Elsevier

Nutrition

Volume 16, Issue 10, October 2000, Pages 947-952
Nutrition

Ingestive behavior and obesity
Obesity and quality of life

https://doi.org/10.1016/S0899-9007(00)00404-4Get rights and content

Abstract

The focus of this review is the impact of obesity and weight loss on quality of life. A focus on quality of life broadens the scope of treatment efficacy beyond weight loss and provides a patient-centered perspective. The concept of quality of life is defined, and both general and obesity-specific measures are reviewed. It is clear that obesity confers negative consequences on both the physical and psychosocial aspects of quality of life, especially among the severely obese. The effects of weight loss appear to be favorable, although few studies have examined non-surgical interventions. Future studies would be enhanced by assessing a variety of approaches to weight loss by using both general and obesity-specific measures of quality of life and conducting follow-up studies to assess the effects of weight regain on quality of life.

Introduction

The other articles in this special issue of Nutrition provide a thorough review of the literature on key topics, including genetic and metabolic control systems, that govern regulation of body weight, the biological systems that control hunger and satiety, the use of current and future pharmacologic agents, and obesity-related morbidity and mortality. In contrast, this review provides a unique perspective on obesity from the patient’s point of view. By using health-related quality of life (HRQL) instruments, we are able to gain insight to the patients’ subjective experience of being overweight: to capture their feelings, values, abilities, and expectations. We can use these instruments to assess their perceptions of what it is like to be obese and the changes that result from various weight-reduction interventions. Over the past decade, evaluation of HRQL has become an essential clinical and research outcome measurement. It is important to remember that the primary therapeutic goal of any obesity intervention is to improve the patient’s outlook and not simply promote weight loss.

Section snippets

Measurement of health status and quality of life

When patients are asked why they are seeking treatment for obesity, their responses are generally related to disappointment with their appearance or difficulty with daily physical functioning due to shortness of breath, pain of the weight-bearing joints, low energy levels, and/or reduced mobility. Other patients may present with psychological concerns such as low self-esteem and disturbance of body image. Occasionally, patients will relay other health-related concerns, such as newly diagnosed

Obesity HRQL measurements

At the time of this writing, we were able to identify five obesity HRQL instruments published in the medical literature (Table I). In general, the process used to construct the instruments was quite similar: obese patients and/or health professionals who treat this population were asked to generate questions (items) that represent relevant complaints and concerns. For most, the initial list of items was then modified and evaluated for test–retest reliability. Items were then categorized under

Impact of obesity on general health

The impact of obesity on overall daily functioning and quality of life is best measured by general health perceptions using several HRQL domains, including general health, physical, social, and emotional functioning, and vitality. Individuals with obesity uniformly perceive their general health as poorer than do healthy-weight individuals.1, 10, 11, 12 Moreover, a continuum has been observed between mildly, moderately, and severely (morbidly) obese individuals and worsening perceived health

Effects of obesity on physical functioning

Obesity places several physiologic demands on multiple organ functions that are physically perceived by the individual, most notably the heart and vascular system (blood and oxygen exchange), respiratory system (oxygen and carbon dioxide exchange), musculoskeletal system (mobility and weight bearing), and skin (heat loss and hygiene). The effect of obesity on the skin is particularly noticeable by increased sweating, cutaneous infections, and swelling and/or discoloration of the lower

Effects of obesity on psychological functioning

Despite the serious physical consequences associated with obesity, an expert panel, composed predominantly of physicians, concluded: “Obesity creates an enormous psychological burden. In terms of suffering, this burden may be the greatest adverse effect of obesity.”24 Numerous population studies have shown few significant differences between obese and non-obese participants on standardized measures of psychopathology (for review, see Wadden and Stunkard25). Body-image dissatisfaction26 and

Effects of weight loss on quality-of-life measurements

Given the significant adverse consequences of obesity and their effect on quality of life, it is imperative to assess whether weight loss improves the quality of life for obese patients.46 Numerous studies have assessed quality of life before and after weight loss, but fewer have included no or minimal weight-loss controls. The studies reviewed in this article assessed quality of life before and after weight loss and included appropriate controls.47, 48, 49, 50, 51, 52 Several studies have

References (53)

  • G.H Guyatt et al.

    Users’ guide to the medical literature. XII. How to use articles about health-related quality of life. Evidence-based medicine working group

    JAMA

    (1997)
  • J.E Ware et al.

    The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection

    Med Care

    (1992)
  • M Bergner et al.

    The Sickness Impact Profiledevelopment and final revision of a health status measure

    Med Care

    (1981)
  • T.M Gill et al.

    A critical appraisal for the quality of quality-of-life measurements

    JAMA

    (1994)
  • R.L Kolotkin et al.

    Assessing impact of weight on quality of life

    Obesity Res

    (1995)
  • S.D Mathias et al.

    Assessing health-related quality-of-life, and health state preference in persons with obesity

    Qual Life Res

    (1997)
  • G.S Bulter et al.

    The Obesity Adjustment Surveydevelopment of a scale to assess psychological adjustment to morbid obesity

    Int J Obesity

    (1999)
  • K.R Fontaine et al.

    Health-related quality of life in obese persons seeking treatment

    J Fam Pract

    (1996)
  • J.C Seidell et al.

    The relation between overweight and subjective health according to age, social class, slimming behavior and smoking habits in Dutch adults

    Am J Public Health

    (1986)
  • M.M Richards et al.

    Functional status and emotional well-being, dietary intake, and physical activity of severely obese subjects

    J Am Diet Assoc

    (2000)
  • P.L Dwyer et al.

    Obesity and urinary incontinence in women

    Br J Obstet Gynaecol

    (1988)
  • M.E.J Lean et al.

    Impairment of health and quality of life using new US federal guidelines for the identification of obesity

    Arch Intern Med

    (1999)
  • I Barofsky et al.

    Pain in the obeseimpact on health-related quality of life

    Ann Behav Med

    (1998)
  • T.S Han et al.

    The prevalence of low back pain and associations with body fatness, fat distribution and height

    Int J Obesity

    (1997)
  • R.A Stoohs et al.

    Traffic accidents in commercial long-haul truck driversthe influence of sleep-disordered breathing and obesity

    Sleep

    (1994)
  • R.R Grunstein et al.

    Impact of self-reported sleep-breathing disturbances on psychosocial performance in the Swedish Obese Subjects (SOS) study

    Sleep

    (1995)
  • Cited by (230)

    • Self-compassion in weight management: A systematic review

      2021, Journal of Psychosomatic Research
    View all citing articles on Scopus
    View full text