Differences between treatment seekers in an obese population: medical intervention vs. dietary restriction

The Effect of Deep Breathing Exercise and 4-7-8 Breathing Techniques Applied to Patients After Bariatric Surgery on Anxiety and Quality of Life

BACKGROUND

This study aims to determine the effects of the deep breathing exercise and the 4-7-8 breathing technique applied to patients after bariatric surgery on their anxiety and quality of life.

METHODS

The research was carried out using the pre-test post-test randomized controlled experimental research design with a control group. A total of 90 patients (30 patients in the deep breathing group, 30 patients in the 4-7-8 breathing group, and 30 patients in the control group) who met the research inclusion criteria were included in the study. While routine care was applied to the control group, 1 group was given deep breathing training, and the other group was given 4-7-8 breathing training. Personal Information Form, the Obesity-Specific Quality of Life Questionnaire, Status, and the State-Trait Anxiety Inventory were used for data collection.

RESULTS

There was no significant difference between the groups in terms of descriptive characteristics (p > 0.05). It was found that the post-test State Anxiety levels of the 4-7-8 breathing group were lower than the mean scores of the deep breathing group and the control group, and the difference was statistically significant (p < 0.05). It was found that the quality of life scores of the patients in the deep breathing group increased significantly in the post-test compared to the pre-test.

CONCLUSION

The 4-7-8 breathing technique was found to be beneficial in reducing the anxiety level of patients in clinical practice after bariatric surgery. It was found that deep breathing exercise was also effective in improving the quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05492929.

Risk of Suicide and Self-harm Is Increased After Bariatric Surgery-a Systematic Review and Meta-analysis

BACKGROUND

Bariatric surgery is endorsed by multiple societies as the most effective treatment for obesity. Psychosocial functioning has also been noted to improve for most patients after bariatric surgery. However, some studies have shown an increase in post-operative suicide risk. The aim of this study was to review the published literature and evaluate the association of bariatric surgery with suicide events and suicide/self-harm attempts in patients who have undergone weight loss surgery.

METHODS

MEDLINE and Embase were searched from inception through January 2018 for retrospective or prospective studies reporting mortality outcomes and self-harm or suicide rates after bariatric procedures. The primary outcome was the pooled event rate with 95% confidence interval (95% CI) for suicide. Secondary outcomes were suicide/self-harm attempts after bariatric surgery compared to same population prior to surgery and to matched control subjects, with the respective calculated odds ratios (OR) and 95% CI.

RESULTS

From 227 citations, 32 studies with 148,643 subjects were eligible for inclusion. The patients were predominantly females (76.9%). Roux-en-Y gastric bypass (RYGB) was the most commonly performed procedure (58.9%). The post-bariatric suicide event rate was 2.7/1000 patients (95% CI 0.0019-0.0038), while the suicide/self-harm attempt event rate was 17/1000 patients (95% CI 0.01-0.03). The self-harm/suicide attempt risk was higher after bariatric surgery within the same population with OR of 1.9 (95% CI 1.23-2.95), and compared to matched control subjects, OR 3.8 (95% CI, 2.19-6.59).

CONCLUSIONS

Post-bariatric surgery patients had higher self-harm/suicide attempt risk compared to age-, sex-, and BMI-matched controls. Various pre- and post-surgical psychosocial, pharmacokinetic, physiologic, and medical factors may be involved.

A systematic review and narrative synthesis of interventions for uncomplicated obesity: weight loss, well-being and impact on eating disorders

OBJECTIVE

Most weight loss research focuses on weight as the primary outcome, often to the exclusion of other physiological or psychological measures. This study aims to provide a holistic evaluation of the effects from weight loss interventions for individuals with obesity by examining the physiological, psychological and eating disorders outcomes from these interventions.

METHODS

Databases Medline, PsycInfo and Cochrane Library (2011-2016) were searched for randomised controlled trials and systematic reviews of obesity treatments (dietary, exercise, behavioural, psychological, pharmacological or surgical). Data extracted included study features, risk of bias, study outcomes, and an assessment of treatment impacts on physical, psychological or eating disorder outcomes.

