Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study

Abstract

BackgroundThere is little robust evidence relating to changes in health related quality of life (HRQL) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass (RYGB). The aim of the present study was to describe and compare changes in five dimensions of HRQL in morbidly obese subjects. In addition, we wanted to assess the clinical relevance of the changes in HRQL between and within these two groups after one year. We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program (ILI) with morbidly obese subjects.MethodsA total of 139 morbidly obese patients chose treatment with RYGB (n=76) or ILI (n=63). The ILI comprised four stays (seven weeks) at a specialized rehabilitation center over one year. The daily schedule was divided between physical activity, psychosocially-oriented interventions, and motivational approaches. No special diet or weight-loss drugs were prescribed. The participants completed three HRQL-questionnaires before treatment and 1 year thereafter. Both linear regression and ANCOVA were used to analyze differences between weight loss and treatment for five dimensions of HRQL (physical, mental, emotional, symptoms and symptom distress) controlling for baseline HRQL, age, age of onset of obesity, BMI, and physical activity. Clinical relevance was assessed by effect size (ES) where ES<.49 was considered small, between .50-.79 as moderate, and ES>.80 as large.ResultsThe adjusted between group mean difference (95% CI) was 8.6 (4.6,12.6) points (ES=.83) for the physical dimension, 5.4 (1.5–9.3) points (ES=.50) for the mental dimension, 25.2 (15.0–35.4) points (ES=1.06) for the emotional dimension, 8.7 (1.8–15.4) points (ES=.37) for the measured symptom distress, and 2.5 for (.6,4.5) fewer symptoms (ES=.56), all in favor of RYGB. Within-group changes in HRQOL in the RYGB group were large for all dimensions of HRQL. Within the ILI group, changes in the emotional dimension, symptom reduction and symptom distress were moderate. Linear regression analyses of weight loss on HRQL change showed a standardized beta-coefficient of –.430 (p<.001) on the physical dimension, –.288 (p=.004) on the mental dimension, –.432 (p<.001) on the emotional dimension, .287 (p=.008) on number of symptoms, and .274 (p=.009) on reduction of symptom pressure.ConclusionsMorbidly obese participants undergoing RYGB and ILI had improved HRQL after 1 year. The weaker response of ILI on HRQL, compared to RYGB, may be explained by the difference in weight loss following the two treatments.Trial registrationClinical Trials.gov number NCT00273104

Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis

“…The comparatively inferior results of pharmacological therapy, dietary and behavioral modification have been documented in recent meta-analyses [2,3], while bariatric surgery has been proven to be safe and reliable in achieving massive weight loss and improvement in comorbidities [4,5]. Over the years, different surgical approaches have been tried; some have risen to acceptance and common use [6], while others have become obsolete due to negative effects on quality of life [4] or inferior long-term weight results. The chosen bariatric procedure has to be well tolerated by the individual on a daily basis, in addition to resulting in a low frequency of short-and long-term surgical complications.…”

“…Obesity-related comorbidities such as hypertension, cardiovascular disease, diabetes and sleep apnea are known to reduce quality of life and life expectancy, as well as to increase healthcare costs [1]. The comparatively inferior results of pharmacological therapy, dietary and behavioral modification have been documented in recent meta-analyses [2,3], while bariatric surgery has been proven to be safe and reliable in achieving massive weight loss and improvement in comorbidities [4,5]. Over the years, different surgical approaches have been tried; some have risen to acceptance and common use [6], while others have become obsolete due to negative effects on quality of life [4] or inferior long-term weight results.…”

Materiell og profesjonell stigmatisering av mennesker med sykelig overvekt

“…Disse ble trukket ut blant 139 respondenter i en stor, kvantitativ kartleggingsundersøkelse om sykelig overvekt. De ble valgt ut blant de respondentene fra denne undersøkelsen som hadde rapportert om store, følelsesmessige utfordringer i et fedmespesifikt livskvalitetsskjema (Karlsen, Lund, Roislien, Tonstad, Natvig og Sandbu 2013). Vi er klar over at det nødvendigvis ikke er en tydelig sammenheng mellom følelsesmessige utfordringer knyttet til fedme og det å bli stigmatisert, men vi har som vist over valgt å se på dette som et hverdagsbegrep blant mennesker med sykelig overvekt.…”

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“…Bariatric procedures show excellent short term results (Karlsen et al, 2013, Andersen, 2011, and acceptable long term results (Sjostrom, 2013) with weight loss, remission of comorbidities and quality of life as the outcome measures. Nevertheless, between 30 and 40% of morbidly obese patients undergoing bariatric surgery seem to experience insufficient weight loss or regain of weight (Biron et al, 2004, Magro et al, 2008, Livhits et al, 2012.…”

“…The scale assesses health related quality of life outcomes, known to be most directly affected by unspecific disease and treatment and was first translated and adapted to Norwegian in 1998 (Loge et al, 1998) (Ware, 2000) and are validated for use in a Norwegian morbidly obese population (Karlsen et al, 2011).…”