The impact of obesity on health-related quality of life in Spain

Association Between Physical Activity Amount and Cardiorespiratory Fitness, Sleep Quality, and Health-Related Quality of Life in Patients With Long COVID: A Cross-sectional Study

OBJECTIVE

To investigate the association between physical activity (PA) amount and gender differences on cardiorespiratory fitness (CRF), sleep quality, and health-related quality of life (HRQoL) in individuals with long COVID.

DESIGN

Cross-sectional study.

SETTING

An integrated outpatient clinic for post-COVID-19 at a medical center.

PARTICIPANTS

Convenience sample of patients (N=264) diagnosed with long COVID.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

PA amounts, sleep quality, and HRQoL were measured by the International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, and the World Health Organization Questionnaire on Quality of Life: Short Form, respectively. CRF was evaluated through graded exercise testing.

RESULTS

The participants had a mean age of 42.5±13.5 years and a mean duration of post-COVID-19 symptoms of 12.7±6.8 weeks. More than half (n=149, 56.5%) were female patients. Female participants had significantly lower CRF than male participants (P<.05). Older age and higher body mass index were associated with worse CRF and HRQoL (P<.05). Less sitting behavior and greater amounts of vigorous-intensity PA (VPA) or total PA were associated with better CRF (P<.05). In addition, greater total PA and moderate-intensity PA (MPA) were associated with better sleep quality and HRQoL (P<.05), respectively.

CONCLUSIONS

Gender differences were found in CRF among patients with long COVID. Greater self-reported VPA or total PA was associated with better CRF, whereas greater total PA and MPA were associated with better sleep quality and HRQoL, respectively, in patients with long COVID. Further research is needed to explore these associations in longitudinal studies.

Health-Related Quality of Life during 26-Week Intervention with the New Nordic Renal Diet

The New Nordic Renal Diet (NNRD) is a whole-food approach, tailored to meet recommended guidelines in patients with moderate chronic kidney disease (stage 3b-4). The NNRD improved various metabolic and physiological endpoints during a 26-week randomized controlled study. Here, we examined the effect of dietary intervention on health-related quality of life (HRQoL). Sixty participants were recruited (NNRD group n = 30, control group n = 30) and 58 completed the study. During the intervention, the NNRD group received food boxes, and recipes once a week. The control group continued their habitual diet. HRQoL was examined at baseline and at the end of the intervention using the validated EuroQol-5D-5L, including a 5-point scale Likert questionnaire at the end of the intervention. Assessed by the EuroQol-5D-5L questionnaire, the NNRD group experienced a reduction in pain/discomfort during the intervention by 26% [-0.44 points (95% CI; -0.73, -0.16)], compared with no change in the control group [0.25 points (95% CI; -0.02, 0.53)] and a between-group difference of -0.70 points (95% CI; -1.03, -0.37, p < 0.001). A larger decrease of body fat mass was associated with a larger decrease in pain/discomfort (p = 0.014). In addition, the NNRD group reported an overall improvement in conducting usual daily activities by 23% [-0.30-point (95% CI; -0.50, -0.11)], while no change was seen in the control group [-0.02 points (95% CI; -0.21, 0.17)], with a between-group difference -0.28 points (95% CI; -0.51, -0.06, p = 0.014). A larger decrease in 24 h urine phosphorus excretion, used as a marker of compliance, was associated with a larger improvement in conducting usual daily activities (p = 0.036). The NNRD group had a clinically relevant improvement in various HRQoL outcomes.

Effects of resveratrol on the anthropometric indices and inflammatory markers: an umbrella meta-analysis

BACKGROUND

The evidence for resveratrol's anti-obesity and anti-inflammatory qualities is accumulating, though meta-analyses have reported mixed results. The current umbrella meta-analysis aimed to assess the present evidence and provide an accurate estimate of the overall effects of resveratrol on the anthropometric indices and inflammatory markers.

METHOD

The Web of Science, PubMed, Scopus, and Google Scholar databases were searched till March 2023. The meta-analysis was performed utilizing a random-effects model. Moreover, the overall strength and quality of the evidence were assessed using the GRADE tool.

RESULTS

The results from 19 meta-analyses investigating 81 unique randomized controlled trials with 4088 participants revealed that resveratrol supplementation reduced the body mass index (ES =  - 0.119, 95% CI (- 0.192, - 0.047), p = 0.001), waist circumference (ES =  - 0.405, 95% CI [- 0.664, - 0.147], p = 0.002), serum levels of C-reactive protein (ES =  - 0.390, 95% CI [- 0.474, - 0.306], p < 0.001), and tumor necrosis factor-α (ES =  - 0.455, 95% CI [- 0.592, - 0.318], p < 0.001) in comparison to the control group. The effects of resveratrol on body weight and Interleukin-6 levels of participants were not significant. However, resveratrol administration significantly decreased body weight in trials with intervention duration ≥ 12 weeks [ES =  - 0.160, 95% CI (- 0.268, - 0.052)] and supplement dosage ≥ 500 mg/day [ES =  - 0.130, 95% CI (- 0.238, - 0.022)].

CONCLUSION

The findings suggest the beneficial effects of resveratrol supplementation on reducing general and central obesity, as well as decreasing some inflammatory markers. Nevertheless, further high-quality research is required to prove these achievements and also evaluate resveratrol's effects on other inflammatory markers.

The association between body mass index and health-related quality of life in the 2017 and 2018 health survey of England data: A cross-sectional observational analysis

AIM

To provide an updated estimate of the association between body mass index (BMI) and health-related quality of life (HRQoL) among the general population in England and to identify population subgroups with the highest potential utility gains from obesity interventions.

MATERIALS AND METHODS

The sample included 12 158 adults with valid HRQoL and BMI data from the 2017 and 2018 Health Survey for England. Robust standard error linear regression, controlling for demographic and socioeconomic characteristics, lifestyle behaviours and obesity-related comorbidities, was used for the baseline analysis. Robustness checks assessed the impact of (a) estimator selection; (b) model specifications; (c) statistical outliers at high BMI; (d) potential BMI measurement error; and (e) data pooling.

RESULTS

The study found a significant association between HRQoL and BMI, which exhibited an inverted U-shaped relationship. The mean HRQoL peaked at 25.7 kg/m2 in men and 22.6 kg/m2 in women and was reduced in the underweight, overweight and obesity BMI ranges. Sensitivity analyses reported similar coefficients, suggesting a robust model specification.

CONCLUSIONS

Reduced HRQoL beyond optimal BMI underlines the importance of maintaining a normal BMI range for overall health. The rising prevalence of class III obesity is a major public health concern given its disproportionate impact on health, health care utilization and costs. Obesity management is key to preventing the reduction in HRQoL associated with obesity-related comorbidities, and this analysis supports the development of targeted policies and population health initiatives for people with class III obesity.

Depression, anxiety, and health-related quality of life in normal weight, overweight and obese individuals with diabetes: a representative study in Germany

OBJECTIVE

Diabetes in the course of lifetime is related to a higher risk for mental disorders. The present study addresses the comparison of individuals with diabetes and non-diabetic individuals in depressive symptoms, generalized anxiety symptoms, and health-related quality of life. Furthermore, mediator effect of BMI and health-related quality of life (HRQOL) on the association between diabetes, depression, and generalized anxiety was analyzed.

METHODS

In this cross-sectional study, the three questionnaires PHQ-9, GAD-7, EQ-5D-5L were measured in a representative sample of the German population (N = 2386). In addition, the presence of diabetes and BMI were assessed via self-report.

RESULTS

There were higher values in depressive and anxiety symptoms as well as lower score in HRQOL in individuals with diabetes compared to non-diabetic individuals. Obese individuals with diabetes showed the highest rates in depressive symptoms and generalized anxiety as well as lowest score in HRQOL. With regard to the mediator analyses, association between diabetes, depressive symptoms, and anxiety symptoms is partially mediated by the BMI and fully mediated by the HRQOL.

CONCLUSIONS

In conclusion, individuals with diabetes have an increased risk in the development of depressive and anxiety symptoms as well as lower health-related quality of life. Future research and strategies in the public health policies among individuals with diabetes should take into account that the association between diabetes, depression, and anxiety is mediated by BMI and HRQOL.

Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits

Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.

Aging related obesity and type 2 diabetes mellitus suppress neuromuscular communication and aggravate skeletal muscle dysfunction in rhesus monkeys

Age-related functional deterioration in skeletal muscle raises the risk for falls, disability, and mortality in the elderly, particularly in obese people or those with type 2 diabetes mellitus (T2D). However, the response of the skeletal muscle to transitioning from obesity to diabetes remains poorly defined, despite that obesity is classified as a stage of pre-diabetes. We screened and selected spontaneously obese and diabetic rhesus monkeys and examined altered protein expression in skeletal muscle of healthy aging (CON), obesity aging (OB), and type 2 diabetes mellitus aging (T2D) rhesus monkeys using Tandem Mass Tags (TMT)-based quantitative proteomic analysis. In total, we identified 142 differentially expressed proteins. Muscle-nerve communication proteins were firstly suppressed at obese-stage. With the disintegration of skeletal muscle, mitochondrial complex I and other energy homeostasis relate proteins were significantly disordered at T2D stage. Indicating that aging related obesity suppressed muscle-nerve communication and contribute to T2D related functional deterioration of skeletal muscles in elderly rhesus monkeys. Some alterations of muscular functional regulator are detected in both obesity and T2D samples, suggesting some T2D related skeletal muscular hypofunctions are occurring at obesity or pre-obesity stage. Muscle-nerve communication proteins and muscular function related proteins could be potential therapy target or early diagnose marker of for skeletal muscular hypofunctions in aging obesity populations.

