Clinical and psychological correlates of health-related quality of life in obese patients

Psychosocial distress in people with overweight and obesity: the role of weight stigma and social support

We aimed to assess the role of weight stigma and social support in depression, anxiety, and loneliness controlling for sociodemographic and clinical variables. A total of 189 adults with overweight/obesity were included. Participants were recruited from outpatient clinics by general practitioners which covered all regions of Slovakia. Correlation analyses and multiple linear regression were used to analyze the data. Participants experienced weight-related teasing (40.4%), unfair treatment (18.0%), and discrimination (14.1%). We found an association between lower age, female sex and psychological distress. No role of obesity indicators in psychosocial distress was identified, except for a small association between body mass index and depression in correlation analyses. Significant associations between experienced weight stigma/self-stigmatization and psychosocial distress weakened when variables related to the social support system were added to the linear regression. Poor social support was strongly associated with depression, anxiety, and loneliness. The explained variance in the final regression models was 42, 44, and 54%, respectively. Weight stigma negatively affects mental health and a sense of belonging while it seems to be a more significant contributor to psychosocial distress compared to obesity per se. Interventions targeting weight-related self-stigmatization and social relationships may mitigate the negative impact of weight stigma on psychosocial well-being.

The Association Between Appetite and Quality of Life in Adults with Obesity or Severe Obesity Post-Sleeve Gastrectomy Procedure: A Cross-Sectional Study

Background

Sleeve gastrectomy (SG) is considered as the most common bariatric procedure in Saudi Arabia. It is a non-reversible procedure defined as removal of a large portion of the stomach.

Objective

The objective of the current study is to compare the appetite and quality of life (QoL) between adults' post-sleeve gastrectomy and obese/morbidly obese adults (pre-SG).

Methods

A cross-sectional study design was conducted in adults (aged between 18 and 65 years), post-sleeve gastrectomy (n = 80, 41 Males and 39 Females) and obese group (n = 60, 28 Males and 32 Females). The study population was recruited from the bariatric surgery clinic of King Abdullah Bin Abdul-Aziz University Hospital. A self-reported questionnaire was collected that included a visual analogue scale (VAS) to assess the appetite level, and SF-36 QoL questionnaire.

Results

No significant differences were found in age and gender between the study groups (p > 0.05). The median score feeling of fullness was significantly higher in the SG group (77.5, IQR: 48 and 50, IQR: 40, respectively) than in the obese group (p < 0.001). The amount of food eaten was statistically lower in the SG group (30, IQR: 20) than the obese group (50, IQR: 60) (p = 0.005). Patients post SG had significantly higher QoL scores in all physical and mental scales, physical component summary and mental component summary (p < 0.003).

Conclusion

Patients post SG have improved appetite and QoL. Satiety, less prospective food consumption, BMI, age, gender and comorbidities are associated with QoL. Future studies are needed to compare the QoL in post-SG patients with the normative values of the QoL in Saudi Arabia.

Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022)

Obesity is the largest pandemic in the world, and its prevalence continues to increase. The purpose of the presented publication is to raise awareness of doctors about modern methods of diagnosing obesity and approaches to therapy, using an interdisciplinary team approach similar to that used in other chronic diseases, such as diabetes, heart disease and cancer. The article presents data from the World Gastroenterological Organization (2023) and the European Guidelines for the Treatment of Obesity in patients with diseases of the gastrointestinal tract and liver (2022). According to modern approaches, obesity should be considered as a chronic recurrent progressive disease, the treatment of which requires a comprehensive interdisciplinary approach involving psychologists and psychiatrists, nutritionists/nutritionists, therapists, endoscopists and surgeons, including lifestyle changes, a well-defined diet and exercise regimen, drug therapy, endoscopic or surgical methods of treatment. Conclusions. In order to stop the growing wave of obesity and its many complications and costs, doctors, insurance companies and health authorities should make systematic efforts to raise public awareness of both the adverse health risks associated with obesity and the potential reduction of risks through a comprehensive approach to therapy.

Health-related quality of life after surviving intensive care for COVID-19: a prospective multicenter cohort study

In survivors of severe coronavirus disease 2019 (COVID-19) incomplete mental and physical recovery may considerably impact daily activities and health-related quality of life (HRQoL). HRQoL can be evaluated with the RAND-36 questionnaire, a multidimensional instrument that assesses physical and mental aspects of health in eight dimensions. The objective was to investigate HRQoL in intensive care patients previously treated for COVID-19 at three Nordic university hospitals, in a prospective multi-center cohort study. HRQoL was measured using RAND-36, 3-9 months after discharge from intensive care units (ICU). One hospital performed a second follow-up 12 months after discharge. A score under the lower limit of the 95% confidence interval in the reference cohorts was considered as significantly reduced HRQoL. We screened 542 and included 252 patients. There was more than twice as many male (174) as female (78) patients and the median age was 61 (interquartile range, IQR 52-69) years. Hypertension was the most common comorbidity observed in 132 (52%) patients and 121 (48%) patients were mechanically ventilated for a median of 8 (IQR 4-14) days. In RAND-36 physical functioning, physical role functioning, general health (p < 0.001 for all) and social functioning (p < 0.05) were below reference, whereas bodily pain, emotional role functioning and mental health were not. In a time-to-event analysis female sex was associated with a decreased chance of reaching the reference HRQoL in the physical function, bodily pain and mental health dimensions. Higher body mass index was found in the physical functioning dimension and hypertension in the physical functioning, vitality and social functioning dimensions. Similar results were seen for diabetes mellitus in general health, vitality and mental health dimensions, as well as pulmonary illness in the physical role functioning dimension and psychiatric diagnosis in the social functioning dimension. Mechanical ventilation was associated with a decreased likelihood of achieving reference HRQoL in the bodily pain and physical functioning dimensions. Patients treated in an ICU because of COVID-19 had lower HRQoL 3-9 months after ICU discharge than 95% of the general population. Physical dimensions were more severely affected than mental dimensions. Female sex and several comorbidities were associated with a slower rate of recovery.Study registration: clinicaltrials.gov: NCT04316884 registered on the 13th of March 2020, NCT04474249 registered on the 29th of June 2020 and NCT04864938 registered on the 4th of April 2021.