RESULTS

From 3628 novel records, 134 studies met all inclusion criteria and were evaluated in this review. Lifestyle interventions had the strongest evidence base as a first-line approach, with escalation to pharmacotherapy and bariatric surgery in more severe or complicated cases. Quality of life was the most common psychological outcome measure, and improved in all cases where it was assessed, across all intervention types. Behavioural, psychological and lifestyle interventions for weight loss led to improvements in cognitive restraint, control over eating and binge eating, while bariatric surgery led to improvements in eating behaviour and body image that were not sustained over the long-term.

DISCUSSION

Numerous treatment strategies have been trialled to assist people to lose weight and many of these are effective over the short-term. Quality of life, and to a lesser degree depression, anxiety and psychosocial function, often improve alongside weight loss. Weight loss is also associated with improvements in eating disorder psychopathology and related measures, although overall, eating disorder outcomes are rarely assessed. Further research and between-sector collaboration is required to address the significant overlap in risk factors, diagnoses and treatment outcomes between obesity and eating disorders.

Changes in Health-Related Quality of Life After Gastric Bypass in Patients With and Without Obesity-Related Disease

BACKGROUND

A substantial proportion of severely obese patients undergoing bariatric surgery have not developed disease as a consequence of obesity. Little is known about the effects of bariatric surgery on health-related quality of life (HRQL) in this patient group. In a prospective study at a public hospital, we compared HRQL in gastric bypass patients with and without obesity-related disease before and 2 years after surgery.

METHODS

HRQL was assessed in 232 severely obese patients before, 1 year, and 2 years after Roux-en-Y gastric bypass. We used a general HRQL questionnaire, the Short Form 36, and an obesity-specific questionnaire, the Obesity-related Problems scale. The patients were divided into two groups based on the presence of obesity-related disease (n = 146) or not (n = 86) before surgery. We defined obesity-related disease as having at least one of the following conditions: type 2 diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, obstructive sleep apnea, gastroesophageal reflux disease, or osteoarthritis. Linear mixed models were used to analyze the HRQL outcomes.

RESULTS

Before surgery, patients with no obesity-related disease reported equal HRQL compared with patients with obesity-related disease. Two years after gastric bypass, substantial improvements in all subscales of Short Form 36 and in Obesity-related Problems scale were observed in both groups, and the improvements were similar in 7 out of 8 subscales of Short Form 36 as well as for the Obesity-related Problems scale.

CONCLUSIONS

Baseline HRQL was similar in patients with and without obesity-related disease prior to gastric bypass. After surgery, patients with no comorbidity had similar positive changes in HRQL as patients with one or several comorbidities. These findings indicate that other factors than obesity-related disease are at least as important for severely obese patients' impaired HRQL.

Bariatric surgery in adolescents: what do we know so far?

Introduction:

Obesity represents a vast and rapidly increasing global burden. Bariatric surgery is the only intervention achieving sustained weight loss, among its wide-ranging benefits.

Methods:

In this article, we describe the growing challenges presented by adolescents with severe obesity and review the literature on surgical and other treatment options.

Results:

Outcomes in terms of weight loss, metabolic and quality of life improvement, reversal of obstructive sleep apnea, insulin resistance, type II diabetes mellitus, hypertension, and dyslipidemia appear comparable to those seen in adults. However, long-term data on safety and sustainability are lacking. There is a growing acceptance of the need for surgery as a treatment for the morbidly obese adolescent population, and the number of studies reporting outcomes after adolescent bariatric surgery is increasing.

Conclusion:

Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. Thus, adolescent bariatric surgery appears to be safe and effective in achieving benefits desired in terms of weight control and improvements in metabolic health and quality of life. However, particular care must be taken when treating a young population, and long-term outcomes are awaited to properly define indications and limitations.

Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews

Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. This paper (1) reviews the results of the published studies using the structured interviews to assess psychopathology in bariatric surgery candidates; (2) compares the prevalence rates of psychiatric disorders across these studies with the data from other population samples; and (3) assesses whether sociodemographic variables appear to affect these prevalence rates. We searched online resources, PubMed, PsychINFO and reference lists of all the relevant articles to provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. The prevalence estimates in the non-treatment obese group did not appear to differ substantially from the general population group in the US or the Italian population samples, although they were relatively higher for the German population. However, the rates of psychopathology in the bariatric surgery candidates were considerably higher than the other two population groups in all the samples. Overall, the most common category of lifetime Axis I disorders in all the studies was affective disorders, with anxiety disorders being the most common category of current Axis I disorders. Certain demographic characteristics are also associated with higher rates of psychopathology, such as, female gender, low socioeconomic status, higher BMI. Overall, methodological and sociodemographic differences make these studies difficult to compare and these differences should be taken into account when interpreting the results.