Predictors of Mental Health Outcomes in a Multidisciplinary Weight Management Program for Class 3 Obesity

This study aimed to examine the potential predictors of improvement in mental health outcomes following participation in an intensive non-surgical outpatient weight management program (WMP) in an Australian public hospital. This was a retrospective cohort study of all adults with Class 3 obesity (BMI ≥ 40 kg/m2) who enrolled in the WMP from March 2018 to June 2021. The participants completed the Eating Disorder Examination Questionnaire Short Version (EDE-QS), Kessler-10 Psychological Distress Scale, and 36-Item Short-Form Survey (SF-36) at baseline and 12-month follow-up. A total of 115 patients completed 12 months in the WMP and were included in the study, with 76.5% being female, a mean ± SD age at baseline of 51.3 ± 13.8 years, a weight of 146 ± 26 kg, and a BMI of 51.1 ± 8.6 kg/m2. The participants lost an average of 8.6 ± 0.2 kg over 12 months, and greater weight loss at follow-up was significantly associated with improved global EDE-QS scores, psychological distress, and improved mental health quality of life. However, improvements in most mental health outcomes were not predicted by weight loss alone. Notably, a lower eating disorder risk at baseline was associated with less psychological distress at follow-up and greater weight loss at follow-up. Our results also found an association between reduced psychological distress and reduced binge eating frequency. These findings support the inclusion components of obesity interventions that target the psychological correlates of obesity to support improved outcomes in people with Class 3 obesity. Future studies should aim to identify which aspects of the WMP helped improve people's psychological outcomes.

Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study

OBJECTIVE

This report from the NORD-STAR (Nordic Rheumatic Diseases Strategy Trials and Registries) trial aimed to determine if obesity is associated with response to conventional and biological antirheumatic treatment in early rheumatoid arthritis (RA).

METHODS

This report included 793 participants with untreated early RA from the randomised, longitudinal NORD-STAR trial, all of whom had their body mass index (BMI) assessed at baseline. Obesity was defined as BMI ≥30 kg/m2. All participants were randomised 1:1:1:1 to one of four treatment arms: active conventional treatment, certolizumab-pegol, abatacept and tocilizumab. Clinical and laboratory measurements were performed at baseline and at 8, 12, 24 and 48-week follow-up. The primary endpoint for this report was response to treatment based on Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) remission and Disease Activity Score with 28 joints using C-reactive protein (DAS28-CRP) <2.6 stratified by BMI.

RESULTS

Out of 793 people included in the present report, 161 (20%) had obesity at baseline. During follow-up, participants with baseline obesity had higher disease activity compared with those with lower BMI, despite having similar disease activity at baseline. In survival analyses, obesity was associated with a lower likelihood of achieving response to treatment during follow-up for up to 48 weeks (CDAI remission, HR 0.84, 95% CI 0.67 to 1.05; SDAI, HR 0.77, 95% CI 0.62 to 0.97; DAS28-CRP <2.6, HR 0.78, 95% CI 0.64 to 0.95). The effect of obesity on response to treatment was not influenced by the treatment arms.

CONCLUSION

In people with untreated early RA followed up for up to 48 weeks, obesity was associated with a lower likelihood of good treatment response, irrespective of the type of randomised treatment received.

TRIAL REGISTRATION NUMBER

NCT01491815.

Bariatric Surgery Outcomes in Patients with Severe Obesity Compared to Patients with Non-Severe Obesity at A New Institution in The United Arab Emirates

Background: Bariatric surgery is an effective treatment for weight loss, but a higher body mass index (BMI) may lead to higher postoperative complication rates. This study aims to compare perioperative and postoperative outcomes between UAE patients with severe obesity (SO) [BMI ≥ 50 kg/m2] and non-severe obesity (NSO) [BMI < 50 kg/m2] undergoing primary bariatric surgery. Methods: From September 2015 to July 2019, 542 patients, 94 SO (56.5 ± 6.2 kg/m2) and 448 NSO (41.8 ± 4.1 kg/m2), were retrospectively reviewed. Results: Patients with SO were younger (33.8 ± 13.4 vs. 37.0 ± 11.5 years, p = 0.02) but otherwise had similar demographic characteristics. Their rates of Roux-en-Y gastric bypass (39.4% SO vs. 44.4% NSO, p = 0.37) and sleeve gastrectomy (60.6% vs. 55.6%, p = 0.37) were similar. There were no differences between perioperative complications (6.4% SO vs. 5.8% NSO, p = 0.83), major postoperative complications (5.3% vs. 3.5%, p = 0.42), readmissions (5.3% vs. 3.3%, p = 0.36), or reoperations (3.2% vs. 2.7%, p = 0.78). There were no mortalities. Their total body weight loss was comparable at 12 months (28.1 ± 10.2% vs. 29.0 ± 7.7%, p = 0.58). Conclusions: Although a higher BMI may pose operative challenges, UAE patients with SO do not have worsened outcomes in bariatric surgery, demonstrating similarly low morbidity to patients with NSO, and similar rates of improvement in their BMI.

Cultural Translation and Validation of the Bariatric Quality of Life Index to European Portuguese

INTRODUCTION

Obesity is a chronic noncommunicable disease, defined by a body mass index over 30 kg/m2. Its impact is not restricted to its association with higher risks of mortality and morbidity from other noncommunicable diseases, but also with a decrease in quality of life (QoL). There are several tools to assess QoL, from generic health-related tools to obesity-related specific ones. However, to assess QoL in patients undergoing bariatric surgery, only the Bariatric Analysis and Reporting Outcome System was available, which presented some significant problems. Therefore, the Bariatric Quality of Life (BQL) Index was developed. The aim of this study was the validation and cultural adaptation of the BQL Index for European Portuguese.

METHODS

A cross-sectional study was conducted, with the presentation of two questionnaires to the participants: BQL Index and EQ-5D-3L (European Quality of Life 5 Dimensions and 3 Level) Index. Direct translation followed reviewing, back-translation, comparison, and pilot testing were performed. Retest was done six months after the baseline. The following psychometric properties were assessed: convergent validity using the Spearman r correlation coefficient between BQL Index and EQ-5D-3L Index; internal consistency based on Cronbach alpha coefficient; and reproducibility between test and retest through Spearman r correlation coefficient and intraclass correlation coefficient (ICC).

RESULTS

A total of 260 participants were included, the mean age was 45 ± 10 years old, the mean body mass index was 44 ± 6.5 kg/m2 and 78% were females. The most frequent obesity-related comorbidities were osteoarticular disease (69%), anxiety/depression (60%), and hypertension (54%). The most common eating patterns were volume eater (67%) and sweet eater (62%). Quality of Life scores were 41.3 ± 9.3 for the BQL Index, 0.35 ± 0.19 for the EQ-5D-3L Index and 55.7 ± 19.8 for the EQ-5D-3L VAS. The translation yielded good convergent validity (r = 0.62), good internal consistency (alpha = 0.94), and good reproducibility (r = 0.62 and ICC = 0.79).

CONCLUSION

Our translation exhibited good parametric properties, with validity within the original BQL values, higher internal consistency, and good reproducibility.

Anthropometric Predictors of Health-Related Quality of Life in Obese Patients Attending a Tertiary Hospital in Nnewi, South-East Nigeria: A Cross-Sectional Study

BACKGROUND

Obesity as a disorder with excess body fat directly decreases quality of life. While Body Mass Index (BMI) has been used largely in health studies as a measure of obesity, it is largely unable to differentiate between body fat and lean body mass, hence other anthropometric measures can be used to assess body fat.

OBJECTIVE

To determine the association of anthropometric indicators with health-related quality of life (HRQoL) in obese adults.

MATERIALS AND METHODS

A cross-sectional study of obese adults (BMI ≥30kg/m2) attending the general outpatient clinic was conducted over four months. The quality of life was assessed using the short form-36 (SF-36) questionnaire. The anthropometric indicators used were BMI, waist circumference (WC), waist hip ratio (WHR), and waist-height ratio (WHtR).

RESULTS

Physical component summary (PCS) was significantly related to BMI, WHtR, and WC. After adjusting for co-variables (gender, age, occupation, and marital status), they remained significantly associated with PCS. Mental component summary (MCS) was significantly related to BMI, WHtR, and WC. After adjusting for the known determinants of HRQoL, only BMI remained significantly associated with MCS (P = -0.004; r = -0.146). When all the indicators were included in the same regression model, no anthropometric indicator was significantly related to MCS while only WHtR was significantly associated with PCS (P = 0.001; r = -0.465).