Butyrate and obesity: Current research status and future prospect

Over the past few decades, increasing prevalence of obesity caused an enormous medical, social, and economic burden. As the sixth most important risk factor contributing to the overall burden of disease worldwide, obesity not only directly harms the human body, but also leads to many chronic diseases such as diabetes, cardiovascular diseases (CVD), nonalcoholic fatty liver disease (NAFLD), and mental illness. Weight loss is still one of the most effective strategies against obesity and related disorders. Recently, the link between intestinal microflora and metabolic health has been constantly established. Butyrate, a four-carbon short-chain fatty acid, is a major metabolite of the gut microbiota that has many beneficial effects on metabolic health. The anti-obesity activity of butyrate has been demonstrated, but its mechanisms of action have not been fully described. This review summarizes current knowledge of butyrate, including its production, absorption, distribution, metabolism, and the effect and mechanisms involved in weight loss and obesity-related diseases. The aim was to contribute to and advance our understanding of butyrate and its role in obesity. Further exploration of butyrate and its pathway may help to identify new anti-obesity.

Validity and reliability of the Turkish version of the Obesity-Related Well-Being Questionnaire (ORWELL 97-TR)

PURPOSE

This study aimed to perform the validity and reliability of the Turkish version of the Obesity-Related Well-Being Questionnaire (ORWELL 97-TR) for the Turkish society.

DESIGN AND METHODS

This methodological study involved 125 people for obesity treatment. Data collection tools were the Patient Information Form, the ORWELL 97-TR, and the Obesity and Weight-Loss Quality of Life Instrument (OWLQOL).

FINDINGS

The content validity index of the scale was 0.94, and Cronbach's alpha value was 0.906. The findings indicate that the three-factor structure of the scale, which was reduced from 18 items to 15, showed a good agreement.

PRACTICAL IMPLICATIONS

The ORWELL 97-TR scale can be used to assess the life quality of Turkish patients seeking obesity treatment.

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.

Personality type, eating behaviour and suicide risk in women in treatment for obesity

OBJECTIVES

To determine the personality types of women in treatment for obesity and the associations among their personality characteristics, eating behaviour and suicide risk.

SUBJECTS

Sixty women in pharmacological treatment for obesity (clinical group: CG) and 60 women post-bariatric gastric bypass surgery (surgical group: SG) were evaluated.

METHODS

This was an observational and transversal study conducted in a specialized outpatient unit. Personality types were evaluated through the Myers-Briggs Type Indicator (MBTI) test. A semi-structured questionnaire that investigated sociodemographic and lifestyle characteristics was applied, along with the Binge Eating Scale (BES) and the Columbia-Suicide Severity Rating Scale (C-SSRS).

RESULTS

Among the 16 possible personality types, the ISFJ (Introversion, Sensing, Feeling, Judging) and ESFJ (Extraversion, Sensing, Feeling, Judging) types were more frequent. In the SG, 32% of the participants presented with the ISFJ type, and 18.3% presented with the ESFJ type. In the CG, 33% presented with the ISFJ type and 25% presented with the ESFJ type. There was a higher prevalence of binge eating behaviour in the CG (Cohen's d: - 0.47; p < 0.0001) and a higher tendency to graze in the SG (p = 0.005). Participants with introverted attitudes showed a higher prevalence of severe binging (13.3% vs 3.3%, p = 0.07), suicidal thoughts throughout life (STTL) (69.5% vs 45.1%, p = 0.007), and recent suicidal thoughts (RSTs) (30.4% vs 11.7%, p = 0.01) in comparison to extraverted participants. BMI was associated with a higher chance of STTL (37.96 ± 6.41 kg/m² with STTL vs 33.92 ± 4.68 kg/m² without STTL; p = 0.01) in the CG compared to the SG. RSTs were associated with BMI in the SG (34.47 ± 3.86 kg/m² with RSTs vs 30.61 ± 5.72 kg/m² without RSTs; p = 0.01). In the multivariable analysis, personality type (ISFJ) was an independent predictor of STTL (OR: 3.6; CI 1.3-10.2; p = 0.01) and Suicidal Behaviour (SB) (OR: 9.7; CI 2.44-38.9; p = 0.001). Conversely, while BMI was an independent factor associated with binge eating, personality type was not.

CONCLUSIONS

Women who were in pharmacological treatment for obesity or were post-bariatric surgery present specific types of personality. Introversion was associated with a higher BMI and a higher risk of suicidal thoughts.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients

Introduction

Unhealthy lifestyles may hinder bariatric surgery outcomes. This non-randomized controlled study aimed to evaluate the effects of an integrated post-operative exercise-based educational and motivational program in improving behaviors, quality of life, anthropometric features, cardiorespiratory and physical fitness in bariatric patients respect to the only surgical intervention.

Methods

A group of adult sedentary bariatric patients chose to attend a 12-month exercise program integrated with diet education and motivational support, or to receive usual care. Dietary habits, binge eating disorder, physical activity, obesity-related quality of life, Body Mass Index, waist and hip circumference, VO₂max, strength and flexibility were assessed at the start and at the end of the study in both groups.

Results

On a total of 82 patients enrolled, follow-up measures were obtained from 28 (85.7% females, mean age 38.2±8.7) and 42 (71.4% females, mean age 40.2±9.5) patients included in the intervention and control group, respectively. All the behavioral and physical outcomes improved significantly in the participants to the intervention, while the control group showed lesser changes, especially regarding quality of life and physical fitness.

Conclusions

Notwithstanding the self-selection, these results suggest that a timely postoperative behavioral multidisciplinary program for bariatric patients may be effective in establishing healthy behaviors which can lead to better surgery outcomes.

Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: a cross-sectional study in Malaysia

PURPOSE

This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia.

METHODS

A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis.

RESULTS

A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification.

CONCLUSION

Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL.

TRIAL REGISTRATION

NMRR-17-2264-37814.

The Impact of Obesity on Sexual Functions and Dyadic Consensus in Patients with Obesity

Background: Obesity is a chronic disease with several co-morbidities that increase morbidity and mortality and decrease quality of life. Psychopathologies are an important group of co-morbidities. In this study, it was aimed to search for the presence of depression and sexual dysfunction in patients with obesity, examine impact of obesity on marital adjustment, and highlight those important problems that are usually overlooked. Methods: Fifty patients who were seen in the obesity outpatient clinic in a random month as case group and gender-matched 50 healthy individuals as control group were included in the study. The inclusion criteria were body mass index (BMI) ≥30 kg/m² and having a sexual partner. The exclusion criteria were having psychiatric/mental or any other chronic illness, using medication that would affect sexual functions, and alcohol/substance abuse. After recording the sociodemographic data, patients were asked to take three internationally validated questionnaires: The Arizona Sexual Experience Scale (ASEX), Dyadic Adjustment Scale (DAS), and Beck Depression Inventory (BDI). Results were analyzed using SPSS. Results: Fifty patients with obesity as case group and 50 normal weight healthy persons as control group were included in the study. BMI and BDI score were significantly higher in the case group than in the control group. DAS score was lower in the case group for consensus and affectional expression than the control group but there was no difference for satisfaction, cohesion, or total score between the groups. ASEX score was higher in the case group than in the control group. Conclusion: Patients with obesity have dyadic consensus problems with their partners. Their excessive weight causes distress and difficulty in expressing their feelings and usually results in marital problems and depression. Evaluation of the patient with a multidisciplinary approach in obesity centers will allow patients to be analyzed in every aspect of obesity including these issues and contribute to the success of the treatment.

