Skip to main content
SpringerLink
Log in

Patient-Level Factors Associated with Health-Related Quality of Life and Satisfaction with Body After Bariatric Surgery: a Multicenter, Cross-Sectional Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Health-Related Quality of Life (HRQL) is a key outcome of success after bariatric surgery. Not all patients report improved HRQL scores postoperatively, which may be due to patient-level factors. It is unknown which factors influence HRQL after surgery. Our objective was to assess patient-level factors associated with HRQL after surgery.

Methods

This international cross-sectional study included 730 patients who had bariatric surgery. Participants completed BODY-Q scales pertaining to HRQL and satisfaction with body, and demographic characteristics were obtained. The sample was divided into three groups based on time since surgery: 0 – 1 year, 1 – 3 years and more than 3 years. Uni- and multivariable linear regression analyses were conducted to identify variables associated with the BODY-Q scales per group.

Results

The 0 – 1 year postoperative group included 377 patients (50.9%), the 1 – 3 years postoperative group 218 (29.4%) and the more than 3 years postoperative group 135 patients (18.2%). Lower current body-mass index (BMI), more weight loss (%TWL), being employed, having no comorbidities, higher age and shorter time since surgery were significantly associated with improved HRQL outcomes postoperatively. None of these factors influenced all BODY-Q scales. The effect of current BMI increased with longer time since surgery.

Conclusion

Factors including current BMI, %TWL, employment status, presence of comorbidities, age and time since surgery were associated with HRQL postoperatively. This information may be used to optimize patient-tailored care, improve patient education and underline the importance of long-term follow-up with special attention to weight regain to ensure lasting improvement in HRQL.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014;CD003641.

  2. Neylan CJ, Kannan U, Dempsey DT, Williams NN, Dumon KR. The surgical management of obesity. Gastroenterol Clin North Am. 2016;45(4):689–703.

    Article  Google Scholar 

  3. Panagiotou OA, Markozannes G, Adam GP, Kowalski R, Gazula A, Di M, et al. Comparative effectiveness and safety of bariatric procedures in Medicare-eligible patients: a systematic review. JAMA Surg. 2018;153:e183326.

    Article  Google Scholar 

  4. Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.

    Article  Google Scholar 

  5. Coulman KD, Hopkins J, Brookes ST, Chalmers K, Main B, Owen-Smith A, et al. A core outcome set for the benefits and adverse events of bariatric and metabolic surgery: the BARIACT Project. PLOS Med. 2016;13:e1002187.

    Article  Google Scholar 

  6. Centers for Disease Control and Prevention. Measuring healthy days: population assessment of health-related quality of life. Centers for Disease Control and Prevention; 2000. https://www.cdc.gov/hrqol/pdfs/mhd.pdf.

  7. Weldring T, Smith SMS. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights. 2013;6:61–8.

    PubMed  PubMed Central  Google Scholar 

  8. Coulman KD, Abdelrahman T, Owen-Smith A, Andrews RC, Welbourn R, Blazeby JM. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev. 2013;14:707–20.

    Article  CAS  Google Scholar 

  9. Coulman KD, Blazeby JM. Health-related quality of life in bariatric and metabolic surgery. Curr Obes Rep. 2020;9:307–14.

    Article  Google Scholar 

  10. Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7:273–89.

    Article  CAS  Google Scholar 

  11. Jumbe S, Bartlett C, Jumbe SL, Meyrick J. The effectiveness of bariatric surgery on long term psychosocial quality of life—a systematic review. Obes Res Clin Pract. 2016;10:225–42.

    Article  Google Scholar 

  12. Szmulewicz A, Wanis KN, Gripper A, Angriman F, Hawel J, Elnahas A, et al. Mental health quality of life after bariatric surgery: a systematic review and meta-analysis of randomized clinical trials. Clin Obes. 2019;9:e12290.

    Article  Google Scholar 

  13. Rausa E, Kelly ME, Galfrascoli E, Aiolfi A, Cavalcoli F, Turati L, et al. Quality of life and gastrointestinal symptoms following laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2019;29:1397–402.

    Article  Google Scholar 

  14. Flølo TN, Tell GS, Kolotkin RL, Aasprang A, Norekvål TM, Våge V, et al. Changes in quality of life 5 years after sleeve gastrectomy: a prospective cohort study. BMJ Open. 2019;9:e031170.

    Article  Google Scholar 

  15. deMeireles AJ, Carlin AM, Bonham AJ, Cassidy R, Ross R, Stricklen A, et al. A longitudinal analysis of variation in psychological well-being and body image in patients before and after bariatric surgery. Ann Surg. 2020;271:885–90.

