Journal of General Internal Medicine

, Volume 28, Issue 2, pp 231–238 | Cite as

Quality of Life Among Obese Patients Seeking Weight Loss Surgery: The Importance of Obesity-Related Social Stigma and Functional Status

  • Christina C. WeeEmail author
  • Roger B. Davis
  • Karen W. Huskey
  • Daniel B. Jones
  • Mary B. Hamel
Original Research



Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown.


We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients’ health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients’ willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients’ health utility.


Our study sample (n = 574) had a mean body mass index of 46.5 kg/m2 and a mean health utility of 0.87, reflecting the group’s average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients’ utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients’ utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients’ health utility.


Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a 10 % risk of death to achieve their most valued health/weight state. Interference with role functioning due to physical limitations and obesity-related social stigma were strong determinants of reduced health utility.


Utility Score Health Utility Weight Stigma Public Distress Weight Control Intervention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was funded by the National Institute of Diabetes, Digestive and Kidney Diseases (R01 DK073302). Dr. Wee is also supported by a midcareer mentorship award from the National Institute of Health (K24DK087932). The sponsor had no role in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; and the preparation, review, or approval of the manuscript. Dr. Wee conceived the research question, designed the study, obtained funding, supervised the conduct of the study, and drafted the manuscript. Drs. Jones and Wee facilitated the collection of the data. Ms. Huskey had full access to all the data, conducted all the analyses, and takes responsibility for the integrity of the data and accuracy of the data analysis. Dr. Davis provided statistical expertise and along with Drs. Hamel and Wee interpreted the data. All authors provided critical revision of the manuscript for intellectual content and approved the final manuscript. We thank the patients for participating in our study and thank the ABS study team for their efforts.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Flegal KM, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S.Google Scholar
  3. 3.
    Calle EE, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med. 2003;348(17):1625–38.PubMedCrossRefGoogle Scholar
  4. 4.
    Resnick HE, et al. Differential effects of BMI on diabetes risk among black and white Americans. Diabetes Care. 1998;21(11):1828–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Stevens J. Impact of age on associations between weight and mortality. Nutr Rev. 2000;58(5):129–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9(12):788–805.PubMedCrossRefGoogle Scholar
  7. 7.
    White MA, et al. Gender, race, and obesity-related quality of life at extreme levels of obesity. Obes Res. 2004;12(6):949–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Nguyen NT, et al. Trends in use of bariatric surgery, 2003–2008. J Am Coll Surg. 2011;213(2):261–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019–28.PubMedCrossRefGoogle Scholar
  10. 10.
    Kolotkin RL, et al. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Kolotkin RL, et al. Assessing impact of weight on quality of life. Obes Res. 1995;3(1):49–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Wadden TA, Phelan S. Assessment of quality of life in obese individuals. Obes Res. 2002;10(Suppl 1):50S–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.PubMedCrossRefGoogle Scholar
  14. 14.
    Russell LB, et al. The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996;276(14):1172–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Wee CC, et al. Understanding patients’ value of weight loss and expectations for bariatric surgery. Obes Surg. 2006;16(4):496–500.PubMedCrossRefGoogle Scholar
  16. 16.
    Ware JE, Kosinski M, Dewey JE. How to score version two of the SF-36 health survey. QualityMetric Incorporated: 2000.Google Scholar
  17. 17.
    Wee CC, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. Arch Surg. In press.Google Scholar
  18. 18.
    Kolotkin RL, Crosby RD. Psychometric evaluation of the impact of weight on quality of life-lite questionnaire (IWQOL-lite) in a community sample. Qual Life Res. 2002;11(2):157–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Corica F, et al. Construct validity of the Short Form-36 Health Survey and its relationship with BMI in obese outpatients. Obesity (Silver Spring). 2006;14(8):1429–37.CrossRefGoogle Scholar
  20. 20.
    Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care. 2000;38(6):583–637.PubMedCrossRefGoogle Scholar
  21. 21.
    Wee CC, et al. Assessing the value of weight loss among primary care patients. J Gen Intern Med. 2004;19(12):1206–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Dixon S, Currie CJ, McEwan P. Utility values for obesity and preliminary analysis of the Health Outcomes Data Repository. Expert Rev Pharmacoecon Outcomes Res. 2004;4(6):657–65.PubMedCrossRefGoogle Scholar
  23. 23.
    Hakim Z, Wolf A, Garrison LP. Estimating the effect of changes in body mass index on health state preferences. Pharmacoeconomics. 2002;20(6):393–404.PubMedCrossRefGoogle Scholar
  24. 24.
    Groessl EJ, et al. Body mass index and quality of well-being in a community of older adults. Am J Prev Med. 2004;26(2):126–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Ware JE. SF-36 Health Survey. Boston, MA: Manual & Interpretaion Guide; 2002.Google Scholar
  26. 26.
    Kolotkin RL, et al. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes. 2009;7:53.PubMedCrossRefGoogle Scholar
  27. 27.
    Wee CC, et al. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med. 2000;132(9):697–704.PubMedGoogle Scholar
  28. 28.
    Wee CC, Phillips RS, McCarthy EP. BMI and cervical cancer screening among white, African-American, and Hispanic women in the United States. Obes Res. 2005;13(7):1275–80.PubMedCrossRefGoogle Scholar
  29. 29.
    Drury CA, Louis M. Exploring the association between body weight, stigma of obesity, and health care avoidance. J Am Acad Nurse Pract. 2002;14(12):554–61.PubMedCrossRefGoogle Scholar
  30. 30.
    Steinbrook R. Surgery for severe obesity. N Engl J Med. 2004;350(11):1075–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Christina C. Wee
    • 1
    Email author
  • Roger B. Davis
    • 1
  • Karen W. Huskey
    • 1
  • Daniel B. Jones
    • 2
  • Mary B. Hamel
    • 1
  1. 1.Division of General Medicine and Primary Care, Department of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  2. 2.Section of Minimally Invasive Surgery, Division of General Surgery, Department of SurgeryBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA

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