Emotion-Focused Cognitive Behavioral Therapy in Comorbid Obesity With Binge Eating Disorder: A Pilot Study of Feasibility and Long-Term Outcomes

Obesity coupled with binge eating disorder (BED) is an increasing problem. Incorporation of treatment strategies that address both problems in people with comorbid symptoms is of major interest. This study aimed to investigate the feasibility and preliminary long-term outcomes of a brief emotion-focused cognitive behavioral therapy (EF-CBT) program. Seven out of 10 women with obesity and BED completed the intervention. Standardized outcome measures to assess the intensity of distress caused by complaints, psychological distress, emotional processing, eating behavior, and weight loss were completed at baseline, end-of-treatment, 6- and 18-month follow-ups. Individualized outcome measures were also applied to describe the personal experiences during the intervention. Findings suggest the program's long-term efficacy for improving psychological distress, emotional processing, and alexithymia. Positive reliable changes in emotional processing and alexithymia were observed in almost all participants. The mean intensity of distress caused by complaints also decreased at the end of the intervention, with a large effect size (d = 0.89). Reliable changes in these outcome measures were observed at all time-points, despite the mean scores for the 18-month follow-up suggest a retraction in improvement. Weight loss was below expectations at all time-points, as were changes in emotional and external eating. Restrained eating mean scores remained stable throughout the study. Participants perceived the program to be useful in improving emotional awareness and eating control. Program feasibility was supported by the retention rate (70%) and the average number of attended sessions (M = 9.71; SD = 2.06). Further studies are needed to examine the effectiveness of EF-CBT interventions.

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.

Relationship between psychological stress and metabolism in morbidly obese individuals

BACKGROUND

Despite evidence for a bidirectional relationship between obesity and stress-related mental disorders, the general relationship between psychological stress and metabolism is still controversial. Only few studies have addressed this relationship in morbidly obese individuals.

METHODS

The present study investigated the relationship between psychological distress, health-related quality of life (HRQL), eating behavior, negative emotions and body mass index (BMI), body composition and biomedical parameters of metabolism in an adult sample of 123 (94 females) morbidly obese individuals.

RESULTS

No significant relationship was found between psychological distress and BMI, body composition or any of the parameters of metabolism; however, there was a strong and robust association between HRQL in the physical domain and BMI, body composition and several biomedical parameters of sugar and fat metabolism. The results also showed an interesting dissociation in the relationship between BMI and HRQL in the physical and psychology domains. Only little evidence was found for a relationship between eating behavior (e.g. restraint) or negative emotions (e.g. anger) and BMI, body composition and parameters of metabolism. There was, however, a significant gender difference in restraint eating. Other commonly reported gender differences in BMI, body composition, fat metabolism and liver values were also observed in this sample of morbidly obese individuals.

CONCLUSION

Results from the present study highlight the relationship between HRQL in the physical domain and metabolism. Implications of these findings for weight loss treatment are discussed, emphasizing HRQL as an important treatment goal and the need for long-term psychological monitoring.

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.

Emotional intelligence, emotion regulation and affectivity in adults seeking treatment for obesity

Obesity has become an increasingly widespread endemic with social implications; however, the relationship between higher body mass index (BMI) and psychological functioning is still not fully understood. This study examined the differences in affect-related psychological variables among BMI classes. A total of 134 adults seeking treatment for obesity and 124 controls completed a set of questionnaires to assess: trait emotional intelligence, emotion regulation strategies, anxiety, depression, binge eating behaviors and happiness. Correlations and multivariate analysis of variance were run per each study variable controlling for BMI class (normal weight, overweight, or obesity class I, II, III). Individuals with obesity class III were characterized by reduced trait emotional intelligence and happiness, and a higher tendency to use emotion suppression compared to normal weight individuals. All individuals with obesity also showed higher levels of depression and binge eating behaviors compared to both normal weight and overweight adults. Depression and emotion suppression were the most relevant discriminant factors across BMI classes, while trait emotional intelligence resulted as an important psychological factor clustering individual differences between obese and non-obese individuals. These results suggest that more attention to the affective domain of psychological functioning is needed for proper and comprehensive treatment of obesity.

Body mass index and health-related quality of life

OBJECTIVE

There are conflicting data regarding the association between body mass index (BMI) and health-related quality of life (HRQoL), especially among certain population subgroups and for mental and physical health domains.

METHODS

This study analysed the relationship between BMI and HRQoL (Patient-Reported Outcomes Measurement Information System mental and physical health scales) using ordinary least squares regression. Each model allowed for the possibility of a non-linear relationship between BMI and the outcome, adjusting for age, gender, comorbidities, diet and physical activity.

RESULTS

A total of 10,133 respondents were predominantly female (71.7%), White (84.1%), median age of 52.1 years (interquartile range 37.2-63.3) and median BMI of 27.9 (interquartile range 24.0-33.2). In adjusted models, BMI was significantly associated with physical and mental HRQoL (p < 0.001). For physical HRQoL, there was a significant interaction with age (p = 0.02). For mental HRQoL, there was a significant interaction with sex (p = 0.0004) but not age (p = 0.7).

CONCLUSIONS

This study demonstrates a non-linear association of variable clinical relevance between BMI and HRQoL after adjusting for demographic factors and comorbidities. The relationship between BMI and HRQoL is nuanced and impacted by gender and age. These findings challenge the idea of obesity as a main driver of reduced HRQoL, particularly among women and with respect to mental HRQoL.

Drunkorexia among adolescents: The role of motivations and emotion regulation

BACKGROUND

The co-occurrence of disordered eating and alcohol use and misuse has frequently been highlighted in literature.

METHOD

The first aim of the present study was to examine the association of drunkorexia with various disordered eating behaviors and alcohol consumption in a sample of male and female adolescents. The second goal was to investigate the motivations underlying drunkorexia and the third goal was to examine the relationship between drunkorexia and different dimensions of emotion regulation. One thousand adolescents (608 females and 392 males; range 16-21) completed a survey of self-report measures.

RESULTS

Results from hierarchical multiple regression analyses revealed that fasting and engaging in binge drinking and getting drunk were significant predictors of drunkorexia in both males and females; furthermore, females were found to engage in drunkorexia mainly for enhancement motives. Conversely, drunkorexia in males was significantly predicted by difficulties regulating emotions.