CONCLUSION

HRQoL in obese patients is related to measures of body fat. The physical and mental components of health-related quality of life are correlated differently with the various anthropometric measures of obesity. The WHtR was found to be an independent predictor of the physical component of HRQoL.

Lower quality of life in obese ICU survivors: a multicenter cohort study

PURPOSE

To compare health-related quality of life (HRQoL) and functional status between obese, underweight, normal-weight, and overweight patients after three months post-intensive care unit (ICU) discharge.

METHODS

Multicenter cohort study (10 Brazilian ICUs). 1600 ICU survivors (≥ 72 h in the ICU) were included.The main outcomes were HRQoL and functional status assessed three months after the ICU discharge. The secondary outcomes were mortality, hospital readmission, and ICU readmission during the same period.

RESULTS

Obese patients (median 50.1; IQR 39.6-59.6) had lower HRQoL in the mental component than normal-weight patients (median 53; IQR 45.6-60.1) (p = 0.033). No differences were found between BMI categories regarding the physical component of HRQoL and the Barthel Index (p = 0.355 and 0.295, respectively). Regarding readmissions, 65.1 and 25.1% of patients were readmitted to the hospital and ICU, but there was no difference between the groups (p = 0.870 and 0.220, respectively). Obese patients died less frequently (11.8%) than underweight (30.9%) and normal-weight (19.3%) patients (p < 0.001).

CONCLUSION

After three months of post-ICU discharge, obese patients had lower HRQoL in the mental component than normal-weight patients. However, obese patients died less than underweight and normal-weight patients.

The Impact of Obesity on the Health of the Older Population: A Cross-Sectional Study on the Relationship between Health-Related Quality of Life and Body Mass Index across Different Age Groups

Obesity is strongly associated with mortality and morbidity, but there is a lack of data on its impact on health-related quality of life (HRQoL) across different age groups. Therefore, this study's objective was to determine the association between body mass index (BMI) and HRQoL in the Austrian adult population based on age groups using the 36-Item Short Form (SF-36) survey.

METHODS

The SF-36 survey was sent to 500 randomly assigned Austrian adults (response rate: 80.6%). This study assessed HRQoL subscale and component scores based on gender, level of education, smoking status, and alcohol consumption in 403 participants.

RESULTS

Increasing BMI is associated with a negative impact on all domains of physical health and social function. The study uncovered substantial variations in the impact of increasing BMI on HRQoL across different age groups, with a pronounced effect observed in the physical components, particularly among individuals aged 65-74.

CONCLUSIONS

BMI is negatively associated with the physical aspects of HRQoL and social function, affecting various adult age groups differently. Consequently, our results emphasize assessing different age groups and possible influencing factors on HRQoL, such as BMI, for further optimization in designing prevention programs against obesity.

Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass

PURPOSE

Obesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery.

MATERIALS AND METHODS

We conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12-18 months after surgery in 11 of them.

RESULTS

We observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium.

CONCLUSION

Weight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.

The influence of body mass index on physical activity engagement following anterior cruciate ligament reconstruction: A systematic literature review

Background

The objective of this study was to summarize available literature that explored the impact of body mass index (BMI) on physical activity participation among individuals who were subjected to the anterior cruciate ligament reconstruction (ACLR).

Methods

A total of three electronic databases, including Web of Science, Scopus, and PubMed, were comprehensively searched to identify relevant investigations. The following inclusion criteria were applied: (1) study design was observational; (2) participants underwent the ACLR; (3) BMI was estimated as a predictor variable; and (4) outcomes evaluated referred to physical activity. The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results

After a database search, 787 studies were found, and only 10 of them met each of the eligibility criteria and were included in the qualitative analysis. Regarding respondents' characteristics, 7171 individuals underwent ACLR, 4080 males and 3091 females, with a mean age of 25.5 years. Most importantly, the average BMI of the examined population was 24.9 kg/m2. In all studies, physical activity was evaluated subjectively using the Tegner activity scale and the Marx activity scale. The main findings unambiguously demonstrated that a negative relationship between BMI and physical activity engagement was observed. More specifically, there is convincing evidence that BMI over 25 kg/m2 harmfully affected subjectively assessed physical activity in individuals with a history of ACLR.

Conclusion

The results obtained in the presented research indicated that increased values of BMI were a factor that correlated with reduced physical activity levels in the ACLR population. Hence, taking into account the clinical and health implications of reduced physical activity participation, stimulation of a healthy lifestyle, such as a combination of adequately designed physical exercise and nutrition, seems necessary for the analyzed population.

Anti-obesity effect of Neoagaro-oligosaccharides with overweight and obese subjects: a 16-week, randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

This trial aimed to evaluate the anti-obesity effects and safety of Neoagaro-oligosaccharides (NAOs) in humans in a 16 week, randomized, double-blind, placebo-controlled clinical trial.

METHODS

One hundred overweight or obese subjects with a body mass index of 23 to 34.9 kg/m2 and a percent body fat of > 25% for males or > 30% for females were enrolled. NAOs or placebo products were administered at 3 g (twice a day, four capsules once) each for 16 weeks. Efficacy and safety biomarkers were measured before and after intervention.

RESULTS

After 16 weeks of intervention, the group administered with NAOs had statistically significant decreases in visceral fat area and visceral-subcutaneous fat area ratio compared to the placebo group. The NAOs group suppressed the increase in weight and BMI compared to the placebo group, which was significant between groups. High-density lipoprotein- cholesterol was increased in the group administered with NAOs, which showed a significant trend compared to the placebo group. Clinical changes were not observed for any safety biomarkers.

CONCLUSIONS

These results suggest that NAOs have a beneficial effect on obesity. Thus, NAOs could be used as an anti-obesity supplement without side effects.

TRIAL REGISTRATION

cris.nih.go.kr: (KCT0006640, 07/10/2021).

The effects of weight loss on health-related quality of life in obese women with PCOS and controls

BACKGROUND

Polycystic ovary syndrome (PCOS) is a complicated endocrine disorder with widespread symptoms that reduce women's quality of life. The adverse effect of associated obesity on this reduction is unclear, therefore the impact of weight loss on health-related quality of life (HRQOL) in obese women with PCOS is unknown. This study aimed to compare the impact of weight loss following a 24-week dietary intervention on HRQOL in obese women with and without PCOS.

METHODS

In a 24-week hypocaloric LGI (low glycemic index) diet intervention study, 286 women were recruited (140 PCOS, 146 controls) and 216 participants (PCOS = 105, non-PCOS = 111) completed the study. HRQOL was assessed using the SF-36 questionnaire (Short Form Health Survey). Physical activity was measured using the short form of the International Physical Activity Questionnaire (IPAQ). Anthropometric assessments, dietary intake, physical activity levels, and HRQOL scores, according to the Iranian version of SF-36, were compared at baseline and 24 weeks with intervention.

RESULTS

At the end of the intervention, there was no significant difference in the percentages of weight loss between the two groups (PCOS: 6.29 ± 3.32% vs. non-PCOS: 7 ± 3.62%, p = 0.1). At baseline, women with PCOS had lower mean scores in aspects of physical function (PF), general health perception (GH), role limitation due to emotional problem (RE), vitality (VT), mental health (MH), physical (PCS) and mental component summary scales (MCS), compared to non-PCOS (P < 0.01). At 24 weeks, the percentage of improvement in HRQOL in the non-PCOS group was higher compared to the PCOS group but this difference didn't reach statistical significance except for PCS. In both groups, greater weight loss was associated with further improvement in the physical aspects of HRQOL and vitality. In the non-PCOS group, with trivial exception, greater weight loss was associated with greater improvement in the mental aspects of HRQOL.

CONCLUSIONS

Both obese PCOS and non-PCOS women achieved nearly similar levels of improvement in HRQOL due to weight loss induced by a hypocaloric LGI diet.

TRIAL REGISTRATION

This study is registered in the Iranian Randomized Clinical Trials Registry (IRCT, code: IRCT2016092129909N1).

Long-term outcomes of laparoscopic sleeve gastrectomy in those with class I obesity: safety, efficacy, and quality of life

BACKGROUND

Class I obesity carries significant morbidity and mortality risk similar to higher grades of obesity, and persons with class I obesity have a high risk of progression to class II and III obesity. While bariatric surgery has made strides in safety and efficacy, it remains inaccessible for persons with class I obesity (body mass index [BMI] of 30-35 kg/m2).

OBJECTIVES

To assess safety, weight loss durability, co-morbidity resolution, and quality of life after laparoscopic sleeve gastrectomy (LSG) in persons with class I obesity.

SETTING

Multidisciplinary medical center that specializes in obesity management.

