both before and 12 months after surgery, by using demographic variables, and measures of body mass index (BMI) and depressive symptoms as predictors.

RESULTS

At baseline the predictors accounted for 19% of the variance of physical HRQL, and 56% of the variance of mental HRQL. At 12 months after surgery, the predictors accounted for 32% of the variance of physical HRQL and 48% of mental HRQL. In the prediction of 12-month postoperative HRQL, baseline BMI, BMI unit change, baseline BDI, and improvements in BDI score made significant contributions to most of the Medical Outcomes Study Short Form-36 Health Survey scales. Demography contributed little to these predictor analyses. Depressive symptoms made greater contributions than weight and demography, and change in BDI score made the greatest contributions (ranging from 3% to 37%) of all the variables tested.

CONCLUSIONS

Measures of weight and depressive symptoms were useful in predicting quality of life both before and 12 months after gastric bypass surgery; however, this is the first study to document that improvements in HRQL postsurgery may be largely related to improved depressive symptoms.

Influence of complications and extent of weight loss on quality of life after laparoscopic Roux-en-Y gastric bypass

INTRODUCTION

Obesity decreases health-related quality of life, but bariatric surgery improves it. This study evaluates the effect of laparoscopic Roux-en-Y gastric bypass, postoperative complications, and percentage of excess body weight loss on quality of life.

METHODS

SF-36v.1 questionnaires were administered preoperative (n = 505), 1 year (n = 237) and 2 years (n = 106) following laparoscopic Roux-en-Y gastric bypass. Analysis was performed using Student's t-test and multiple logistic regression analysis. Complications were defined as requiring additional intervention or hospitalization. SF-36 responses were normalized to 1998 US norms.

RESULTS

Bariatric patients scored significantly lower on all scales compared to the normal population. Health-related quality of life notably improves after surgery. At 1 year, scores not only improved from baseline, but were higher than those of the non-obese reference population regardless of complications. Compared to patients at 2 years without complications, patients experiencing complications reported decreased scores, but scores remained higher than preoperative scores in five scales. At 1 and 2 years, < or = 50% excess body weight loss decreased scores; however, scores were significantly improved from baseline.

CONCLUSIONS

Health-related quality of life in bariatric patients is worse than in controls, but it improves 1 and 2 years after laparoscopic Roux-en-Y gastric bypass. Complications or < or = 50% excess body weight loss slightly decreases this improvement.

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

OBJECTIVE

To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years.

DESIGN

Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese.

SUBJECTS

A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMI>or=34) and women (BMI>or=38) who completed 10 years of the study.

MEASUREMENTS

HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years.

RESULTS

HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1- and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6- to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study.

CONCLUSION

Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.

Weight loss treatment and psychological well-being: a review and meta-analysis

Research suggests that weight loss treatment generally benefits psychological well-being but these effects have never been quantitatively reviewed. A meta-analysis of 117 weight loss treatment tests showed that weight loss treatment was associated with lowered depression and increased self-esteem. Treatment type moderated treatment effects on depression and self-esteem. Actual weight loss moderated treatment effects on self-esteem but not depression; only treatments that produced actual weight loss predicted increased self-esteem whereas improvements in depression were independent of weight loss. The clinical implications of the findings and the possible causal relationships among weight, depression and self-esteem are discussed.

Comparison of combinations of drugs for treatment of obesity: body weight and echocardiographic status

BACKGROUND

Obesity treatment with single drugs produces weight losses of about 8-10% of initial body weight. Few studies of combinations of drugs for treating obesity have been published. The combination of phentermine, an adrenergic agent, and fenfluramine, a serotonergic agent, (phen-fen) produced weight losses of about 15% of initial body weight. Fenfluramine is no longer available because it was associated with cardiac valve lesions. Phentermine-fluoxetine (phen-flu) has been proposed as an alternative for phen-fen.

OBJECTIVE

To compare the efficacy of treatment and prevalence of cardiac valve abnormalities on phen-flu vs phen-fen.