CONCLUSION

This research suggests that disordered eating and alcohol use similarly contribute to drunkorexia in male and female adolescents, even though highlights important gender differences.

Expected benefits and motivation to weight loss in relation to treatment outcomes in group-based cognitive-behavior therapy of obesity

PURPOSE

We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs.

METHODS

We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived treatment needs, readiness and self-confidence to be successful and a battery of psychopathology questionnaires in 793 subjects with obesity (68% women; mean age 48.7; 46% obesity class III) enrolled into a group-based cognitive-behavioral treatment program. Their relevance on attrition and successful weight loss outcome were tested by logistic regression analysis.

RESULTS

The expected benefits of weight loss scored very high in all physical, psychological and social areas, with differences between genders. Attrition rate was 24, 41 and 65% at 6-, 12-, and 24-month follow-up. Average weight loss was 5.8 ± 7.1 kg (- 4.8%) at 6 months, with 17% of cases (32% of continuers) maintaining weight loss > 10% at 24 months. After adjustment for confounders, attrition was reduced by concern for present health, motivation/consciousness of the importance of physical activity and need for support; treatment discontinuation was favored by concern for body image, by expectations for drug treatment or bariatric surgery, and by high-challenging weight loss targets. Male gender, higher BMI and concern for present health predicted weight loss > 10%, whereas concern for body appearance was associated with lower probability of attaining the desired weight loss targets.

CONCLUSION

A more precise definition of needs and expectations might help tailor treatment to individual patients, but attrition rates and target reach remain difficult to predict.

LEVEL OF EVIDENCE

Level V, descriptive studies.

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.

Validation of the Italian version of the Laval questionnaire: health-related quality of life in subjects with obesity

Background

Obesity is associated to increased risk of metabolic comorbidity as well as increased mortality. Notably, obesity is also associated to the impairment of the psychological status and of quality of life.

Only three questionnaires are available in the Italian language evaluating the health-related quality of life in subjects with obesity.

The aim of the present study was to test the validity and reliability of the Italian version of the Laval Questionnaire.

Methods

The original French version was translated into Italian and back-translated by a French native speaker. 273 subjects with obesity (Body Mass Index ≥ 30 kg/m²) were enrolled; the Italian version of the Laval Questionnaire and the O.R.Well-97 questionnaire were administered in order to assess health- related quality of life. The Laval questionnaire consists of 44 items distributed in 6 domains (symptoms, activity/mobility, personal hygiene/clothing, emotions, social interaction, sexual life). Disability and overall psychopathology levels were assessed through the TSD-OC test (SIO test for obesity correlated disabilities) and the SCL-90 (Symptom Checklist-90) questionnaire, respectively. To verify the validity of the Italian version, the analysis of internal consistency, test-retest reliability, and construct validity were performed.

Results

The observed proportion of agreement concordance of results was 50.2% with Cohen’s K = 0.336 (CI 95%: 0.267–0.404), indicating a fair agreement between the two tests.

Test-retest correlation was statistically significant (ρ = 0.82; p < 0.01); validity (standardized Chronbach’s alpha) was considered reliable (α > 0.70). The analysis of construct validity showed a statistically significant association in terms of both total score (ρ = −0.66) and scores at each single domain (p < 0.01). A high correlation (p < 0.01) was observed between Laval questionnaire total and single domain scores and other related measures (Body Mass Index, TSD-OC scores, SCL-90 global severity index), revealing a high construct validity of the test.

Conclusions

The Italian version of the Laval Questionnaire is a valid and reliable measure to assess the health-related quality of life in subjects with obesity.

Central obesity and risks of cardiovascular events and mortality in prevalent hemodialysis patients

BACKGROUND

To date, no attempt has been made to assess the best anthropometric method for defining abdominal adiposity in hemodialysis (HD) patients or to determine whether the quantity of intra-abdominal fat relates to morbidity and mortality in that population. We aimed to describe the prevalence of central obesity in HD patients and to investigate the relationship between central obesity assessed by anthropometric variables, and composite outcomes, cardiovascular morbidity and mortality among HD patients and whether this parameter correlates with intra-abdominal fat assessed by computed tomography scan (CT scan).

METHODS

The procedures followed were in accord with the ethical standards of the committee on human experimentation of our institution. Informed oral consent was obtained from all patients. This was a cross-sectional study of 120 prevalent HD patients. Anthropometric measurements including body mass index, conicity index (Ci), waist-hip ratio (WHR), waist circumference (WC), waist-to-height ratio (WHtR), and visceral adiposity index (VAI) were recorded. Visceral and subcutaneous abdominal fat were assessed by CT scan. Comorbidity was scored for both the Charlson comorbidity index (CCI) and Davies comorbidity index.

RESULTS

Twenty-eight patients (23.3%) were centrally obese based on anthropometry. By linear regression analysis, Ci, WHR, and VAI were predictors of CT assessed central obesity; p 0.042, 0.001, and 0.010, respectively. On assessment of the relationship between the abdominal obesity and the comorbidity indices, there was a positive significant correlation between Ci and CCI (p 0.025) and Davies score (p 0.002) which are predictors of mortality. During the mean follow-up period (3.2 years), 56 patients reached the composite outcome; eight patients died and 48 experienced CV events. Central obesity measured by anthropometry was a predictor of composite outcomes, cardiovascular morbidity, and mortality in HD patients by regression analysis and cox regression model. Only WC and WHtR did not predict mortality.

CONCLUSION

Ci, WHR, and VAI are cheap alternatives for accurate assessment of morbidity and mortality risk in centrally obese prevalent HD patients.

Critical review of bariatric surgery, medically supervised diets, and behavioural interventions for weight management in adults

AIMS

Patient selection of weight management treatment option is often guided by a variety of factors. Currently, there is no comprehensive tool to facilitate informed decision-making for patients and clinicians. This article aims to synthesise evidence on the treatment effectiveness, health benefits, risks, and patient experiences of treatment options presently available at the Weight Management Clinic at The Ottawa Hospital (TOH), as a first step towards developing a decision aid.

METHODS

Narrative and systematic reviews published in English between 1999 and 2014 were included that focused on one or more of the following weight management treatments in adults aged 18 years and over: roux-en-y gastric bypass (RYGB), sleeve gastrectomy (SG), medically supervised meal replacement, and behavioural or lifestyle intervention.