Prevalence of psychiatric disorders before and 1 year after bariatric surgery: the role of shame in maintenance of psychiatric disorders in patients undergoing bariatric surgery

OBJECTIVE

The present study examined prevalence of psychiatric disorders before and 1 year after weight loss surgery. Furthermore, we studied if level of pre-operative shame could be a maintaining factor for psychiatric disorders at 1-year follow-up.

METHOD

One-hundred and twenty-seven patients (F/M: 94/33) with mean body mass index (BMI) ± standard deviation (s) =45.3±5.2 kg/m(2) and mean age 41.3±10.3 years participated in the study. Eighty-seven patients met for follow-up 1 year after surgery. Psychiatric disorders were assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Structured Clinical Interview (SCID-II). Levels of depression, anxiety and shame were assessed by the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Internalized Shame Scale (ISS).

RESULTS

Sixty-one patients (48%) at pre-operative assessment and 16 patients (18%) at 1-year follow-up had a comorbid psychiatric disorder. The strongest predictor of post-operative psychiatric disorder was pre-operative psychiatric disorder, odds ratio of 27.7 (95% CI for EXP (B) 3.2-239.8, P =0.003). Pre-operative level of shame (higher than 50-point ISS score) was also a significant predictor for post-operative psychiatric disorders, odds ratio of 9.1 (95% CI for EXP (B) 1.8-44.4, P =0.007).

CONCLUSION

There was a significant reduction in prevalence of psychiatric disorders from pre-operative assessment to follow-up 1 year after surgery. Level of shame at pre-operative assessment was associated with maintenance of psychiatric problems. This finding is of clinical importance, since psychiatric disorders persisting after bariatric surgery have strong impact on the course of weight loss and quality of life.

The impact of bariatric surgery on psychological health

Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental health gain is likely attributed to weight loss and resultant gains in body image, self-esteem, and self-concept; however, other important factors contributing to postoperative mental health include a patient's sense of taking control of his/her life and support from health care staff. Preoperative psychological health also plays an important role. In addition, the literature suggests similar benefit in the obese pediatric population. However, not all patients report psychological benefits after bariatric surgery. Some patients continue to struggle with weight loss, maintenance and regain, and resulting body image dissatisfaction. Severe preoperative psychopathology and patient expectation that life will dramatically change after surgery can also negatively impact psychological health after surgery. The health care team must address these issues in the perioperative period to maximize mental health gains after surgery.

Psychiatric disorders and participation in pre- and postoperative counselling groups in bariatric surgery patients

BACKGROUND

Psychological and behavioural factors seem to influence the results of bariatric surgery and the ability to achieve sustained weight loss and subjective wellbeing after the operation. Adequate pre- and postoperative psychological counselling are suggested to improve the results of surgery. However, some patients are reluctant to participate in pre- and postoperative counselling. The aim of the present study was to investigate the possible influence of psychiatric disorders on willingness to participate in group counselling in patients accepted for bariatric surgery.

METHODS

One hundred and forty-one patients referred to bariatric surgery (F/M: 103/38) with mean body mass index (BMI) of 45.2 kg/m2 (SD = 5.3) and mean age of 42.0 years (SD = 10.4) were interviewed with Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II) preoperatively.

RESULTS

The overall prevalence of current psychiatric disorders was 49%. Thirty-one percent did not want to participate in counselling groups. Patients who were unwilling to participate in counselling groups had significantly higher prevalence of social phobia (32%/ 12%, p = 0.006) and avoidant personality disorder (27%/ 12%, p = 0.029) than patients who agreed to participate.

CONCLUSIONS

Psychiatric disorders are prevalent among candidates for bariatric surgery. Social phobia and avoidant personality disorder seem to influence the willingness to participate in counselling groups. Individual counselling and/or web-based counselling might be recommended for bariatric surgery patients who are reluctant to participate in group counselling.

Evaluation of general psychopathology, subjective sleep quality, and health-related quality of life in patients with obesity

OBJECTIVE

Recently, the increasing rate of obesity has been elucidated as a major public health problem. The aim of this study was to examine the psychological distress, subjective sleep quality, and health-related quality of life (HRQOL) in a group of patients diagnosed with obesity.

