International Journal of Public Health

, Volume 59, Issue 2, pp 279–288 | Cite as

The longitudinal association between weight change and health-related quality of life: the KORA S4/F4 cohort study

  • Michael LaxyEmail author
  • Rolf Holle
  • Angela Döring
  • Annette Peters
  • Matthias Hunger
Original Article



Despite the increasing importance of patient-centered perspectives, the impact of weight change on the health-related quality of life (HRQL) has remained unclear. This work aims to investigate this longitudinal relationship.


Data was collected from a population-based cohort study of 3,080 Germans. Anthropometrics and HRQL were assessed at baseline and after a 7-year follow-up period. Using linear regression the average change in HRQL scores was calculated among 5 mutually exclusive weight change groups. Multilevel growth modeling was conducted to differentiate between interpersonal (cross-sectional) and intrapersonal (longitudinal) associations between body mass index (BMI)/BMI change and HRQL.


Heavy weight gain (≥10 % body weight) was associated with impairments in physical health among women (−2.82 points, CI: −4.29, −1.34) and obese men (−4.33 points, CI: −7.62, −1.04) and with improvements in mental health among women (+3.20 points, CI: +1.37, +5.02). Results from the multilevel models were consistent, showing negative associations between BMI change and physical health, positive associations between BMI change and mental health and a high degree of similarity between interpersonal and intrapersonal associations.


Weight gain leads to clinically relevant impairments in physical health. More research is needed to clarify the antipodal effects of weight change on physical and mental health components.


Health-related quality of life Weight change Obesity Longitudinal Population-based 



This work was supported by the German Competence Network Obesity, which is funded by the Federal Ministry of Education and Research (Grant No. 01GI1127). The KORA research platform (KORA, Cooperative Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München—German Research Centre for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria.

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

38_2013_506_MOESM1_ESM.pdf (85 kb)
Supplementary material 1 (PDF 85 kb)