RESULTS

Overall, bariatric surgeries have received the greatest research attention and have been associated not only with greater weight loss and health benefit but also with greater risks, complications, and financial cost. Dietary programmes demonstrated weight loss and health benefits to a lesser extent than with surgery but were associated with lower and shorter-term risks and complications. Behavioural and lifestyle interventions have been studied less yet have shown significant, albeit small, weight loss outcomes alone and in combination with dietary or surgical options; they also appear to be the lowest risk interventions. Patient experiences of weight management options are mixed and not well understood.

CONCLUSION

Further research is needed; however, this review identified some general trends related to weight loss outcomes, benefits, risks, and barriers for weight management options that have implications for shared treatment decision-making.

Peer-relationship-problems account for quality of life impairments in pediatric psoriasis

OBJECTIVE

Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample.

METHODS

The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n=6518) of children and adolescents aged 11-17.

RESULTS

Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale 'quality of relationships with friends/peers'. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%.

CONCLUSION

Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.

The Association Between Obesity and Hostility: The Mediating Role of Plasma Lipids

OBJECTIVE

Recent research indicates an association between obesity and psychopathology status, the nature of which remains unclear. We evaluated the mediating role of biochemical disturbances in this association among a treatment-seeking sample of obese individuals.

METHOD

The study enrolled 143 consecutive overweight and obese individuals (mean age 35±9 y) and 143 normal-weight controls (mean age 34±9 y), matched by age and sex. We measured psychopathology features using the Symptom Checklist 90-Revised (SCL-90-R), a standardized self-evaluation rating scale, and biochemical parameters (plasma cholesterol, triglyceride, and fasting glucose levels) of all participants. Nonlinear regression models were used to estimate the associations among obesity, psychopathology, and biochemical factors.

RESULTS

Obesity was associated positively and significantly (P<0.05) with all of the SCL-90-R subscales, with the exception of anxiety and phobic anxiety, as well as with levels of plasma glucose, cholesterol (P<0.01), and triglycerides (P<0.001). Tests for mediation showed that obesity was significantly associated, for the mediators of plasma cholesterol [parameter estimate=-0.033, P<0.05] and triglycerides (parameter estimate=-0.059, P<0.05), only with hostility (parameter estimate=-0.024, P<0.05 and parameter estimate=-0.041, P<0.05, respectively).

CONCLUSIONS

Our data suggest that biological substrates that are critically related to obesity, such as dyslipidemia, may mediate, at least in part, the association between obesity and hostility.

Quality of life as a mediator in the association between body mass index and negative emotionality in overweight and obese non-clinical sample

PURPOSE

The present study investigates the differences in physical health-related quality of life (HRQoL) among overweight and obese people, as well as the correlates of HRQoL in this population and the association between BMI, depression, anxiety, and potential mediating effects of HRQoL.

METHODS

The research was conducted on a sample of overweight and obese adults who visited their primary care physician. A total of 143 women and 130 men were enrolled in the study, 43% of the subjects were overweight, and 57% of the subjects were obese. The subjects ranged in age between 21 and 60 years. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, and HRQoL was evaluated using the Medical Outcome Study Short-Form 36.

RESULTS

The analysis of variance results showed that women in comparison to men have lower physical HRQoL (e.g. worst physical functioning, more bodily pain), and that severely obese patients have lower physical HRQoL in comparison to overweight ones. The regression analysis results indicated that some of the aspects of physical HRQoL (e.g. physical functioning, role limitations) mediate the relationship between BMI and depression only in women. The higher level of body mass decreased the physical HRQoL, which became a potential risk factor for the development of depressive symptoms.

CONCLUSIONS

The results from the present study show that a different pattern of functioning exists between men and women. It is important to identify the factors that can effectively motivate and stimulate obese people to change their lifestyle and to consider the differences in psychological functioning between women and men.

Does comorbid obesity impact quality of life outcomes in patients undergoing endoscopic sinus surgery?

BACKGROUND

Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS).

METHODS

Adult patients with medically refractory CRS (n = 241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5 to 24.9, overweight: 25.0 to 29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI] and the 22-item Sino-Nasal Outcome Test [SNOT-22]) were evaluated compared across BMI groups and obesity subclasses.

RESULTS

The prevalence of comorbid obesity was 41% (n = 99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p ≤ 0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p ≥ 0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs 55%, respectively) and SNOT-22 total score (29% and 40% vs 48%, respectively).

CONCLUSION

Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without.

Obesity in the Context of Aging: Quality of Life Considerations

The progressive increase in the prevalence of obesity and aging in the population is resulting in increased healthcare and disability spending. The burden of obesity is particularly relevant in old age, due to accumulating co-morbidities and changes in body composition. Sarcopenic obesity, a mix of over- and under-nutrition, causes frailty, disability, and problems in social and psychological areas, impacting overall health-related quality of life (HR-QOL). The relationship between obesity, aging, and HR-QOL is, however, much more complex than generally acknowledged and is difficult to disentangle. The impact of obesity on HR-QOL is particularly strong in young people, who are free of co-morbidities. It progressively attenuates, compared with the general population, with advancing age, when co-morbid conditions are diffusely present and reduce the perceived health status, independent of obesity. However, even this apparent 'obesity paradox' should not minimize the importance of obesity on HR-QOL, as other obesity-associated limitations and disabilities do impact HR-QOL in older age. A patient-centered approach aimed at reducing the disability and social isolation of advancing age is mandatory to improve HR-QOL in any class of obesity.

Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient

OBJECTIVES

To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight-loss surgery (WLS) to inform clinical care.

STUDY DESIGN

Baseline (preoperative) data from Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational study of 242 adolescents with severe obesity (MedianBMI = 50.5 kg/m(2); Meanage = 17.1; 75.6% female; 71.9% white) undergoing WLS, were used to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids).

RESULTS

WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Male subjects had a greater CLoad (P = .01) and BMI (P = .01), yet less impairment in total WRQOL (P < .01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (vs physical) comorbidities, BMI, and white race were significant predictors of WRQOL impairment. Less prevalent conditions (eg, stress urinary incontinence) also emerged as contributors to lower WRQOL.

CONCLUSIONS

WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals before WLS. Furthermore, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes after WLS, as weight and comorbidity profiles change over time.