METHODS

A longitudinal prospective single-surgeon registry was queried for data pertaining to persons with class I obesity who underwent primary LSG. Primary endpoint was weight loss. Secondary endpoints included change in obesity-related co-morbidities, adverse events, and post hoc analysis of symptoms of gastroesophageal reflux disease (GERD) and Bariatric Analysis and Reporting Outcome System results. Follow-up was divided into short- (1-3 yr), intermediate- (4-7 yr), and long-term (8-12 yr). We evaluated percent excess weight loss (%EWL) using linear mixed models adjusting for age, sex, years since operation, and baseline BMI. Least-squares means estimates and 95% confidence intervals (CI) were generated.

RESULTS

Of 13,863 bariatric procedures, a total of 1851 patients were included. Mean baseline BMI, age, and male:female ratio were 32.6 ± 2.1 kg/m2, 33.7 ± 9.2 years, and 1:5, respectively. Adjusted mean %EWL (95% CI) at short-, intermediate-, and long-term follow-up were 111% (95% CI, 91%-131%), 110% (95% CI, 89%-131%), and 141% (95% CI, 57%-225%), respectively. Of 195 patients with type 2 diabetes, 59% experienced complete remission, and of 168 patients with hypertension, 43% experienced complete remission. Being on oral antidiabetes medication was a significant predictor of sustained remission compared with being on insulin or combination therapy (P < .001). Sixty-nine patients had symptoms of GERD before surgery, which improved in 55 (79.7%). Thirty-three patients developed de novo symptoms of GERD. The average Bariatric Analysis and Reporting Outcome System score was 4.5 ± 1.7, with 83% of participants rating their quality of life after surgery as good, very good, or excellent.

CONCLUSION

Those with class I obesity who undergo LSG experience normalization of weight, sustained remission of co-morbidity, and good quality of life without significant risk of morbidity or mortality.

Examining Associations Between Women's Mental Health and Obesity

Obesity is a common comorbidity associated with mental illness. It is important to understand the many ways weight gain and obesity can impact the cause and course of mental illness in women, with a special focus on vulnerable life stages. Women seem disproportionally impacted by the weight gain side effects of medications, and issues such as weight gain are more likely to impact symptoms of mental illness, impacting self-esteem. This article summarizes the existing literature on the associations between women's mental health and obesity. Understanding this association will lead to better health outcomes.

Alterations in skeletal muscle morphology and mechanics in juvenile male Sprague Dawley rats exposed to a high-fat high-sucrose diet

Although once a health concern largely considered in adults, the obesity epidemic is now prevalent in pediatric populations. While detrimental effects on skeletal muscle function have been seen in adulthood, the effects of obesity on skeletal muscle function in childhood is not clearly understood. The purpose of this study was to determine if the consumption of a high-fat high-sucrose (HFS) diet, starting in the post-weaning period, leads to changes in skeletal muscle morphology and mechanics after 14 weeks on the HFS diet. Eighteen 3-week-old male CD-Sprague Dawley rats were randomly assigned to a HFS (C-HFS, n = 10) or standard chow diet (C-CHOW, n = 8). Outcome measures included: weekly energy intake, activity levels, oxygen consumption, body mass, body composition, metabolic profile, serum protein levels, and medial gastrocnemius gene expression, morphology, and mechanics. The main findings from this study were that C-HFS rats: (1) had a greater body mass and percent body fat than control rats; (2) showed early signs of metabolic syndrome; (3) demonstrated potential impairment in muscle remodeling; (4) produced lower relative muscle force; and (5) had a shift in the force-length relationship, indicating that the medial gastrocnemius had shorter muscle fiber lengths compared to those of C-CHOW rats. Based on the results of this study, we conclude that exposure to a HFS diet led to increased body mass, body fat percentage, and early signs of metabolic syndrome, resulting in functional deficits in MG of childhood rats.

The Impact of Bariatric Surgery on Quality of Life in Patients with Obesity

Obesity has become a widespread health problem influencing people's health, general well-being, and healthcare costs. It also represents an important risk factor for multiple comorbidities and malignancies.

OBJECTIVES

the primary objective of this study was to provide notable insights to healthcare professionals regarding the management of patients with obesity, to highlight the effectiveness of bariatric surgical methods in losing excess weight, and to establish the relationship between weight loss and changes in quality of life (QoL).

MATERIAL AND METHODS

our study evaluated the QoL of 76 patients following bariatric surgery at different postoperative stages using the 36-Item Short Form Survey (SF-36) and The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires.

RESULTS

regarding the type of bariatric procedure performed, out of the 76 respondents, 39.47% underwent gastric bypass surgery (RYGB), 56.57% underwent sleeve gastrectomy (LSG), and only 3.94% underwent single anastomosis duodeno-ileal switch (SADI-S). Pertaining to the SF-36 questionnaire, the lowest average scores were found in the energy/fatigue subscales and in the limitations due to mental health, which remained consistent across surgery types with a significant decrease in the SADI-S group. Concerning the WHOQOL-BREF questionnaire, the lowest mean scores were found in the environment (15.03 ± 2.37) and social relations (16.08 ± 2.22) subscales, whilst the highest average scores were in physical health (16.30 ± 2.03) and mental health (16.57 ± 2.16).

CONCLUSIONS

the findings revealed that whilst bariatric surgery significantly improved physical health, it resulted in a decrease in mental health scores. Consequently, the study emphasizes the importance of adopting a holistic approach to managing obesity that considers improving both physical and mental health outcomes.

Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients

Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.

Health-related Quality of Life and Determinants of the Mental Dimension Among Tunisian Nurses in Public Hospitals

BACKGROUND

The health-related quality of life (HR-QoL) has been in-creasingly investigated in health sciences. The Objectives of this study are to evaluate the HR-QoL among nurses in Tunisian public hospitals and to identify the determinants of its mental dimension.

METHODS

A cross-sectional, bi-centric study was conducted within a representative sample of the 1,179 nurses assigned to 28 departments of two Tunisian public hospitals. A structured inquiry (socio-professional characteristics, occupational perceived workload) and validated questionnaires (SF12, Job Content Questionnaire of Karasek, Work Ability Index) have been completed.

RESULTS

Response rate was equal to 97.34%. The mean age of nurses was 42.60 ± 21 years. Nearly half of caregivers (49.07%) had a poor mental quality of life. The multivariate analysis concluded that mental HR-QoL was correlated with the female gender (0.010), obesity and the non-practice of regular physical activity (0.027), musculoskeletal diseases (<10-3), the low ability to work (<10-3). This deterioration of the mental HR-QoL dimension was also associated with the job tenure (0.002), the perceived workload (0.015), and conflictual relationships with colleagues (0.006) the feeling of insecurity at work (0.034), and the intention to leave the profession early (0.007) Conclusion: The results of this study showed that a considerable number of nurses had a poor mental quality of life. This study also identified factors associated with this deterioration. Acting on these determining factors may improve the well-being and global health of nurses, as well as their work performance and quality of care provided.

The Interplay between Conventional Cardiovascular Risk Factors and Health-Related Quality of Life in a Cohort of Working Young and Middle-Aged Adults: A Prospective Study

Psychosocial and work stress, socioeconomic status, and environmental health directly impact the onset and progression of cardiovascular diseases, irrespective of sex or conventional cardiovascular risk factors (cCRFs). On the other hand, the impact of cCRFs on health-related quality of life (HRQoL) is not well known, and the psychological socioeconomic environmental somatic health interaction is often neglected. Accordingly, we aimed to: (i) compare the self-reported HRQoL using the WHOQOL-BREF questionnaire between healthy subjects and those with cCRFs; and (ii) evaluate the interplay between HRQoL, cCRFs, and cardiovascular treatment adherence. We prospectively included 90 working adults (46 healthy and 44 with cCRFs age- and sex-matched adults) evaluated by clinical examination, 12-leads electrocardiography, and transthoracic echocardiography as part of a cardiovascular diseases screening program, that also filled in the WHOQOL-BREF questionnaire. Subjects with CRFs were less satisfied with their own individual health. The presence and the number of CRFs, as well as the need for cardiovascular treatment and the number of drugs taken correlated with reduced scores at the majority of HRQoL domains. The results in the social relationships domain were the best predictor of cardiovascular treatment adherence. Finally, the results of all HRQoL domains were strongly correlated to each other demonstrating the psychological socioeconomic environmental somatic health interaction.

