Quality of Life Among Obese Patients Seeking Weight Loss Surgery: The Importance of Obesity-Related Social Stigma and Functional Status
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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.
KeywordsUtility Score Health Utility Weight Stigma Public Distress Weight Control Intervention
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.
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