Two-year changes in generic and obesity-specific quality of life after gastric bypass

  • Javier Mar
  • Jan Karlsson
  • Arantzazu Arrospide
  • Blanca Mar
  • Gabriel Martínez de Aragón
  • Cándido Martinez-Blazquez
Original Article


The study objectives were to assess 2-year changes in health-related quality of life (HRQL) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery. This was a prospective intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country. We used both generic (Short Form Health Survey, SF-36 and EuroQol, EQ-5D), and specific questionnaires (Moorehead-Ardelt, MA II and Obesity-related Problems Scale, OP). Effect sizes and receiver operating characteristic (ROC) curves were calculated to assess the change in quality of life. Spearman’s correlation coefficient was calculated to assess whether there was an association between changes in body mass index (BMI) and HRQL. Of 82 patients who underwent surgery, 79 were followed-up for 2 years. Mean weight loss was 37 % of body weight (49 kg) and BMI fell from 50.6 to 31.8. The initial problems and final improvements were greater in the physical dimensions. Considerable benefits were observed in assessments with all the instruments used. However, the changes in weight/BMI and HRQL were not linear. The comparison with general population showed a similar profile in SF-36 dimensions after surgery. Severely obese patients have lower perceived health across all dimensions of quality of life. Moreover, the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment. ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI.