METHODS

A total of 124 obese patients (32 of them Class I obesity (BMI: 30-34.9 kg/m2), 92 Class II obesity (BMI: > or = 35kg/m2)) and 106 healthy control subjects were involved in the study. Subjects were evaluated with self-administered questionnaires including the Symptoms Checklist-90-Revised (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Short Form 36 (SF-36). Several clinical and socio-demographic data were also recorded.

RESULTS

Class II obesity group had a significantly worse psychological status, quality of life, and sleep quality than control group, Although Class I obesity group did not differ from Class II and control groups according to sleep quality and psychological status, they had worse HRQOL than the control group. BMI scores positively correlated with the majority of subscales of psychological distress (SCL-90-R) and sleep quality (PSQI, ESS) and negatively correlated with all dimensions of HRQOL (SF-36).

CONCLUSIONS

Obesity is associated with psychological distress, poor sleep quality, and reduced quality of life. Thus, obesity should be evaluated in a biopsychosocial manner, including management of patients' psychopathology.

Psychosocial evaluation for bariatric surgery: the Boston interview and opportunities for intervention

The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554-558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376-382, 2007; Lanyon and Maxwell in Obes Surg 17:321-328, 2007; Sogg and Mori in Obes Surg 14:370-380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.

Disordered eating cognitions and behaviours among slimming organization competition winners

BACKGROUND

Long-term success in weight loss treatments for obesity is elusive. The most widely used approach after diet books is slimming clubs. A percentage of members achieve dramatic and lasting weight losses. The study aimed to evaluate the prevalence of binge eating and unhealthy eating-related thought patterns among a group of highly successful weight losers.

METHODS

Sixty-five slimming competition winners self reported their weight history and eating habits in a semi-structured questionnaire. The Eating Disorders Examination Questionnaire (EDE-Q) and the Emotional Eating Scale (EES) were also administered.

RESULTS

Despite substantial weight loss (mean = 38%, SD = 10%) and widespread maintenance of losses, participants evidenced high levels of dietary restraint and weight, shape and eating overconcern. Emotional eating levels were significantly higher than those seen in noneating disordered populations on two of three subscales. Seventy-one per cent also reported bingeing in the past 3 months.

CONCLUSIONS

Commercial slimming organizations should engage with broader psychological and behavioural features of obesity, including bingeing and eating-related cognitive patterns.

Long-term health and psychosocial outcomes from surgically induced weight loss: results obtained in patients not attending protocolled follow-up visits

OBJECTIVE

Obesity management is focused at weight loss to obtain health, psychological and social benefits. Outcomes from controlled trials, however, do not reflect the everyday routine practice. Therefore, we aimed to investigate the results from surgically induced weight loss in patients devoid of a protocol-wise follow-up, who were visited at home.

PATIENTS AND METHODS

Patients who underwent a vertical banded gastroplasty or a gastric bypass between 1980 and 1997 were eligible. Body weight and height were measured. Patients filled out questionnaires on health status (Nottingham Health Profile (NHP)), psychological symptoms (Symptom Check List (SCL-90-R)), personality traits (Dutch Personality Questionnaire (DPQ)) and eating behaviour (Dutch Eating Behaviour Questionnaire (DEBQ)).

RESULTS

Out of 451 operated patients the addresses of 313 subjects could be traced and 236 (75%) agreed to participate. They maintained a mean (s.d.) loss of 32.1 (22.6) kg and 45.2 (29.3) % of excess weight, 8.2 (4.5) years after the operation, about two-third of the largest weight loss they achieved after 17 months postoperatively. The NHP and SCL-90-R conformed to norm values in males except for energy, sleep and emotional reactions. Females differed from norm values in every aspect and even women achieving a BMI<30 kg/m(2) did not catch up to norm values. Weight loss was inversely related to physical immobility and pain. Personality traits (DPQ) showed a higher grievance and dominance and a lower rigidity and self-esteem compared to norm values. Females scored higher in inadequacy and lower in social inadequacy. Eating patterns (DEBQ) showed mainly emotional eating and restrained eating. Effect sizes of >/=0.8 s.d. were chosen to reflect the clinical relevance of statistically significant findings. Pain, disturbances in sleep, energy and mobility and emotional and restrained eating proved to be clinically relevant. In subjects operated >5 years ago, a higher sensitivity, a higher inadequacy and a lower social inadequacy were observed compared to more recently operated subjects. A more restrained eating pattern was related to an operation of recent date.