Differential bone metabolism and protein expression in mice fed a high-fat diet versus Daurian ground squirrels following natural pre-hibernation fattening

This study compared the effects on bone metabolism and morphology of pathological obesity induced by excessive fat intake in a non-hibernator (mice) versus healthy obesity due to pre-hibernation fattening in a hibernator (ground squirrels). Kunming mice were fed a high-fat diet to provide a model of pathological obesity (OB group). Daurian ground squirrels fattened naturally in their pre-hibernation season (PRE group) were used as a healthy obesity model. Micro-computed tomography (micro-CT) and three-point bending tests were used to determine the microstructure and mechanical properties of bone. Western blots were used to analyze protein expression levels related to bone metabolism (Runt-related transcription factor 2 (RunX2), osteocalcin (OCN), alkaline phosphatase (ALP), osteoprotegerin (OPG), receptor activator of nuclear factor-‍κB ligand (RANKL), cathepsin K, matrix metallopeptidase 9 (MMP9), patched protein homolog 1 (Ptch1), phosphorylated β‍-‍catenin (P‍-‍β‍-‍catenin), and glycogen synthase kinase-3β (GSK-3β)). Compared with controls, there was no obvious bone loss in the OB mice, and the stiffness of the femur was increased significantly. Compared with summer active squirrels, bone formation was enhanced but the mechanical properties did not change in the PRE group squirrels. In OB mice, western blots showed significantly increased expression levels of all proteins except RunX2, OPG, and Ptch1. PRE ground squirrels showed significantly increased expression of most proteins except OCN and Ptch1, which decreased significantly, and P‍-‍β‍-‍catenin and OPG, which did not change. In conclusion, for non-hibernating mice, moderate obesity had a certain protective effect on bones, demonstrating two-way regulation, increasing both bone loss and bone formation. For pre-hibernating ground squirrels, the healthy obesity acquired before hibernation had a positive effect on the microstructure of bones, and also enhanced the expression levels of proteins related to bone formation, bone resorption, and Wnt signaling.

Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.

Prioritising long-term outcomes for preterm babies: A survey of consumers and clinicians

AIM

To determine if consumers and clinicians believe intelligence or health outcomes are more important long-term outcomes for babies born preterm.

METHODS

Prospective, online survey of six outcomes ranked using a hierarchy ladder, Likert scale and a hypothetical scenario: education (complete secondary school); longevity (70 years of age or more); money (sufficient for rent and food); normal weight; good health and intelligence. Participants were clinicians taking care of preterm babies, parents of preterm babies, ex-preterm adults and adult controls.

RESULTS

The survey was completed by 145 participants (35 controls, 36 clinicians, 39 parents and 35 ex-preterm adults). Health was the most frequently top-ranked variable on the hierarchy ladder (health; 99/145 (68.3%), money; 17/145 (11.7%), longevity; 10/145 (6.9%), education; 8/145 (5.5%), normal weight; 6/145 (4.1%), intelligence; 5/145 (3.4%), P < 0.0001), with no statistical difference between the groups. On a 5-point Likert scale, participants were most likely to agree that sufficient money, health and finishing secondary school were important for preterm babies to have a good life (mean (SD): money 4.43 (0.81); health 4.39 (0.72); education 4.37 (0.81); normal weight 4.10 (0.81); intelligence 4.03 (0.94); longevity 4.01 (1.07), P < 0.0001). In the scenario, the option of an ex-preterm adult having a healthy life with low socio-economic status (SES), was preferred over high SES with an unhealthy life (p < 0.0001).

CONCLUSIONS

Health was perceived as the most important long-term outcome for preterm babies. Future research should prioritise good health outcomes for babies born preterm.

Quality of Life in Obese Patients from a Multidisciplinary Bariatric Consultation: A Cross-Sectional Study Comparing to a Non-Bariatric Population and to the General Population

Obesity is a chronic disease defined by a body mass index of ≥30 kg/m², which can result in a decrease in quality of life (QoL). Our study aim was to assess the QoL of an obese population of bariatric surgery (BS) candidates, and to compare it to both that of a non-bariatric obese population (C) and that of the general population. This was a cross-sectional study using: (1) the EQ-5D-3L instrument: comparing BS with the C population and with the Portuguese general population; and (2) the Bariatric Quality of Life (BQL) Index: comparing the two groups of obese patients. We included 228 BS and 68 C obese patients. BS patients had higher BMI (44 ± 6 kg/m² vs. 41 ± 6.5 kg/m²; p < 0.001), higher waist circumference (130 ± 13 cm vs. 123 ± 17 cm; p = 0.03), and higher total body fat mass (49.9 ± 6.7% vs. 45 ± 6.7%; p < 0.001). QoL as evaluated by EQ-5D-3L was similar, but the BQL index showed lower QoL in BS patients (40.9 ± 8.9 vs. 44.2 ± 11.2; p = 0.01). Compared to the Portuguese general population, BS patients had lower QoL (VAS: 55 ± 19 vs. 74.9; p < 0.001; index: 0.33 ± 0.2 vs. 0.76; p < 0.001). Despite higher adiposity in the BS group, QoL was similar between the groups by EQ-5D-3L. Nevertheless, there was a decrease in the QoL for the BS patients as determined using the BQL, a tool with higher sensitivity to bariatric patients.

Morbid obesity, multiple long-term conditions, and health-related quality of life among Australian adults: Estimates from three waves of a longitudinal household survey

This study aims to investigate the impact of morbid obesity and multiple long-term conditions (MLTCs) on health-related quality of life (HRQoL). Data for this study were sourced from three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The paper analyses 37,887 person-year observations from 19,387 individuals during the period 2009-2017. The longitudinal random-effects Tobit model was fitted to examine the association between morbid obesity, MLTCs and HRQoL. This study found that morbid obesity and MLTCs were both negatively associated with HRQoL as measured through physical component summary (PCS), mental component summary (MCS), and the short-form six-dimension utility index (SF-6D) of the 36-item Short-Form Health Survey (SF-36). Morbidly obese scored lower points on the PCS (β = -5.05, 95% CI: -5.73, -4.37), MCS (β = -1.03, 95% CI: -1.84, -0.23), and in the SF-6D utility index (β = -0.045, 95% CI: -0.054, -0.036) compared to their healthy weight counterparts. Similar findings were observed for individuals with MLTCs, with lower scores for the PCS (β = -4.79, 95% CI: -5.20, -4.38), MCS (β = -4.95, 95% CI: -5.43, -4.48), and SF-6D utility (β = -0.071, 95% CI: -0.076, -0.066). Additionally, multiplicative interaction between morbid obesity and MLTCs was observed to modestly exacerbated the negative effect of morbid obesity on PCS scores (β = -1.69, 95% CI: -2.74, -0.64). The interaction effect, on the other hand, significantly lessen the unfavourable effect of morbid obesity on the MCS score (β = 1.34, 95% CI: 0.10, 2.58). The findings of this study will be useful for future cost-effectiveness analyses and measuring the burden of diseases since it provides information on the disutility associated with morbid obesity and MLTCs.

The prototype of a preference-based index of weight-related quality of life: demonstrating the possibilities

PURPOSE

Evidence for comparative and cost-effectiveness of weight-loss interventions is lacking as there are no obesity-specific measures fit for this purpose. This study aimed to estimate the extent to which a prototype of a brief, multi-dimensional obesity-specific Preference-Based Index of Weight-Related Quality of Life (PBI-WRQL) could fill this gap.

METHODS

Longitudinal data from a Canadian bariatric cohort was used. Forty-eight items from the IWQoL-Lite, EQ-5D-3L, and SF-12V2 were mapped onto the WHO ICF domains, and one item was chosen for the dimension based on fit to the Rasch model. Individuals' health ratings (0-100) were regressed on each dimension, and the regression coefficients for the response options were used as weights to generate a total score. Generalized estimation equations were used to compare measure parameters across groups and levels of converging constructs.

RESULTS

Pre-surgery data were available on 201 people (Women: 82%; BMI: 48.8 ± 6.7 kg/m²; age: 43 ± 9.0 years) and on 125 (62%) at 6 months post-bariatric surgery. Seven dimensions with three response options formed the PB-WRQL prototype: Mobility/Physical Function, Pain, Depression, Participation, Energy, Peripheral Edema, and Dyspnea. The prototype showed substantial change (mean + 40) with bariatric surgery, higher than the EQ-5D (mean + 11.5). The prototype showed the strongest relationship with BMI at baseline (t = - 3.68) and was the most sensitive to change in BMI (t = - 3.42).

CONCLUSION

This study demonstrates that a brief, 7-dimension index weighted by health impact performed as well as the 31-item IWQoL-Lite and better than the EQ-5D-3L. These findings demonstrate the potential value of the brief PB-WRQL prototype index and support its further development using preference weights to reflect the current generation's needs and concerns.

Cardiometabolic Health Status, Ethnicity and Health-Related Quality of Life (HRQoL) Disparities in an Adult Population: NutrIMDEA Observational Web-Based Study

Precision public health supported on online tools is increasingly emerging as a potential strategy to achieve health promotion and disease prevention. Our aim was to assess the relationships of sociodemographic variables, anthropometric data, dietary habits and lifestyle factors with health-related quality of life (HRQoL), cardiometabolic health status and ethnicity in an online recruited adult population (NutrIMDEA Study). NutrIMDEA Study is a web-based cross-sectional survey that included 17,333 adults. Self-reported sociodemographic characteristics, anthropometric data, clinical and family history of cardiometabolic illnesses, dietary habits, lifestyle factors and HRQoL features were collected. Diseased individuals showed significative poorer MedDiet and worse HRQoL than those in the healthy cardiometabolic status group (p < 0.05). In comparison, European/Caucasian individuals reported a significantly better HRQoL, higher MedDiet and HRQoL values compared with those of other ethnicities (p < 0.05). We obtained a total of 16.8% who reported poor/fair, 56.5% good and 26.6% very good/excellent HRQoL. Respondents with very good/excellent HRQoL showed lower BMI, greater adherence to a Mediterranean diet (MedDiet) and higher physical activity. The results suggest the presence of interactions between the mental and physical components of HRQoL with obesity, sedentarism and dietary intake, which were dependent on disease status and ethnicity. Online HRQoL assessment could contribute to wider implementation of precision public health strategies to promote health targeted interventions with policy implications to community health promotion.