  1. Ackermann RT et al (2009) Changes in health state utilities with changes in body mass in the Diabetes Prevention Program. Obesity (Silver Spring) 17(12):2176–2181. doi: 10.1038/oby.2009.114 CrossRefGoogle Scholar
  2. Alonso J et al (2004) Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res 13(2):283–298PubMedCrossRefGoogle Scholar
  3. Calle EE, Thun MJ (2004) Obesity and cancer. Oncogene 23(38):6365–6378. doi: 10.1038/sj.onc.1207751 PubMedCrossRefGoogle Scholar
  4. CDC (2011) Healthy Weight—it’s not a diet, it’s a lifestyle! CDC 24/7 Saving Lives. Protecting People. Accessed 15 June 2013
  5. Dolan P (2000) The measurement of health-related quality of life for use in resource allocation decisions in health care. In: Anthony JC, Joseph PN (eds) Handbook of Health Economics. Elsevier, Amsterdam, pp 1723–1760Google Scholar
  6. Engel SG et al (2003) Impact of weight loss and regain on quality of life: mirror image or differential effect? Obes Res 11(10):1207–1213. doi: 10.1038/oby.2003.166 PubMedCrossRefGoogle Scholar
  7. Fine JT et al (1999) A prospective study of weight change and health-related quality of life in women. JAMA 282(22):2136–2142. doi: 10.1001/jama.282.22.2136 PubMedCrossRefGoogle Scholar
  8. Fitzmaurice GM, Laird NM, Ware JH (2004) Applied longitudinal analysis. Wiley, HobokenGoogle Scholar
  9. Flegal KM, Graubard BI, Williamson DF, Gail MH (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293(15):1861–1867. doi: 10.1001/jama.293.15.1861 PubMedCrossRefGoogle Scholar
  10. Fontaine KR, Barofsky I (2001) Obesity and health-related quality of life. Obes Rev 2(3):173–182PubMedCrossRefGoogle Scholar
  11. Gandek B et al (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51(11):1171–1178PubMedCrossRefGoogle Scholar
  12. Garner RE et al (2011) Bodyweight, gender, and quality of life: a population-based longitudinal study. Qual Life Res 21(5):813–825. doi: 10.1007/s11136-011-9989-1 PubMedCentralPubMedCrossRefGoogle Scholar
  13. Guh D, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis A (2009) The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9(1):88PubMedCentralPubMedCrossRefGoogle Scholar
  14. Hedeker D (2004) An introduction to growth modeling. In: Kaplan D (ed) The Sage Handbook of Quantitative Methodology for the Social Sciences. Sage Publications, Inc., Thousands Oaks, pp 215–234Google Scholar
  15. Hopman WM et al (2007) The association between body mass index and health-related quality of life: data from CaMos, a stratified population study. Qual Life Res 16(10):1595–1603. doi: 10.1007/s11136-007-9273-6 PubMedCrossRefGoogle Scholar
  16. Huang IC, Frangakis C, Wu AW (2006) The relationship of excess body weight and health-related quality of life: evidence from a population study in Taiwan. Int J Obes (Lond) 30(8):1250–1259. doi: 10.1038/sj.ijo.0803250 CrossRefGoogle Scholar
  17. Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67(5):968–977PubMedCrossRefGoogle Scholar
  18. Hunger M et al (2011) Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health Qual Life Outcomes 9:53. doi: 10.1186/1477-7525-9-53 PubMedCentralPubMedCrossRefGoogle Scholar
  19. Jenkinson C, Layte R (1997) Development and testing of the UK SF-12 (short form health survey). J Health Serv Res Policy 2(1):14–18PubMedGoogle Scholar
  20. Jenkinson C et al (1997) A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med 19(2):179–186PubMedCrossRefGoogle Scholar
  21. Jia H, Lubetkin EI (2005) The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxford, England) 27(2):156–164. doi: 10.1093/pubmed/fdi025 CrossRefGoogle Scholar
  22. Kaukua J, Pekkarinen T, Sane T, Mustajoki P (2002) Health-related quality of life in WHO class II-III obese men losing weight with very-low-energy diet and behaviour modification: a randomised clinical trial. Int J Obes Relat Metab Disord 26(4):487–495PubMedCrossRefGoogle Scholar
  23. Kolotkin RL, Davidson LE, Crosby RD, Hunt SC, Adams TD (2012) Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. Surg Obes Relat Dis 8(5):625–633. doi: 10.1016/j.soard.2012.01.011 PubMedCentralPubMedCrossRefGoogle Scholar
  24. Larsson U, Karlsson J, Sullivan M (2002) Impact of overweight and obesity on health-related quality of life—a Swedish population study. Int J Obes Relat Metab Disord 26(3):417–424. doi: 10.1038/sj.ijo.0801919 PubMedCrossRefGoogle Scholar
  25. Leon-Munoz LM et al (2005) Changes in body weight and health-related quality-of-life in the older adult population. Int J Obes (Lond) 29(11):1385–1391. doi: 10.1038/sj.ijo.0803049 CrossRefGoogle Scholar
  26. Lopez-Garcia E, Banegas Banegas JR, Gutierrez-Fisac JL, Perez-Regadera AG, Ganan LD, Rodriguez-Artalejo F (2003) Relation between body weight and health-related quality of life among the elderly in Spain. Int J Obes Relat Metab Disord 27(6):701–709. doi: 10.1038/sj.ijo.0802275 PubMedCrossRefGoogle Scholar
  27. Maciejewski ML, Patrick DL, Williamson DF (2005) A structured review of randomized controlled trials of weight loss showed little improvement in health-related quality of life. J Clin Epidemiol 58(6):568–578. doi: 10.1016/j.jclinepi.2004.10.015 PubMedCrossRefGoogle Scholar
  28. Puhan MA, Ahuja A, Van Natta ML, Ackatz LE, Meinert C (2011) Interviewer versus self-administered health-related quality of life questionnaires—does it matter? Health Qual Life Outcomes 9:30. doi: 10.1186/1477-7525-9-30 PubMedCentralPubMedCrossRefGoogle Scholar
  29. Rathmann W et al (2003) High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000. Diabetologia 46(2):182–189. doi: 10.1007/s00125-002-1025-0 PubMedGoogle Scholar
  30. Rawlins MD, Culyer AJ (2004) National Institute for Clinical Excellence and its value judgments. BMJ 329(7459):224–227. doi: 10.1136/bmj.329.7459.224 PubMedCentralPubMedCrossRefGoogle Scholar
  31. Redon J (2001) Hypertension in obesity. Nutr Metab Cardiovasc Dis 11(5):344–353PubMedGoogle Scholar
  32. Schunk M et al (2012) Health-related quality of life in subjects with and without Type 2 diabetes: pooled analysis of five population-based surveys in Germany. Diabet Med 29(5):646–653. doi: 10.1111/j.1464-5491.2011.03465.x PubMedCrossRefGoogle Scholar
  33. Soltoft F, Hammer M, Kragh N (2009) The association of body mass index and health-related quality of life in the general population: data from the 2003 Health Survey of England. Qual Life Res 18(10):1293–1299. doi: 10.1007/s11136-009-9541-8 PubMedCentralPubMedCrossRefGoogle Scholar
  34. Sullivan PW, Ghushchyan VH, Ben-Joseph R (2008) The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Qual Life Res 17(8):1063–1071. doi: 10.1007/s11136-008-9385-7 PubMedCrossRefGoogle Scholar
  35. Van Breukelen GJP (2006) ANCOVA versus change from baseline had more power in randomized studies and more bias in nonrandomized studies. J Clin Epidemiol 59(9):920–925PubMedCrossRefGoogle Scholar
  36. Verkleij SP, Adriaanse MC, Wendel-Vos GC, Schuit AJ (2012) Longitudinal relation between weight change and quality of life in a community-based population: a prospective cohort study. Eur J Public Health. doi: 10.1093/eurpub/cks058 PubMedGoogle Scholar
  37. Ware JE, Kosinski M, Keller SD (1995) SF-12®: How to Score the SF-12® Physical and Mental Health Summary Scales, 2nd edn. The Health Institute, New England Medical Center, BostonGoogle Scholar
  38. Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRefGoogle Scholar
  39. WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894(i–xii):1–253Google Scholar

Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  • Michael Laxy
    • 1
    Email author
  • Rolf Holle
    • 1
  • Angela Döring
    • 2
  • Annette Peters
    • 2
  • Matthias Hunger
    • 1
  1. 1.Helmholtz Zentrum München, German Research Center for Environmental HealthInstitute of Health Economics and Health Care ManagementNeuherbergGermany
  2. 2.Helmholtz Zentrum München, German Research Center for Environmental HealthInstitute of Epidemiology IINeuherbergGermany

Personalised recommendations