CONCLUSIONS

Surgically induced weight losses are satisfactory in the long-term, even in patients not attending a strict follow-up protocol. Health, psychological symptoms, personality traits and eating behaviour were related to weight loss and time lapse since the operation and did not return to reference normal-weight subject values.

A comparative controlled study of personality in severe obesity: a 2-y follow-up after intervention

OBJECTIVE

The primary purpose was to examine 2-y effects of weight change on personality traits in severely obese subjects treated conventionally or surgically. We also assessed differences between the severely obese patients and a primarily normal-weight reference group.

METHOD

Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychasthenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. A total of 1380 surgical candidates, 1241 conventionally treated patients and 1135 subjects from the SOS (Swedish Obese Subjects) reference study, representing the general population, completed the KSP. Data presented in this study were gathered twice from the patients (prior to treatment and after 2 y) and once from the reference subjects. Significance tests and effect sizes (ES) were calculated.

RESULTS

At baseline, the obese were characterised as more anxiety prone, impulsive, irritable and less monotony avoiding than the reference group; surgery patients more so than the conventionally treated. At follow-up, it was found that anxiety proneness decreased and Monotony Avoidance increased with increasing weight loss. The conventionally treated were, on average, weight stable and, hence, only a small decrease was noted regarding Somatic Anxiety. The surgery group lost on average 28 kg, and differences between surgically treated and the reference group decreased on all scales except Impulsiveness, which remained unchanged. The largest improvement was in relation to Psychasthenia.

CONCLUSIONS

Weight reduction maintained for 2 y was associated with changes on practically all personality traits in proportion to the magnitude of weight loss. In particular, Psychasthenia seemed to be alleviated, while Impulsiveness was unaffected.

Disability identity and attitudes toward cure in a sample of disabled activists

This study investigates the assumption that disabled people want improvements in their functional abilities, or complete cures. Contrary to this assumption, many disabled activists are found to have attitudes in which they refuse treatment that promises a cure. In order to explain this attitude, different sources of disability identity are isolated as potential predictor variables. A multivariate model reveals that self-identity related to a personal affirmation of disability is a significant predictor of refusal of treatment, as is the age of onset of disability. Implications for interactions with medical professionals and utility-based modeling of medical treatment seeking are discussed.

Severe obesity and personality: a comparative controlled study of personality traits

OBJECTIVE

The primary purpose was to assess personality trait differences between the severely obese seeking treatment and a mainly non-obese reference group. We also investigated gender differences and differences between obese patients and obese not seeking treatment.

METHOD

Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychastenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. Patients from the Swedish Obese Subjects (SOS) intervention study (n=3270, ages 37-57, 71% women) and the SOS reference study (n=1135, 54% women) completed the survey. Data presented in this study were gathered prior to treatment. Significance tests and effects sizes were calculated.

RESULTS

Although statistically significant differences were found between obese patients and reference subjects on nearly all personality traits, effect sizes were at most moderate. Of the three scales with moderate effects sizes, differences on Somatic Anxiety and Psychastenia could be traced to items tapping condition-specific symptoms, e.g., problems with sweating and breathing as indicators of Somatic Anxiety. Moderate differences on the Impulsiveness scale (men alone) could not be explained by item composition. Further, the obese patients differed from obese in the reference group, and both obese and reference women reported significantly higher levels on Somatic Anxiety, Muscular Tension and Psychic Anxiety compared to men (effect size: small).

CONCLUSIONS

Our results provided no evidence of a general obese personality profile, instead considerable heterogeneity in personality traits was observed across our obese samples (treatment seekers vs non-seekers, men vs women) and generally only small differences were noted compared to a reference study population. Further research is needed to investigate if the somewhat elevated levels of Impulsiveness, particularly among male obese patients, is affected by weight loss. When assessing personality traits in diseased groups consideration should be given to possible confounding from, e.g., somatic symptoms.

Coping and distress: what happens after intervention? A 2-year follow-up from the Swedish Obese Subjects (SOS) study

OBJECTIVE

The study examined effects of weight change on coping and distress in severely obese subjects treated conventionally or undergoing weight reduction surgery.