Poor mental health in severely obese patients is not explained by the presence of comorbidities

The prevalence of obesity, especially severe obesity where body mass index (BMI) exceeds 40 kg m(-2) and where the physical risks are greatest, is increasing. However, little is known about the impact of severe obesity on psychological well-being and self-rated health (SRH). We aimed to investigate this relationship in patients attending an Irish weight management clinic. SRH was measured with a single-item inventory (excellent = 1, poor = 5). Well-being was measured with the validated World Health Organization-Five Well-being Index (WHO-5), in which scores <13 indicate poor well-being. Previous studies of the Irish population have reported mean SRH = 2.56 (males) and 2.53 (females) and mean well-being = 16.96. One hundred eighty-two (46.8%) completed questionnaires were returned. The sample was representative of the clinic population with a mean age of 47.1, mean baseline BMI of 51.9 kg m(-2) and 64.3% females. Mean SRH was 3.73 in males and 3.30 in females; mean well-being was 10.27 in males and 10.52 in females. In the final multivariable models, number of medications, depression and obstructive sleep apnoea, WHO-5 and current BMI were significant predictors of SRH, and secondary level education, social support and mindfulness scores were significant predictors of psychological well-being. Number of medications was not significant. The results suggest that the poor psychological well-being seen is not explained by the presence of comorbidities and that social support and mindfulness may be important targets for improving psychological well-being. Improving psychological well-being in addition to weight loss and effective management of comorbidities may be important for improving SRH.

Beyond weight reduction: improvements in quality of life after an intensive lifestyle intervention in subjects with severe obesity

INTRODUCTION

We examined the effects of 10-14 weeks of inpatient intensive lifestyle intervention (ILI), including a minimum of 90 minutes of adapted physical activity 5 days/week, with regard to changes in quality of life and associations with weight loss in subjects with severe obesity.

METHODS

A total of 100 severely obese subjects (BMI 42.6 ± 5.3 kg/m(2); 42.7 ± 10.6 years) were included. Quality of life was assessed by Binge Eating Scale, Hospital Anxiety, and Depression Scale, and SF- 36. The ILI group completed the questionnaires at inclusion, after 10-14 weeks and 12 months, and controls at inclusion and after 10-14 weeks.

RESULTS

Compared to controls, self-reported binge eating (-6.4, P < 0.0001), anxiety (-1.7, P = 0.005), and depression (-3.0, P < 0.0001) were reduced, and physical (8.0, P < 0.0001) and mental (7.6, P < 0.0001) health increased in the ILI group. After 12 months, reduction in self-reported binge eating (-7.2, P < 0.0001) and depression (-3.4, P < 0.0001) and increase in physical (8.9, P < 0.0001) and mental (3.6, P = 0.035) health were maintained. Decreased self-reported binge eating (β = 0.555, P = 0.010) and increased physical health (β = -0.554, P = 0.003) were associated with weight loss.

CONCLUSION

ILI including a high volume of physical activity in subjects with severe obesity improved quality of life by favorable changes in self-reported binge eating, depression, and mental and physical health. Improvements in binge eating and physical health were associated with weight loss.

Health-related quality of life in morbid obesity: the impact of laparoscopic sleeve gastrectomy

Our aim in this prospective study was to determine the impact of laparoscopic sleeve gastrectomy on the quality of life of patients with morbid obesity in comparison with population standards. The study evaluated 76 morbidly obese patients who underwent laparoscopic sleeve gastrectomy. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was used to evaluate quality of life in the following four areas: physical health, mental health, social relations, and environment. Patients completed the questionnaire before their planned operation and again 3 and 6 months after surgery. Compared with the population standard, patients with morbid obesity had significantly lower quality of life scores in the physical and mental health domains, including on independent questions related to of overall health and quality of life (p<0.001). Women scored lower on indicators of mental health than men. Three and 6 months following surgery a significant trend of body mass index (BMI) reduction was seen, as well as increased quality of life in all indicated areas (p<0.001). Laparoscopic sleeve gastrectomy treatment in morbidly obese patients reduced BMI on a long-term basis, a change seen as early as 3 months after surgery. By 6 months after surgery, patients had the same quality of life scores as the reference population.

Efficacy and safety of the adjustable gastric band - pooled interim analysis of the APEX and HERO studies at 48 weeks

OBJECTIVE

This 48 week combined analysis reports safety and clinical effectiveness of the LAP-BAND AP * laparoscopic adjustable gastric band (LAGB) in severely obese patients enrolled in the 5 year, prospective, observational, open-label APEX (NCT00501085) and HERO (NCT00953173) studies.

METHODS

The studies enrolled 1620 patients (APEX: N = 514; HERO: N = 1106), 1140 patients in the US (including all APEX patients), and 480 patients in the European Union (EU), Canada or Australia. APEX and HERO are non-randomized, non-comparator, open-label studies with differences in study management practices and follow-up. Notably, laboratory data were not collected during the APEX study.

RESULTS

After 48 weeks, mean (SD) percentage weight loss (%WL) was for APEX: 18.7% (7.9); HERO-US: 17.9% (8.5); HERO-EU: 16.5% (10.3); HERO-Canada: 13.4% (8.9); and HERO-Australia: 12.3% (6.9). After 48 weeks, there were no significant differences in %WL for APEX vs. HERO-US. After 48 weeks in the combined analysis (APEX + HERO): (1) patients without vs. with type 2 diabetes at baseline had greater %WL (18% [8.7] vs. 16% [8.5], p = 0.002); (2) female patients had greater %WL vs. male patients (17.9% [8.5] vs. 15.9% [9.3], p = 0.003); (3) younger patients had greater %WL vs. older patients (<50 years: 17.8% [8.7] vs. ≥50 years: 16.7% [8.6], p = 0.035); (4) baseline BMI did not affect %WL (≤35 to ≤45 kg/m(2): 17.7% [8.4] vs. >45 kg/m(2): 17.1% [9.1], p = 0.272). Device-related serious adverse events and adverse events were reported in 1.9% and 17.7% of patients, respectively. Revision and explantation surgeries were carried out on 3.4% and 2.3% of patients, respectively during the 48 weeks of follow-up.

CONCLUSIONS

This analysis demonstrates the effective weight loss and safety profile of the current LAGB system, with US patients achieving better weight loss than patients from outside the US.

Early dropout predictive factors in obesity treatment

Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction.

Correlates of perceived health related quality of life in obese, overweight and normal weight older adults: an observational study

Background

Obesity is a complex multifactorial disease, which also has an impact on quality of life. The aim of this paper is to identify the correlates of perceived health related quality of life in obese, overweight and normal weight Italians older adults.

Methods

205 subjects at the age ≥ 60 yrs. were recruited into the Division of Endocrinology of the Polytechnic University of Marche Region, Ancona (Italy). A protocol of questionnaires was constructed for data collection, and included domains such as physical activity, quality of life, socio-psychological aspects. The association of the latter variables with SF-36 Health Survey physical component (PCS-36) were evaluated in the whole sample. Multiple linear regression models were used to assess the effect of independent variables on PCS-36 and the physical subscales of SF-36.

