Assessing quality of life in severe obesity: development and psychometric properties of the ORWELL-R

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.

The Impact of Sarcopenic Obesity on Health-Related Quality of Life of Treatment-Seeking Patients with Obesity

BACKGROUND

There is a paucity of studies on health-related quality of life (HRQoL) and sarcopenic obesity (SO).

OBJECTIVE

This study aimed to assess the potential association between SO and impaired HRQoL.

METHODS

The ORWELL 97 questionnaire was used to assess HRQoL and body composition was measured using a bioimpedance analyser (Tanita BC-418) in 130 patients with obesity, referred to the Nutritional and Weight Management outpatient clinic of Beirut Arab University in Lebanon. Participants were then categorized on the basis of the absence or presence of SO.

RESULTS

Sixty-four of the 130 participants met the criteria for SO (49.2%) and displayed significantly higher total ORWELL 97 scores than those in the group without SO (64.00 vs. 41.00, p=0.001), indicative of poorer HRQoL. Linear regression analysis showed that SO was associated with an increase in ORWELL 97 scores by nearly 24 units (β=24.35, 95% CI=11.45-37.26; p<0.0001). Moreover, the logistic regression analysis showed that SO increased the odds of clinically significant impairment of HRQoL (ORWELL 97 score ≥74.25) by nearly seven-fold (OR=7.37, 95% CI=1.92-28.39; p=0.004).

CONCLUSION

Our findings show that the presence of SO was associated with increased impairment of HRQoL that reaches clinical significance when compared to obesity only. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programs should incorporate additional strategies to improve HRQoL in individuals with SO.

Validation of an Arabic Version of the Obesity-Related Wellbeing (ORWELL 97) Questionnaire in Adults with Obesity

BACKGROUND

No specific questionnaire that evaluates Health-Related Quality Of Life (HRQOL) in individuals with obesity is available in the Arabic language. The aim of this study was therefore to propose and examine the validity and reliability of an Arabic language version of the ORWELL 97, a validated obesity-related HRQOL questionnaire.

METHODS

The ORWELL 97 questionnaire was translated from English to Arabic language and administered to 318 Arabic-speaking participants (106 from clinical and 212 from community samples), and underwent internal consistency, test-retest reliability, construct and discriminative validity analysis.

RESULTS

Internal consistency and the test-retest reliability were excellent for ORWELL 97 global scores in the clinical sample. Participants with obesity displayed significantly higher ORWELL 97 scores than participants from the community sample, confirming the good discriminant validity of the questionnaire. Confirmatory factor analysis in the clinical sample revealed a good fit for a modified two-factor structure.

CONCLUSION

Overall, the Arabic version of the ORWELL 97 can be considered validated in Arabic adult patients with obesity, paving the way to further assessment of its responsiveness in measuring changes in health-related quality of life associated with obesity treatment.

The Association between Body Mass Index and Health-Related Quality of Life in Treatment-Seeking Arab Adults with Obesity

Few studies have thus far been carried out on Health-Related Quality of Life (HRQoL) and obesity in Arab-speaking countries, an issue that we therefore set out to investigate in this study. HRQoL was assessed by the validated Arabic version of the ORWELL 97 questionnaire in 129 treatment-seeking individuals with obesity referred to the Nutritional and Weight Management Outpatient Clinic at the Department of Nutrition and Dietetics of Beirut Arab University (BAU) in Lebanon, and 129 normal-weight participants of similar age and gender. Participants with obesity, regardless of gender, displayed higher total ORWELL 97 scores when compared with normal-weight controls, indicating that obesity is associated with lower HRQoL. Linear regression analysis showed that a higher body mass index (BMI) is associated with an increase in ORWELL 97 scores, but only among female, not male, participants with obesity (β = 2.89, 95% confidence interval (CI) = 1.43-4.53, p < 0.001). Moreover, logistic regression analysis showed that a one unit increase in BMI increases the odds of an ORWELL 97 score ≥ 71.75-considered indicative of a clinically significant impairment of HRQoL-by nearly 23% (odds ratio (OR), 95% CI = 1.23, 1.09-1.40, p < 0.05). If confirmed, our findings should prompt clinicians operating in Arab countries to encourage patients with obesity to initiate and persevere in weight-loss programs at the earliest opportunity.

Predictors of physical and mental health in persons with morbid obesity attending a patient education course - a two-year follow-up study

Background

People with morbid obesity (body mass index ≥40) may experience changes in their health after participating in a tailored patient education course. The aims of this study were to assess the changes in physical and mental health in persons with morbid obesity during the 2 years following an educational course and to explore possible socio-demographic, treatment, and personal predictors of physical and mental health outcomes.

Methods

In this prospective longitudinal cohort study, self-report questionnaire data were collected from people with morbid obesity at the beginning of mandatory educational courses while on a waiting list for gastric surgery and at two-year follow-up. Of the 185 who attended the courses, 142 (77%) volunteered to participate in the study, and the 59 with complete data at the two-year follow-up were included in the analysis. Physical and mental health were measured with the physical and mental component summary scores from the Short Form 12v2. Self-esteem was measured by the Rosenberg Self-Esteem Scale, and self-efficacy by the General Self-Efficacy Scale.

Results

The participants reported better physical health at two-year follow-up than at baseline. Mental health did not change significantly over time. Receiving surgical treatment during the study period predicted better physical health at two-year follow-up, even after controlling for physical health at baseline. Mental health at baseline was the only significant baseline predictor of mental health at follow-up. However, increasing self-esteem and self-efficacy over the two-year study period independently predicted better mental health at follow up after controlling for mental health at baseline.

Conclusion

Our study showed that people with morbid obesity on a waiting list for bariatric surgery improved their physical health during the 2 years after attending a tailored patient educational course. Improving self-esteem and self-efficacy may be important personal factors for maintaining mental health during this period.

Trial Registration

NCT01336725. Registered 14 April 2011.