METHODS

We used the Obesity Coping (OC) scale measuring emotion-focused, maladaptive coping (Wishful Thinking) and problem-focused, adaptive coping (Social Trust and Fighting Spirit). We also used the Obesity Distress (OD) scale (Intrusion and Helplessness) and the Hospital Anxiety and Depression (HAD) scale. A total of 1146 surgical candidates and 1085 conventionally treated patients completed the OC and OD before treatment and after 24 months.

RESULTS

Weight gainers reduced their use of both problem- and emotion-focused coping, thus leaving distress levels unchanged. All participants who lost weight decreased in emotion-focused coping and distress. Participants losing 20 kg or more also increased in problem-focused coping, resulting in even greater improvements regarding distress.

CONCLUSIONS

Two years after starting treatment, the pattern and magnitude of change in coping and distress was the same irrespective of type of treatment and was, instead, related to the amount of weight change (the more weight change the greater the changes in coping and distress). Increases in problem-focused coping required major weight reduction, whereas minor weight gain led to a decrease. Emotion-focused coping decreased irrespective of direction of weight change, suggesting a general intervention effect of receiving professional help and support. These results have implications concerning behavior-based interventions of obese patients.

Health-related quality of life varies among obese subgroups

OBJECTIVE

To compare the health-related quality of life (HRQOL) of overweight/obese individuals from different subgroups that vary in treatment-seeking status and treatment intensity.

RESEARCH METHODS AND PROCEDURES

Participants were from five distinct groups, representing a continuum of treatment intensity: overweight/obese community volunteers who were not enrolled in weight-loss treatment, clinical trial participants, outpatient weight-loss program/studies participants, participants in a day treatment program for obesity, and gastric bypass patients. The sample was large (n = 3353), geographically diverse (subjects were from 13 different states in the U.S.), and demographically diverse (age range, 18 to 90 years; at least 14% African Americans; 32.6% men). An obesity-specific instrument, the Impact of Weight on Quality of Life-Lite questionnaire, was used to assess health-related quality of life (HRQOL).

RESULTS

Results indicated that obesity-specific HRQOL was significantly more impaired in the treatment-seeking groups than in the nontreatment-seeking group across comparable gender and body mass index (BMI) categories. Within the treatment groups, HRQOL varied by treatment intensity. Gastric bypass patients had the most impairment, followed by day treatment patients, followed by participants in outpatient weight-loss programs/studies, followed by participants in clinical trials. Obesity-specific HRQOL was more impaired for those with higher BMIs, whites, and women in certain treatment groups.

DISCUSSION

There are differences in HRQOL across subgroups of overweight/obese individuals that vary by treatment-seeking status, treatment modality, gender, race, and BMI.

A review of psychosocial outcomes of surgery for morbid obesity

There is consistent evidence to support the notion that morbid obesity poses serious risks to physical health and has a substantial impact on psychosocial well-being. Researchers agree that bariatric surgery is currently the most viable option for successful weight loss and maintenance in the morbidly obese individual. The drastic, major weight loss and alleviation of medical risks that patients typically experience post-surgically are accompanied by psychosocial changes that appear to be equally remarkable. These psychosocial changes have yet to be studied as systematically or diligently as the physical changes and therefore remain to be fully understood. This paper (1) reviews the literature of psychosocial outcomes of obesity surgery for the past 36 years; (2) provides a critical assessment of the methodology utilized; and (3) suggests future research directions.

Quality of life and obesity

Interest in the quality of life of patients with different diseases continues to grow. Recent years have witnessed a dramatic rise in the prevalence of obesity worldwide, stimulating interest in the health and quality of life consequences of this phenomenon. The body of research on the quality of life of obese individuals has grown to a point that a review of this literature is warranted. Numerous studies have demonstrated that obese persons experience significant impairments in quality of life as a result of their obesity, with greater impairments associated with greater degrees of obesity. Weight loss has been shown to improve quality of life in obese persons undergoing a variety of treatments. Further research is needed to clarify whether quality of life differs among subsets of obese persons. Until recently, there has been little standardization of quality of life measures in obesity. The SF-36 has been used in a number of studies of obese persons. Several obesity-specific instruments have also been developed and have shown great promise. The quality of life of obese individuals is an important issue that should be included in weight management treatment and research.