Morbid obesity Gastric bypass Quality of life Disability ROC curves 


  1. 1.
    Dixon JB (2010) The effect of obesity on health outcomes. Mol Cell Endocrinol 316:104–108PubMedCrossRefGoogle Scholar
  2. 2.
    Livingston EH, Finks AS (2003) Quality of life: cost and future of bariatric surgery. Arch Surg 138:383–388PubMedCrossRefGoogle Scholar
  3. 3.
    Clark MM, Balsiger BM, Sletten CD et al (2003) Psychosocial factors and 2-year outcome following bariatric surgery for weight loss. Obes Surg 13:739–745PubMedCrossRefGoogle Scholar
  4. 4.
    Karlsson J, Taft C, Rydén A et al (2007) Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond) 31:1248–1261CrossRefGoogle Scholar
  5. 5.
    Herpertz S, Kielmann R, Wolf AM et al (2003) Does obesity surgery improve psychosocial functioning? A systematic review. Int J Obes Relat Metab Disord 27:1300–1314PubMedCrossRefGoogle Scholar
  6. 6.
    Kolotkin RL, Meter K, Williams GR (2001) Quality of life and obesity. Obes Rev 2:219–229PubMedCrossRefGoogle Scholar
  7. 7.
    van Nunen AM, Wouters EJ, Vingerhoets AJ et al (2007) The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment: a meta-analysis. Obes Surg 17:1357–1366PubMedCrossRefGoogle Scholar
  8. 8.
    Guyatt GH, Osoba D, Wu AW, Clinical Significance Consensus Meeting Group et al (2002) Methods to explain the clinical significance of health status measures. Mayo Clin Proc 77:371–383PubMedCrossRefGoogle Scholar
  9. 9.
    Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Ann Intern Med 118:622–629PubMedCrossRefGoogle Scholar
  10. 10.
    Doll HA, Petersen SE, Stewart-Brown SL (2000) Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obes Res 8:160–170PubMedCrossRefGoogle Scholar
  11. 11.
    ICF International Classification of Functioning (2001) Disability and health: ICF. WHO, GenevaGoogle Scholar
  12. 12.
    Andreyeva T, Puhl RM, Brownell KD (2008) Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity (Silver Spring) 16:1129–1134CrossRefGoogle Scholar
  13. 13.
    de Man Lapidoth J, Ghaderi A, Norring C (2011) Binge eating in surgical weight-loss treatments. Long-term associations with weight loss, health related quality of life (HRQL), and psychopathology. Eat Weight Disord. 16:e263–e269PubMedGoogle Scholar
  14. 14.
    Ware JR, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  15. 15.
    EuroQoL Group (1990) EuroQoL—a new facility for measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
  16. 16.
    Moorehead MK, Ardelt-Gattinger E, Lechner H et al (2003) The validation of the Moorehead-Ardelt quality of life questionnaire. Obes Surg 13:684–692PubMedCrossRefGoogle Scholar
  17. 17.
    Karlsson J, Taft C, Sjostrom L et al (2003) Psychosocial functioning in the obese before and after weight reduction: construct validity and responsiveness of the obesity-related problems scale. Int J Obes Relat Metab Disord 27:617–630PubMedCrossRefGoogle Scholar
  18. 18.
    Alonso J, Prieto L, Antó JM (1995) La versión española del SF-36 Health Survey (Cuestionario de salud SF-36): un instrumento para la medida de los resultados clínicos. Med Clin (Barc) 104:771–776Google Scholar
  19. 19.
    Badía X, Roset M, Montserrat S et al (1999) La versión española del EuroQol: descripción y aplicaciones. Med Clin (Barc) 112(suppl 1):S79–S86Google Scholar
  20. 20.
    Martín García-Almenta M, Camuñas Segovia J, Sánchez Pernaute A et al (2007) Adaptación transcultural del cuestionario de calidad de vida de Moorehead-Ardelt II en pacientes intervenidos de obesidad mórbida. Nutr Hosp. 22:254–278Google Scholar
  21. 21.
    Bilbao A, Mar J, Mar B et al (2009) Validation of the Spanish Translation of the Questionnaire for the Obesity-Related Problems Scale. Obes Surg 19:1393–1400PubMedCrossRefGoogle Scholar
  22. 22.
    Health Survey of the Basque Country. (Encuesta de Salud del País Vasco, ESCAV 2002). Department of Health, Government of the Basque Country.
  23. 23.
    Kazis LE, Anderson JJ, Meenan RF (1989) Effect sizes for interpreting changes in health status. Med Care 27:S178–S189PubMedCrossRefGoogle Scholar
  24. 24.
    Brazier J, Deverill M, Green C, et al (1999) A review of the use of health status measures in economic evaluation. Health Technol Asses 3(9):i–iv, 1–164Google Scholar
  25. 25.
    Deyo RA, Centor RM (1986) Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. J Chronic Dis 39:897–906PubMedCrossRefGoogle Scholar
  26. 26.
    Cohen J (1998) Statistical power analysis for the behavioural sciences. Lawrence Earlbaum, New JerseyGoogle Scholar
  27. 27.
    Mar J, Larrañaga I, Arrospide A et al (2010) Impact of disability on different domains of health-related quality of life in the noninstitutionalized general population. Clinicoecon Outcomes Res 2:97–103PubMedCrossRefGoogle Scholar
  28. 28.
    Müller MK, Wenger C, Schiesser M et al (2008) Quality of life after bariatric surgery—a comparative study of laparoscopic banding vs. bypass. Obes Surg 18:1551–1557PubMedCrossRefGoogle Scholar
  29. 29.
    Ogden J, Clementi C (2010) The experience of being obese and the many consequences of stigma. J Obes. 2010. [pii:429098]Google Scholar
  30. 30.
    Mannucci E, Petroni ML, Villanova N et al (2010) Clinical and psychological correlates of health-related quality of life in obese patients. Health Qual Life Outcomes 8:90PubMedCrossRefGoogle Scholar
  31. 31.
    Dixon JB, Dixon ME, O’Brien PE (2001) Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res 9:713–721PubMedCrossRefGoogle Scholar
  32. 32.
    Pilone V, Mozzi E, Schettino AM, Italian Group for Lap-Band et al (2012) Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 8:260–268PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Javier Mar
    • 1
    • 2
  • Jan Karlsson
    • 3
  • Arantzazu Arrospide
    • 6
  • Blanca Mar
    • 4
  • Gabriel Martínez de Aragón
    • 5
  • Cándido Martinez-Blazquez
    • 5
  1. 1.Clinical Management ServiceAlto Deba HospitalMondragonSpain
  2. 2.Health Research Unit (West Gipuzkoa)Alto Deba HospitalMondragonSpain
  3. 3.Centre for Health Care Sciences, Department of Medicine, School of Health and Medical SciencesÖrebro University HospitalÖrebroSweden
  4. 4.Surgery DepartmentDonostia HospitalDonostia-San SebastiánSpain
  5. 5.Surgery DepartmentTxagorritxu HospitalVitoria-GasteizSpain
  6. 6.Health Research Unit (AP-OSIs Gipuzkoa)Alto Deba HospitalMondragonSpain

Personalised recommendations