Comparison of time-matched aerobic, resistance or combined exercise training in women living with obesity: a protocol for a pilot randomised controlled trial-the EXOFFIT (Exercise for Obesity in Females to increase Fitness) study

INTRODUCTION

Obesity in women has more than doubled in the past thirty years. Increasing research suggests that increased cardiorespiratory fitness (CRF) can largely attenuate the negative health risks associated with obesity. Though previous literature suggests that combined training may be the most effective for improving CRF in adults with obesity, there is minimal research investigating the efficacy of combined and resistance programmes in women with obesity. This article outlines a protocol for a parallel pilot study which aims to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for increasing CRF and strength and improving body composition and other health outcomes (i.e. quality of life).

METHODS AND ANALYSIS

Sixty women (aged 18-50) with obesity (body mass index [BMI] ≥ 30 and/or waist circumference ≥ 88 cm) who are physically inactive, have no unstable health conditions and are safe to exercise will be recruited from September 2021 to December 2022. The main outcome will be feasibility and acceptability of the intervention and procedures. Trial feasibility outcomes will be evaluated to determine if a definitive trial should be undertaken. Trial acceptability will be explored through follow-up qualitative interviews with participants. Secondary outcomes will include CRF (predicted VO2 max), anthropometrics (i.e. BMI), strength (5RM bench press, leg dynamometry, grip strength) and other health outcomes (i.e., pain). Participants will be block randomised into one of four trial arms (aerobic exercise, resistance training and combined training groups, non-active control group) and measurements will be completed pre- and post-intervention. The exercise groups will receive an individualised supervised exercise programme for 3× sessions/week for 12 weeks. The change in mean values before and after intervention will be calculated for primary and secondary outcomes. ANOVA and t-tests will be applied to evaluate within-group and between-group differences. If sufficient participants are recruited, the data will be analysed using ANCOVA with the age and BMI as covariates.

DISCUSSION

This pilot will provide data on the feasibility and acceptability of trial procedures and of the programmes' three progressive time-matched exercise interventions (aerobic, resistance and combined) for women living with obesity, which will help inform future research and the potential development of a full-scale randomised clinical trial.

TRIAL REGISTRATION

ISRCTN, ISRCTN13517067 . Registered 16 November 2021-retrospectively registered.

Review about Psychological Barriers to Lifestyle Modification, Changes in Diet Habits, and Health-Related Quality of Life in Bariatric Endoscopy

Obesity is an expanding disease responsible for significant deterioration in the Health-Related Quality of Life (HRQL) of those who suffer from it. Bariatric Endoscopy (BE) therapies have proven to be an effective treatment for this pathology. A multidisciplinary approach is essential for the successful therapeutic management of BE. This article addresses the multidisciplinary treatment of BE by considering the possible variables that can influence treatment. In particular, the variables that can facilitate or hinder changes in patients’ habits are discussed. These include the neuropsychological, emotional, and social implications that may influence the formation of healthy habits necessary for improvement in a patient’s quality of life; the individual and environmental psychological factors that influence the monitoring of nutritional and physical activity indications; and different psychological disorders such as depression, anxiety, or disorders related to eating. The main objective of BE treatment, except in certain special biological situations, must be to establish a long-term sustainable change in habits such that patients, once they reach a healthy weight, do not revert to the lifestyle that caused their obesity, as well as identifying and addressing major problems that may exist prior to, or arise during, treatment.

The Association Between Level of Physical Activity and Body Mass Index, and Quality of Life Among Elderly Women

The process of aging leads to changes in functional abilities, fitness levels, level of physical activity, and body mass index (BMI), all of which causes changes in the quality of life. The current study aims to determine the association between the level of physical activity (PA) and BMI, and quality of life (QoL) among elderly women. The total sample numbered 156 women, with an average age of 67.7 ± 5.6 years. To determine the level of physical activity, the self-reported International Physical Activity Questionnaire Long Form (IPAQ-LF), was used. To calculate the values of the BMI, the standard procedure recommended by the World Health Organization was used. Quality of life was evaluated using the short form of the WHOQOL-BREF questionnaire designed by the World Health Organization. All the data were processed using the statistical package for data analysis SPSS 20.0. Pearson's correlation analysis shows statistically significant relations at the level of p < 0.01 between PA and Physical health in Housework = 0.36, Leisure time PA = 0.27, Walking = 0.24, Moderate PA 0.43, Total PA = 0.43, while the correlations between the variables at the significance level of p < 0.05 were determined in PA in transportation = 0.19 and High-intensity PA = 0.16. Multiple linear regression analysis of different levels of PA as independent variables on individual domains of QoL shows that there is an association of PA and Physical health (Sig = 0.000), more precisely, Total PA is statistically the most closely related to Physical health (Sig = 0.000), and then follows PA at work and Social relations (Sig = 0.036). Similar results were obtained when BMI is added to model A. In contrast to model A, model B shows a statistically significant association between PA and BMI with the environmental domain of QoL (Sig = 0.001). The results of the current study indicate that high- and moderate-intensity physical activity both have benefits for physical health, whereas moderate PA showed higher significance levels. Results also show that elderly women with higher BMI values achieve better results in the environmental domain of QoL.

Relationship of domain-specific quality of life with body mass index and waist circumference in a Korean elderly population

BACKGROUND

Obesity affects health-related quality of life (QoL); however, their relationship among elderly Asians is not well known.

AIMS

Relationship of domain-specific QoL with body mass index (BMI) and waist circumference and the sex differences were investigated using a nationally representative sample of elderly Korean population.

METHODS

In the Korea National Health and Nutrition Examination Survey phase VII (2016-2018), 3659 adults aged ≥ 65 years (1551 men and 2108 women) participated. BMI and waist circumference were classified according to Asian- and Korean-specific criteria. QoL was evaluated using the European Quality of Life Scale-Five Dimensions (EQ-5D). Multivariable logistic regressions were used to examine the relationship of QoL with BMI and waist circumference.

RESULTS

Men with BMI < 18.5 kg/m² and ≥ 25.0 kg/m² had a significant association with poor QoL in mobility and self-care, but no relationship was found with the other domains. Women with BMI ≥ 25.0 kg/m² had poor QoL in mobility and self-care, and those with BMI ≥ 30.0 kg/m² had poor QoL in usual activities and pain/discomfort. There was no significant association with anxiety/depression. Both elderly men and women with abdominal obesity had a significant association with poor QoL in mobility, self-care, usual activities, and pain/discomfort; however, there was no significant relationship with waist circumference and anxiety/depression.

CONCLUSIONS

The association between QoL and BMI was different according to sex and the domains of QoL. Domain-specific QoL should be considered in the management of body weight of the elderly.

Impaired glucose metabolism reduces the neuroprotective action of adipocytokines in cognitively normal older adults with insulin resistance

Evidence suggests that aging-related dysfunctions of adipose tissue and metabolic disturbances increase the risk of diabetes and metabolic syndrome (MtbS), eventually leading to cognitive impairment and dementia. However, the neuroprotective role of adipocytokines in this process has not been specifically investigated. The present study aims to identify metabolic alterations that may prevent adipocytokines from exerting their neuroprotective action in normal ageing. We hypothesize that neuroprotection may occur under insulin resistance (IR) conditions as long as there are no other metabolic alterations that indirectly impair the action of adipocytokines, such as hyperglycemia. This hypothesis was tested in 239 cognitively normal older adults (149 females) aged 52 to 87 years (67.4 ± 5.9 yr). We assessed whether the homeostasis model assessment-estimated insulin resistance (HOMA-IR) and the presence of different components of MtbS moderated the association of plasma adipocytokines (i.e., adiponectin, leptin and the adiponectin to leptin [Ad/L] ratio) with cognitive functioning and cortical thickness. The results showed that HOMA-IR, circulating triglyceride and glucose levels moderated the neuroprotective effect of adipocytokines. In particular, elevated triglyceride levels reduced the beneficial effect of Ad/L ratio on cognitive functioning in insulin-sensitive individuals; whereas under high IR conditions, it was elevated glucose levels that weakened the association of the Ad/L ratio with cognitive functioning and with cortical thickness of prefrontal regions. Taken together, these findings suggest that the neuroprotective action of adipocytokines is conditioned not only by whether cognitively normal older adults are insulin-sensitive or not, but also by the circulating levels of triglycerides and glucose, respectively.