Results

PCS-36 showed a lower score in the obese and overweight subjects than the normal weight group (post-hoc test, p < 0.001 and p < 0.05 respectively). Age, gender (male), Body Mass Index, years of education, Physical Activity Scale for the Elderly (PASE) total score, Hospital Anxiety and Depression Scale anxiety, Hospital Anxiety and Depression Scale depression, number of medications prescribed and number of diseases were included in the model. Negative and significant PCS-associated variables included depression (p = 0.009), BMI (p = 0.001), age in years (p = 0.007), whereas positive and significant PCS-associated independent variables were years of education (p = 0.022), physical activity (p = 0.026). BMI was negatively associated with all the physical subscales of SF-36 (p < 0.05).

Conclusions

Research funding should be invested in the study of the benefits accruing from reducing obesity in the elderly.

Health-related quality of life and sense of coherence among people with obesity: Important factors for health management

OBJECTIVES

The purpose of this study was to evaluate whether health-related quality of life and levels of sense of coherence among people with obesity are correlated with body mass index, age, and gender.

METHODS

A cross-sectional, descriptive research design was used. Subjects (n = 157) were selected from a sample of participants in an ongoing survey and had a body mass index >30 kg/m(2). Data were collected using the Short Form-36 Health Survey and the Sense of Coherence Scale.

RESULTS

The mean body mass index of women was higher than that of men. Compared to men, a greater proportion of women had a low sense of coherence. There was a significant relationship between low physical health and high body mass index. Female gender and older age correlated with a low sense of coherence and showed a significant association with high body mass index.

CONCLUSION

To increase the health-related quality of life, people with obesity need support to help manage their life situation based on their individual needs and personal resources.

Health-related quality of life and quality of sexual life in obese subjects

The increased prevalence of obesity represents, currently, one of the major public health issues, due to its consequences on physical and psychological health status as well as on the psychosocial functioning. As defined by the World Health Organization, sexual health is "a state of physical, emotional, mental, and social well-being in relation to sexuality." The aim of the present study was to explore the relationship between sexual life in obese subjects and quality of life, psychological status, and disability. Methods. 95 obese subjects were recruited from June 2012 to February 2013 and underwent physical examination and measures for the assessment of quality of life, sexual life, psychological status, and disability. Results. In obese subjects sexual life was related to gender, age, psychological status, disability, and quality of life. Conclusion. As obesity is a multifactorial disease, and is accompanied by multiple comorbidities, it is difficult to identify a single causative factor responsible for the impairment of sexual life in obese subjects; thus, a thorough, multidimensional evaluation including sexual function assessment should be performed in obese people.

Concurrent comparison of the measurement properties of generic and disease-specific questionnaires in obese inpatients

BACKGROUND

The concurrent comparison of questionnaires assessing health-related quality of life in the same population is necessary for better appreciating their performance and to select the best instrument for a given purpose (e.g. clinical trials and observational studies).

AIM

The aim of this study was to compare the measurement properties of two disease-specific and generic questionnaires: the Obesity-related Well-Being (ORWELL97), the Obesity-Related Disability test (TSD-OC), the EuroQoL, and the World Health Organization Quality of Life questionnaire.

MATERIALS/SUBJECTS

Two-hundreds and forty-nine obese inpatients [age 47 (standard deviation, SD 15) years, body mass index 44.4 (SD 5.2) kg/m(2), 69 % female] completed the four questionnaires before and after a 3-week multidisciplinary weight reduction program. Standard measurement properties were calculated and compared.

RESULTS

Intra-class correlation coefficient ranged from 0.73 to 0.90 for most of the instruments and subscales. The standard error of measurement ranged from 9 to 21 % for the generic instruments, and from 9 to 44 % for the specific questionnaires. Missing data and ceiling effects were found for TSD-OC. Responsiveness was similar for all the instruments. The correlations between the change scores of the instruments were small (<0.37).

CONCLUSIONS

It was not possible to identify a "best" instrument, but overall the ORWELL97 seems to show better measurement properties. The two specific instruments measured different constructs and they did not show a clear superior performance compared to the generic questionnaires.

Emotionally focused group therapy and dietary counseling in binge eating disorder. Effect on eating disorder psychopathology and quality of life

OBJECTIVE

To test the effect on psychopathology and quality of life of Emotionally Focused Therapy (EFT), Dietary Counseling (DC), and Combined Treatment (CT) in treatment-seeking patients with Binge Eating Disorder (BED) and obesity.

METHODS

Utilizing an observational study design, 189 obese adult patients with BED were treated by manualized therapy protocols. An independent assessment of health-related quality of life (Obesity-Related Well-Being questionnaire - ORWELL-97), attitudes toward eating (Eating Inventory - EI), binge eating (Binge Eating Scale - BES) and body uneasiness (Body Uneasiness Test - BUT) was performed at baseline, end-of-treatment, and six-month follow-up. These data are the secondary outcomes of a previously published treatment study.

RESULTS

A higher dropout rate was observed in the DC compared to the EFT and CT groups, while body weight decreased significantly in all three groups. Pre-post scores on the BES, BUT Global Severity Index, and EI Hunger subscale significantly decreased in the CT and EFT groups (but not the DC group). At six-month follow-up, 71% of participants in CT and 46% of participants in EFT had a BES score below the threshold of attention for BED (≤16), whereas no participants in the DC group reached this target. Finally the ORWELL-97 score decreased significantly in all groups, but significantly more so in the CT and EFT groups.

CONCLUSION

Results support the utility of combining EFT and DC in the treatment of patients with BED and obesity, emphasizing the usefulness of techniques focused on cognitive emotional processing for changing eating disorder psychopathology and quality of life.

Safety and effectiveness of LAP-BAND AP System: results of Helping Evaluate Reduction in Obesity (HERO) prospective registry study at 1 year

BACKGROUND

Laparoscopic adjustable gastric banding has several distinctive features, including band adjustability, easy reversibility, and lack of malabsorption, which contribute to its widespread use. The LAP-BAND AP System (LBAP; Allergan, Inc.), a redesigned and improved version of the original device, was approved by the US Food and Drug Administration in 2006. Because of limited information on LBAP, this study prospectively assesses the efficacy and safety of LBAP in real-world settings at clinical centers located in North America, Europe, and Australia.

STUDY DESIGN

This interim report of the ongoing 5-year prospective, observational, international, multicenter registry, Helping Evaluate Reduction in Obesity (HERO) Study (NCT00953173), describes clinical efficacy and safety of LBAP in real-world settings at 1 year.

