Health-related quality of life in obese outpatients losing weight with very-low-energy diet and behaviour modification—a 2-y follow-up study

Abstract

OBJECTIVE:To study health-related quality of life (HRQL) in a clinically selected sample of obese outpatients. DESIGN: A single-strand before and after study with 2-y follow-up after treatment comprising 10 weeks on very-low-energy diet (VLED) and 4 months of behaviour modification in groups. SUBJECTS: A total of 126 (mean (s.d.) age 48.2 (11.1) y and body mass index 42.8 (6.2) kg/m 2 obese patients (63% women) referred for treatment in an obesity clinic. MEASUREMENTS: Weight and HRQL using questionnaires (RAND 36-Item Health Survey 1.0 and Obesity-related Psychosocial problems scale (OP-scale)). RESULTS: A total of 100 patients (61% women) completed the treatment and 67 (71% women) completed the 2-y follow-up. The mean (s.d.) weight loss was 12.5 (5.6)% at the end of group therapy, 6.0 (7.1)% at 1 y, and 2.6 (7.5)% at 2 y. At baseline, the mean (s.d.) score for the OP-scale was 61.9 (24.6). The mean scores on every RAND-36 scale were markedly lower than in the Finns without chronic conditions. All the scales in HRQL improved markedly during the treatment. During the follow-up, all the scales started to return towards baseline levels, and at 2 y only obesity-related psychosocial problems and physical functioning were still improved relative to baseline. In categories of weight change at 2 y (Z10% weight loss, 0-9.9% weight loss, weight gain), obesity-related psychosocial functioning, physical functioning, and general health showed dose-response improvement with increasing weight loss. A Z10% weight loss at 2 y after treatment was associated with clear improvement in obesity-related psychosocial problems, physical functioning, physical role functioning, bodily pain, general health, mental health, and vitality. A 0-9.9% weight loss was associated with improvement in obesity-related psychosocial problems and physical functioning. Weight gain was associated with improvement in obesity-related psychosocial problems and social functioning. The study population was too small to examine possible gender differences. CONCLUSIONS: Treatment with VLED and behaviour modification produces marked short-term weight loss and clear improvement in all aspects of HRQL. At 2 y after treatment, the average maintained weight loss is modest. However, 1/3 of patients maintained a Z5% weight loss. Improvement in obesity-related psychosocial problems and physical functioning is associated even with less than 10% of maintained weight loss. Since the pattern of HRQL changes only partly followed the pattern of weight change as expected, other factors, such as the therapeutic effect of participating in the weight loss programme or increase in physical activity, may affect HRQL responses.

Association of Self-Reported Weight Change and Quality of Life, and Exercise and Weight Management Behaviors Among Adults with Type 2 Diabetes Mellitus: The SHIELD Study

“…Very few studies have examined this relationship for adults with T2DM [19], and no study has been done on a large population-based sample of T2DM. The present study found a similar association of weight loss and improvement in HRQOL as other studies among the general population [14, 16–18]. With this evidence that weight loss is associated with improved HRQOL among individuals with T2DM, it is important to determine if the improved HRQOL along with the weight loss will assist T2DM patients to better manage their diabetes (possibly improve medication adherence and glucose monitoring) and control their glucose levels.…”

“…Cross-sectional studies among the general population have shown a clear inverse relationship with baseline weight or BMI and health-related quality of life (HRQOL) [11–13]. Studies examining the change in weight over time and HRQOL found that weight gain led to a reduction in HRQOL [14, 15], and in general, weight loss (5%–10%) was associated with significant improvement in HRQOL, typically in physical functioning and bodily pain [14, 16–18]. However, only one study examined this association among individuals with T2DM [19], where the results indicated that patients with diabetes who lost >5% of their weight during the clinical trial had improved their HRQOL scores.…”

Low-Fat Dietary Pattern Intervention and Health-Related Quality of Life: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial

“…Additionally, changes in diet 4-11 and weight status are associated with changes in quality of life: weight gain is associated with lower measures of quality of life while weight loss is associated with improvements. 4,12-20 Because of its focus on dietary change and its size, the dietary modification (DM) trial of the Women’s Health Initiative (WHI) may be able to contribute to the question of whether or not making healthy diet changes is associated with improved HRQoL, both overall and within subgroups of women. The DM trial in the WHI was a randomized controlled trial designed to test the hypothesis that a reduction of fat intake to 20 percent of the total daily calories and an increase in the intake of fruit, vegetables, and whole grains would reduce the risk of breast cancer and of colorectal cancer and, as a secondary outcome, the risk of heart disease in postmenopausal women.…”

Mid-Term Effectiveness of Behavioral and Psychodynamic Inpatient Treatments of Severe Obesity Based on a Randomized Study

“…Proponents of rapid weight loss [18] have favored strong reductions arguing that a greater initial weight loss was predictive of more long-term weight loss [19]. Proponents of a modest weight reduction have argued that achieving between 5 and 10% of weight reduction carried significant benefits regarding blood pressure, serum lipids, coronary risks, etc.…”