Obesity and low levels of physical activity are associated with a decreased health-related quality of life in postmenopausal women: a Wroclaw pilot study

Background: Menopause is associated with numerous somatic dysfunctions, an increased risk of chronic diseases, and complications in the mental and social components of health that lower the quality of life (QoL). Obesity and related comorbidities affect over 60% of postmenopausal women in Poland. A significant role for systematic physical activity (PA) in the prevention of dysfunctions and chronic diseases, including obesity and mental disorders, has been observed previously. A low level of PA is observed across the Polish population, especially in postmenopausal women. Aim of the study: To examine QoL in postmenopausal women participating in a community health promotion program as it relates to obesity and levels of PA. Material and methods: The study sample consisted of 76 postmenopausal women (aged 65.75±5.14 years) participating in the Active Wrocław 55+ program. Before starting the program, anthropometric measurements were taken, and QoL and PA were assessed using the 36-Item Short Form Health Survey (SF-36) and the International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. Results: Most women had a PA level above 600 MET -min/week (78.95%), and were overweight or obese (86.84%). A waist circumference over 80 cm, indicating an increased risk for metabolic syndrome, was observed in 85.89% of the participants. BMI and waist circumference negatively correlated with the level of PA (p=0.001 and p=0.017, respectively). Women exhibiting low levels of PA and higher BMIs showed a significantly lower QoL compared to those with higher PA and lower BMIs, particularly with regard to the physical domains of QoL. Conclusions: Obesity and a low level of PA are associated with a significant decline in the health-related QoL (especially in the PF and PCS domains) of postmenopausal women an urban setting.

The "Fat but Fit" Paradigm from a Children's Health-Related Quality of Life Perspective

Background: The fat but fit paradigm originally argues that the detrimental influence of obesity on cardiovascular risk and mortality could be counterbalanced by normal to high cardiorespiratory fitness (CRF) levels. The aim of the study was to determine whether there is a relationship between categories of the fat but fit conceptual model and health-related quality of life (HRQoL) in children. Materials and Methods: Cross-sectional cluster analyses of the MOVI-daFit! baseline data were conducted in 507 children aged 9 to 11 years in Cuenca, Spain. BMI, body fat percentage, VO₂ max estimate, and HRQoL (measured by the KIDSCREEN questionnaire) were assessed. Results: The cluster analysis of BMI/body fat percentage and VO₂ max estimate z-scores resulted in a four-cluster solution that fit the four categories included in the fat but fit paradigm: fat unfit (FU), unfat unfit (UU), fat but fit (FF), and unfat fit (UF). Analysis of variance (ANOVA) models showed the expected mean trends by cluster category: an increasing trend (FU<UU<FF<UF) in terms of VO₂ max estimate and, conversely, a decreasing trend (FU>FF>UU>UF) in terms of adiposity (p < 0.05). These models also indicated, in the whole sample, that schoolchildren in the FF and UF clusters scored higher on physical well-being, psychological well-being, and total HRQoL scores than their peers in the FU and UU clusters (p < 0.05). The results were similar regardless of gender and whether BMI or body fat percentage was used for clustering. Conclusions: This study reinforces the fat but fit paradigm with respect to a previously unexplored outcome, HRQoL, by indicating that CRF may be mediating in the relationship between obesity and HRQoL. Clinical Trial Registration number: NCT03236337.

Impact of Gastrointestinal Diseases on Health-Related Quality of Life of Patients in Pakistan

Objective

This study aimed to evaluate the impact of gastrointestinal (GI) diseases on health-related quality of life (HRQoL) in Pakistani patients.

Methods

A cross-sectional study was conducted from 1st January 2019 to 15th February 2019 at a tertiary care hospital in Pakistan by employing a self-administered questionnaire called Gastrointestinal Quality of Life Index (GIQLI). Questionnaires were distributed among the patients presenting to outpatient gastroenterology clinics to evaluate their HRQoL.

Results

A total of 199 patients were included in this study, and their mean GIQLI score was 87.8 ± 17.8. Results showed that more severe core symptoms can lead to a poorer QoL. Overall GIQLI scores and most of its domain scores were lower in females as compared to males (p-value: 0.02). Obese patients had an overall lower mean GIQLI score including in the GI, psychological, and social domains while advanced age was associated with a higher disease-specific GIQLI score.

Conclusion

Based on our findings, GI diseases negatively impact the HRQoL in patients. Physicians need to consider the different domains of QoL as part of a holistic approach to treating these patients.

Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE

OBJECTIVES

To investigate whether abnormal BMI is associated with adverse health-related quality of life (HRQoL) outcome, including severe fatigue, after 52 weeks of standard therapy plus belimumab or placebo in patients with SLE.

METHODS

We analysed data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (n = 1684). Adverse HRQoL was defined as SF-36 scores ≤ the fifth percentile in age- and sex-matched US population-based subjects, and FACIT-F scores <30. We compared BMI groups using the Pearson's χ2 test, and assessed independence with multivariable logistic regression analysis.

RESULTS

Overweight (BMI ≥25 kg/m2) and obese (BMI ≥30 kg/m2) patients showed increased likelihood to exhibit adverse SF-36 physical component summary (OR: 1.8; 95% CI: 1.4, 2.3; P <0.001 and OR: 2.4; 95% CI: 1.8, 3.2; P <0.001, respectively) and FACIT-F (OR: 1.3; 95% CI: 1.1, 1.6; P = 0.010 and OR: 1.5; 95% CI: 1.2, 2.0; P = 0.002, respectively) scores at week 52. Underweight was associated with adverse SF-36 mental component summary scores, also after adjustment for sex, ancestry, age, disease duration, disease activity, organ damage and prednisone dose during the study period (OR: 2.1; 95% CI: 1.2, 3.6; P = 0.007). Addition of belimumab to standard therapy independently protected against adverse SF-36 general health (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.025) and FACIT-F < 30 (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.018).

CONCLUSION

Overweight and obesity contributed to adverse physical and mental HRQoL outcomes after therapeutic intervention in SLE patients, and underweight contributed to adverse mental HRQoL outcome. A protective effect of belimumab against adverse general health and severe fatigue was implicated.

Differences in Dietary Habits, Physical Exercise, and Quality of Life between Patients with Obesity and Overweight

BACKGROUND

Overweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity and overweight.

METHODS

A cross-sectional study was undertaken among participants in a clinical trial on education for healthy eating and physical activity, enrolling non-diabetic patients admitted to Internal Medicine Departments. These were classified by body mass index (BMI) as having overweight (25-29.9 Kg/m²) or obesity (≥30 kg/m²). Data were gathered on sociodemographic characteristics, clinical variables (medication for anxiety/depression, Charlson Comorbidity Index, length of hospital stay), physical exercise and diet (International Physical Activity and Pardo Questionnaires), and HRQoL (EQ-5D-5L). The study included 98 patients with overweight (58.2% males) and 177 with obesity (52% males).

RESULTS

In comparison to patients with obesity, those with overweight obtained better results for regular physical exercise (p = 0.007), healthy diet (p = 0.004), and "emotional eating" (p = 0.017). No between-group difference was found in HqoL scores.

CONCLUSION

Patients with overweight and obesity differ in healthy dietary and physical exercise behaviors. Greater efforts are warranted to prevent an increase in the BMI of patients, paying special attention to their state of mind.

Adherence to a Mediterranean diet and health-related quality of life: a cross-sectional analysis of overweight and obese middle-aged and older adults with and without type 2 diabetes mellitus

The relationship between adherence to a Mediterranean diet (MedDiet) and health-related quality of life (HRQoL) is unclear, particularly in vulnerable older adults. This cross-sectional analysis explored the association between adherence to a MedDiet and subscales of HRQoL in two independent cohorts of overweight and obese middle-aged to older adults with and without type 2 diabetes mellitus (T2DM). Both cohorts were community-dwelling (T2DM aged ≥ 50 years; non-T2DM aged ≥ 60 years) with a BMI ≥ 25 kg/m2. Adherence to a MedDiet was assessed using the Mediterranean Diet Adherence Screener, and HRQoL was determined using the 36-item short-form health survey. Multiple regression analysis was used to examine the association between adherence to a MedDiet and HRQoL subscales. A total of 152 middle-aged to older adults were included (T2DM: n 87, 71·2 (sd 8·2) years, BMI: 29·5 (sd 5·9) kg/m2; non-T2DM: n 65, 68·7 (sd 5·6) years, BMI: 33·7 (sd 4·9) kg/m2). Mean adherence scores for the entire cohort were 5·3 (sd 2·2) (T2DM cohort: 5·6(sd 2·3); non-T2DM cohort: 4·9 (sd 2·0)). In the adjusted model, using pooled data from both study cohorts, adherence to a MedDiet was significantly associated with the general health subscale of HRQoL (β = 0·223; 95 % CI 0·006, 0·044; P = 0·001). Similar findings were also observed in the T2DM cohort (β = 0·280; 95 % CI 0·007, 0·054; P = 0·001). However, no additional significant associations between adherence to a MedDiet and HRQoL subscales were observed. We showed that adherence to a MedDiet was positively associated with the general health subscale of HRQoL in middle-aged to older adults with T2DM. However, larger longitudinal data in older adults with a wider range of adherence scores, particularly higher adherence, are required to better understand the direction of this relationship.