RESULTS

One thousand one hundred and six patients were implanted with LBAP and 1-year data were available from 834 patients for efficacy analysis. At 1 year, the mean (SD) percentage of excess weight loss was 39.8% (22.3%), of weight loss was 16.9% (9.0%), and the mean (SD) body mass index decreased to 37.7 (7.0) kg/m(2) from 45.1 (6.9) kg/m(2) at baseline. Patients with type 2 diabetes mellitus or hypertension showed significant improvements at 1 year post LBAP (both p < 0.005). The most common device-related complications were port displacement (n = 20 [1.8%]), pouch dilation (n = 12 [1.1%]), band slippage (n = 7 [0.6%]), and band erosion (n = 5 [0.5%]). Eighteen (1.6%) patients had the device explanted.

CONCLUSIONS

At 1 year post LBAP, progressive weight loss was associated with improvement and/or resolution of comorbid conditions and was safe and well tolerated. Patient follow-up continues.

Morphological and health-related changes associated with a 12-week self-guided exercise programme in overweight adults: a pilot study

Over 12 weeks, supervised physical activity (PA) interventions have demonstrated improvements in morphological and health parameters, whereas community walking programmes have not. The present study piloted a self-guided programme for promoting PA and reducing sedentary behaviour in overweight individuals and measured its effect on a range of health outcomes. Six male and 16 female sedentary adults aged 48.5 ± 5.5 years with body mass index (BMI) 33.4 ± 6.3 kg m(-2) were assessed for anthropometric variables, blood pressure, functional capacity, well-being and fatigue. After an exercise consultation, participants pursued their own activity and monitored PA points weekly. At baseline, mid-point and 12 weeks, eight participants wore activity monitors, and all participants undertook a 5-day food diary to monitor dietary intake. In 17 completers, mass, BMI, sit-to-stand, physical and general fatigue had improved by 6 weeks. By 12 weeks, waist, sagittal abdominal diameter (SAD), diastolic blood pressure, well-being and most fatigue dimensions had also improved. Throughout the intervention, PA was stable, energy intake and lying time decreased and standing time increased; thus, changes in both energy intake and expenditure explain the health-related outcomes. Observed changes in function, fatigue and quality of life are consistent with visceral fat loss and can occur at levels of weight loss which may not be considered clinically significant.

Two-year changes in generic and obesity-specific quality of life after gastric bypass

The study objectives were to assess 2-year changes in health-related quality of life (HRQL) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery. This was a prospective intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country. We used both generic (Short Form Health Survey, SF-36 and EuroQol, EQ-5D), and specific questionnaires (Moorehead-Ardelt, MA II and Obesity-related Problems Scale, OP). Effect sizes and receiver operating characteristic (ROC) curves were calculated to assess the change in quality of life. Spearman's correlation coefficient was calculated to assess whether there was an association between changes in body mass index (BMI) and HRQL. Of 82 patients who underwent surgery, 79 were followed-up for 2 years. Mean weight loss was 37% of body weight (49 kg) and BMI fell from 50.6 to 31.8. The initial problems and final improvements were greater in the physical dimensions. Considerable benefits were observed in assessments with all the instruments used. However, the changes in weight/BMI and HRQL were not linear. The comparison with general population showed a similar profile in SF-36 dimensions after surgery. Severely obese patients have lower perceived health across all dimensions of quality of life. Moreover, the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment. ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI.

Is the impact of atopic disease on children and adolescents' health related quality of life modified by mental health? Results from a population-based cross-sectional study

Background

Eczema, asthma and hay fever are global health problems and their prevalence has increased considerably over the last decades. All appear to share an underlying atopic diathesis but their aetiology is considered to be multifactorial. They have been linked to decreases in health related quality of life (HRQoL) in adults, children/adolescents and/or parents of children. Research also suggests an association of the three conditions with mental health, which in turn is related to HRQoL decreases. We aimed to assess whether the impact of any of the three conditions on HRQoL is modified by presence of mental health problems.

Methods

The impact of occurrence of the three conditions within the past four weeks and 12 months on HRQoL, as measured by the ‘Quality of Life in Children – Revised’ (KINDL-R) questionnaire was analysed by use of the complex sample general linear model in a population-based sample (N = 6518) of children and adolescents aged 11 – 17. Analyses were adjusted for the other atopic conditions, sociodemographic and clinical variables and stratified for mental health as measured by the Strengths and Difficulties Questionnaire (SDQ) (normal n = 5697, borderline n = 609, abnormal n = 193).

Results

Eczema and hay fever within the past four weeks were significantly associated with decreased total or certain subscales of KINDL-R after adjusting for all other variables when no mental health abnormalities were present while asthma was associated with better HRQoL in these individuals. However, when mental health problems were present, eczema was positively associated with several subscales and the positive impact of asthma was stronger. The presence of mental health problems accentuated the negative relationship between hay fever and HRQoL (stronger negative impact). However, due to decreasing numbers in the group with mental health problems only few associations reached statistical significance.

Conclusions

While the results suggest mental health to have a modifying effect on the relationship between some atopic conditions and HRQoL caution needs to be exercised in interpreting the results: First, the groups with borderline or abnormal mental health were comparably smaller than the group with normal mental health. In the group with normal mental health small effects were more likely to become significant than in the other two groups. Secondly some problems regarding the validity of the self-report SDQ still remain.

A direct comparison of quality of life in obese and Cushing's syndrome patients

OBJECTIVE

Obese (OB) individuals and patients with Cushing's syndrome (CS) often have similar clinical presentations. While each group has reduced health-related quality of life (HRQL), it is not known whether the degree of impairment is different and might distinguish between them. The objective of this study was to compare HRQL in these two populations.

DESIGN

Cross-sectional study.

METHODS

Three hundred and twenty-seven OB patients (48.1±11.7 years; 72.5% women) with weight gain and at least two features of CS were recruited from an outpatient weight management clinic. Sixty-six untreated patients with CS (41.6±13.2 years; 78.8% women) presented to the NIH Clinical Center for evaluation. Subjects completed the SF-36 survey and a locally created symptom questionnaire.

RESULTS

After adjusting for symptom count, OB patients had a significantly higher (better HRQL) mean physical component summary (PCS) score than CS patients (44.9±0.6 vs 35.4±1.5, P<0.0001). However, the mean mental component summary (MCS) score was lower (worse HRQL) in the OB group (41.6±0.6 vs 50.7±1.6, P<0.0001). Symptom count showed significant correlations with PCS and MCS scores. BMI correlated with PCS (r=-0.29) in OB but not in CS patients. BMI was not associated with MCS in either group.

CONCLUSION

HRQL is significantly different between OB and CS patients. Surprisingly, after adjusting for symptom count, OB patients showed worse mental health scores than the CS population. Significant differences in HRQL and symptom count may suggest which OB patients should be screened for CS.