DESIGN

Retrospective chart review of all patients treated for at least 3 months with phen-flu (N=97) to a random sample of patients treated with phen-fen (N=98) in the Clinical Nutrition Clinic at the University of Wisconsin. Comparison of echocardiograms in all patients treated solely with phen-flu (N=21) to a random sample of patients treated with phen-fen (N=47), and to a group of subjects never treated with obesity drugs (N=26).

RESULTS

With last observation carried forward analysis (LOCF), at 6 months of treatment the phen-fen patients lost 12.6+/-0.6% of baseline weight and phen-flu patients lost 9.0+/-0.6% (P<0.001). With completers analysis, there were no significant differences in weight loss as a percent of baseline weight at 6 months (14.4+/-0.6 vs 13.3+/-0.9%). LOCF decreases in body mass index (BMI) at 6 months were -5.3 and -3.6 kg/m(2) for phen-fen and phen-flu, respectively (P<0.001), and 6.2+/-0.3 vs 5.4+/-0.4 kg/m(2), respectively, for the completers analysis (P - NS). Dropout rate at 6 months was higher in phen-flu subjects (44 vs 28%). In subjects without atherosclerosis of valves (presumably pre-existing), cardiac valve lesions occurred in eight of 38 phen-fen subjects and in none of 15 phen-flu subjects or 25 control subjects who had not been treated with drugs.

CONCLUSIONS

The combination of phentermine and fluoxetine was not as effective as phen-fen, but was not associated with cardiac valve lesions. Longer term, larger scale studies of phen-flu are warranted.

An overview of obesity-specific quality of life questionnaires

The measurement of quality of life in patients with obesity is useful to evaluate the effects of treatment (including bariatric surgery) and may influence the development of clinical pathways, service provision, healthcare expenditures and public health policy. Consequently, clinicians, researchers and policy makers must rely on valid measurement instruments. We reviewed 11 obesity-specific quality of life questionnaires and classified them according to their domain of interest and described their measurement properties (specifications, validity, reliability, responsiveness and interpretability). We found that (i) nine questionnaires were developed specifically to be used as evaluative instruments in clinical trials; (ii) only three targeted populations with morbid obesity (body mass index > 40 kg m(-2)); (iii) construct validity was properly studied in three questionnaires; (iv) demonstration of responsiveness from independent randomized controlled trials was available for two of the 11 questionnaires; (v) keys to interpretation of scores were provided for three questionnaires. Future research should include further validation and a better definition of the interpretability of existing instruments.

Health-related quality of life and weight loss among overweight and obese U.S. adults, 2001 to 2002

OBJECTIVE

To examine the prevalence and association of health-related quality of life (HRQOL) with trying to lose weight and with weight loss practices (eating fewer calories, physical activity, and both) among overweight and obese U.S. adults >/= 20 years of age.

RESEARCH METHODS AND PROCEDURES

This study used data from the 2001 to 2002 National Health and Nutrition Examination Survey, a continuous annual survey of the civilian non-institutionalized U.S. population. This analysis included those > or = 20 years of age with BMI > or = 25 (n = 2578) who responded to four standard HRQOL measures that assessed general health status and recent physical health, mental health, and activity limitation.

RESULTS

Among obese men, but not women, there were significant increasing linear trends in the adjusted prevalence of trying to lose weight as physically unhealthy and activity limitation days increased. Regardless of BMI or HRQOL, reducing calories was a common weight loss practice (66% to 86%). Except for recent activity limitation, respondents with BMI > or = 35 did not generally differ by HRQOL level in the attainment of recommended physical activity either alone or in combination with reduced calories, whereas those in the BMI 25 to 34.9 groups often differed significantly by HRQOL level. Specifically, increased unhealthy or activity limitation days were associated with reduced prevalence of attained physical activity.

DISCUSSION

Our findings indicate an association between trying to lose weight and a greater number of unhealthy days reported by obese men, suggesting that these men may be influenced by traditional clinical weight-loss counseling that is prompted by weight and comorbidity, whereas women had a high prevalence of trying to lose weight irrespective of weight and HRQOL. Assessment of HRQOL, especially measures that evaluate physical domains, could provide subjective information to assist with weight counseling.