Uncovering men's stereotype content (warmth and competence) associated with a representative range of male body size categories

Research indicates that 40 % of men experience weight-related stigmatization. Yet perceptions of body size continue to be understudied in men and the stereotype content of men's weight status remains largely unknown. Grounded in Stereotype Content Model, the research aims to uncover men's stereotype content associated with distinct body sizes. A pilot study tested the methodological design using a representative measure of BMI-specific images among a sample of undergraduate men (N = 80). Study 1 included the BMI-specific images to assess stereotype content among a broad online sample (N = 142) and explored how participant BMI relates to such perceptions. Study 2 included images of real men to increase the ecological validity of our findings (N = 152). We also included empathy and protestant ethics to examine possible interaction effects. Results revealed that normal to overweight men scored highest on warmth and competence, while underweight and obese classes were perceived less favorably and, evidently, stereotype perceptions were increasingly severe with adiposity. Empathy moderated evaluations of warmth toward stigmatized groups, and protestant ethics moderated warmth appraisals for underweight and normal weight targets but did not influence perceptions of competence. Overall, weight stereotype content should be considered when understanding stigma-related experiences in men.

Improvement in Eating Disorder Risk and Psychological Health in People with Class 3 Obesity: Effects of a Multidisciplinary Weight Management Program

This study aimed to evaluate the risk of eating disorders, psychological distress, and health-related quality of life (HRQoL) in people with class 3 obesity (body mass index (BMI) ≥ 40 kg/m²), and the effect of multidisciplinary weight management over 12 months. This retrospective cohort study included all adults with class 3 obesity who enrolled in a weight management program from March 2018 to December 2019. Questionnaires included the Eating Disorder Examination Questionnaire Short (EDE-QS), Kessler Psychological Distress Scale (K10), and 36-Item Short Form Survey (SF-36) for HRQoL. Physical and Mental Component Summary scores (PCS and MCS) were derived from the SF-36. Of 169 participants who completed 12 months in the program, 65.7% (n = 111) completed questionnaires at baseline and 12 months, with 6.0 ± 6.8% weight loss over this period. Compared to baseline, there was significant improvement at 12 months in EDE-QS (15.7 ± 6.6 vs. 13.6 ± 6.2, p = 0.002), K10 (25.7 ± 9.7 vs. 21.2 ± 9.4, p < 0.001), PCS (29.4 ± 10.1 vs. 36.1 ± 10.9, p < 0.001), and MCS scores (40.2 ± 12.4 vs. 44.0 ± 13.4, p = 0.001). All, apart from EDE-QS scores, remained significant after adjusting for weight change. This study highlights the importance of multidisciplinary management in people with class 3 obesity to help reduce eating disorder risk and psychological distress, and improve HRQoL, in addition to weight loss.

The Effectiveness of an Acceptance and Commitment Therapy and Mindfulness Group Intervention for Enhancing the Psychological and Physical Well-Being of Adults with Overweight or Obesity Seeking Treatment: The Mind&Life Randomized Control Trial Study Protocol

Although several interventions that target obesity have been examined, the success of these interventions in generating and maintaining positive results has yet to be confirmed. This study protocol therefore presents a trial aimed at analyzing the effectiveness of a well-being-centered acceptance and commitment therapy (ACT)- and mindfulness-based group intervention following the valued-based healthy living (VHL) approach (Mind&Life intervention) for individuals experiencing overweight-related distress. A randomized controlled trial with two parallel groups will be conducted in 110 adults attending primary care units with overweight or obesity. Participants will be randomly allocated to one of the two study conditions. Interventions will either be the treatment as usual (TAU) or the Mind&Life intervention—an ACT- and mindfulness-based intervention—plus the TAU intervention. Quality of life, weight self-stigma, general health status, eating habits, physical activity, eating behavior, anthropometric, body composition, cardiovascular, and physiological variables, as well as process variables, will be examined at baseline, posttreatment, 6-month follow-up, and 1-year follow-up. This trial aims to offer a novel psychological approach for addressing the psychological and physical impairments suffered by people with overweight or obesity in the current environment. ClinicalTrials.gov identifier: NCT03718728.

Understanding the Gaps in Obesity Management in the UAE: Perceptions, Barriers, and Attitudes

<b><i>Introduction:</i></b> Obesity is a chronic relapsing disease of which, globally, the prevalence has reached epidemic proportions. The ACTION-IO study (NCT03584191) investigated the perceptions, attitudes, and behaviors of people with obesity (PwO) and healthcare professionals (HCPs), which can help in devising strategies for its optimal management. Here, we present the results from the United Arab Emirates (UAE). <b><i>Methods:</i></b> The ACTION-IO study was a cross-sectional study conducted in 11 countries, including the UAE, that collected data via a survey. Eligible UAE PwO were ≥18 years with a BMI of ≥30 kg/m² (self-reported height and weight). Eligible HCPs were in direct patient care. Data were collected in the UAE between July 11, 2018, and September 5, 2018. <b><i>Results:</i></b> A total of 750 PwO and 200 HCPs completed the survey in the UAE. Both PwO (82%) and HCPs (78%) acknowledged obesity as a chronic disease and agreed that it has a large impact on overall health (PwO 88% and HCPs 80%). More HCPs felt that diabetes and stroke (both 91%) had a larger impact on overall health than did obesity. Many PwO (76%) assumed full responsibility for their weight loss; 84% of HCPs acknowledged responsibility for actively contributing to patient weight loss efforts. The top motivator for weight loss among PwO was wanting to be more fit/in better shape (45%), while HCPs believed the main motivator was general health concerns (83%). The top barrier against initiating weight management discussions provided by HCPs was that they felt PwO were not interested in losing weight (69%), whereas only 10% of PwO selected this response. The mean delay between struggling with excess weight and having a weight management discussion with an HCP was 4 years. <b><i>Discussion/Conclusion:</i></b> These UAE results highlight differences in the perceptions and attitudes toward obesity from PwO and HCPs and reflect a need to understand weight management concerns to initiate earlier and more effective PwO–HCP conversations. The findings will inform educational needs on the biological basis of obesity and its clinical management and will help to address regional barriers for effective obesity care.

Lack of Social Support and Its Role on Self-Perceived Health in a Representative Sample of Spanish Adults. Another Aspect of Gender Inequality

Self-perceived health has been used as a good estimator of health status and receiving affection can be a determining factor for good self-perceived health. The aim of the present study was to assess whether lack of social support (measured through Duke scale, which ranges from 11 to 55) was associated with poorer health status measured as self-perceived health, and whether that association was different between women and men. A cross-sectional study was conducted using data from the 2017 Spanish National Health Survey. A descriptive study was performed, and logistic regression models were applied using self-perceived health as a dependent variable. Mean Duke score was 47.6 for men and 47.9 for women (p = 0.016). Moreover, 36.3% of women and 27.6% of men reported poor self-perceived health (p < 0.001). The multivariate analysis revealed that lower scores in Duke-UNC social support scale were associated with poorer health status. That association was higher in women than in men. Poor self-perceived health was also associated with low level of education and obesity, especially among women. There was gender inequality as regards health status associated with lack of social support. These results can help design prevention strategies to improve health.

Impact of overweight and obesity on patient-reported health-related quality of life in systemic lupus erythematosus

OBJECTIVES

Associations between BMI and health-related quality of life (HRQoL) in SLE have been implied, but data are scarce. We determined the impact of overweight and obesity on HRQoL in a large SLE population.

METHODS

We pooled cross-sectional baseline data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (N = 1684). HRQoL was evaluated using the 36-item Short Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale and the European Quality of Life 5-dimension questionnaire (EQ-5D). Comparisons between BMI groups were conducted using the Mann-Whitney U test and adjustments using linear regression. Clinical relevance was determined by minimal clinically important differences (MCIDs).

RESULTS

In total, 43.2% of the patients had BMI above normal and 17.4% were obese. Overweight and obese patients reported worse SF-36 physical component summary (PCS), physical functioning, role physical, bodily pain and FACIT-Fatigue scores than normal weight patients. Divergences were greater than corresponding MCIDs and more prominent with increasing BMI. Despite no clinically important difference in SF-36 mental component summary scores across BMI categories, patients experienced progressively diminished vitality and social functioning with increasing BMI. In linear regression analysis, BMI above normal and obesity were associated with worse PCS (standardized coefficient β = -0.10, P < 0.001 and β = -0.17, P < 0.001, respectively), FACIT-Fatigue (β = -0.11, P < 0.001 and β = -0.16, P < 0.001) and EQ-5D (β = -0.08, P = 0.001 and β = -0.12, P < 0.001) scores, independently of demographic and disease-related factors. The impact of BMI on the PCS and FACIT-Fatigue was more pronounced than that of SLE activity.

CONCLUSION

Patients with SLE and BMI above normal experienced clinically important HRQoL diminutions in physical aspects, fatigue and social functioning. A survey of potential causality underlying this association is warranted.