    Article  Google Scholar 

  16. Dagsland V, Andenæs R, Karlsen T-I. Generic health-related quality of life may not be associated with weight loss 4 years after bariatric surgery: a cross-sectional study. Obes Surg. 2018;28:3142–50.

    Article  Google Scholar 

  17. Monpellier VM, Antoniou EE, Aarts EO, Janssen IMC, Jansen ATM. Improvement of health-related quality of life after Roux-en-Y gastric bypass related to weight loss. Obes Surg. 2017;27:1168–73.

    Article  Google Scholar 

  18. Sockalingam S, Hawa R, Wnuk S, Santiago V, Kowgier M, Jackson T, et al. Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: results from the Toronto Bari-PSYCH study. Gen Hosp Psychiatry. 2017;47:7–13.

    Article  Google Scholar 

  19. Khandalavala BN, Geske J, Nirmalraj M, Koran-Scholl JB, Neumann-Potash L, McBride CL. Predictors of health-related quality of life after bariatric surgery. Obes Surg. 2015;25:2302–5.

    Article  Google Scholar 

  20. Antonsson T, Wennersten A, Sörensen K, Regnér S, Ekelund M. Differences in health-related quality of life after gastric bypass surgery: a cross-sectional study. Obes Surg. 2021;31:3194–202.

    Article  Google Scholar 

  21. Gryth K, Persson C, Näslund I, Sundbom M, Näslund E, Stenberg E. The influence of socioeconomic factors on quality-of-life after laparoscopic gastric bypass surgery. Obes Surg. 2019;29:3569–76.

    Article  Google Scholar 

  22. Raoof M, Szabo E, Karlsson J, Näslund E, Cao Y, Näslund I. Improvements of health-related quality of life 5 years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register. Surg Obes Relat Dis. 2020;16:1249–57.

    Article  Google Scholar 

  23. Charalampakis V, Bertsias G, Lamprou V, de Bree E, Romanos J, Melissas J. Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study. Surg Obes Relat Dis. 2015;11:70–6.

    Article  Google Scholar 

  24. de Vries CEE, Kalff MC, Prinsen CAC, Coulman KD, den Haan C, Welbourn R, et al. Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review. Obes Rev. 2018;19:1395–411.

    Article  Google Scholar 

  25. de Vries CEE, Makarawung DJS, Monpellier VM, Janssen IMC, de Castro SMM, van Veen RN. Is the RAND-36 an adequate patient-reported outcome measure to assess health-related quality of life in patients undergoing bariatric surgery? Obes Surg. 2022;32(1):48–54.

  26. Klassen AF, Cano SJ, Alderman A, Soldin M, Thoma A, Robson S, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open. 2016;4:e679.

    Article  Google Scholar 

  27. Poulsen L, Klassen A, Rose M, Roessler KK, Juhl CB, Støving RK, et al. Patient-reported outcomes in weight loss and body contouring surgery: a cross-sectional analysis using the BODY-Q. Plast Reconstr Surg. 2017;140:491–500.

    Article  CAS  Google Scholar 

  28. Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res. 2019;19:13.

    Article  Google Scholar 

  29. Dalaei F, Vries CEE, Poulsen L, Kaur MN, Pfob A, Mou D, et al. General population normative scores for interpreting the BODY‐Q. Clin Obes [Internet]. 2022 [cited 2022 Jun 26]; Available from: https://onlinelibrary.wiley.com/doi/10.1111/cob.12528

  30. Klassen AF, Cano SJ, Kaur M, Breitkopf T, Pusic AL. Further psychometric validation of the BODY-Q: ability to detect change following bariatric surgery weight gain and loss. Health Qual Life Outcomes. 2017;15:227.

    Article  Google Scholar 

  31. Poulsen L, McEvenue G, Klassen A, Hoogbergen M, Sorensen JA, Pusic A. Patient-reported outcome measures: BODY-Q. Clin Plast Surg. 2019;46:15–24.

    Article  Google Scholar 

  32. Hachem A, Brennan L. Quality of life outcomes of bariatric surgery: a systematic review. Obes Surg. 2016;26:395–409.

    Article  Google Scholar 

  33. Andersen JR, Aasprang A, Karlsen T-I, Natvig GK, Våge V, Kolotkin RL. Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies. Surg Obes Relat Dis. 2015;11:466–73.

    Article  Google Scholar 

  34. Weinberger N-A, Kersting A, Riedel-Heller SG, Luck-Sikorski C. Body dissatisfaction in individuals with obesity compared to normal-weight individuals: a systematic review and meta-analysis. Obes Facts. 2016;9:424–41.

    Article  Google Scholar 

  35. Sarwer DB, Thompson JK, Cash TF. Body image and obesity in adulthood. Psychiatr Clin North Am. 2005;28:69–87, viii.

  36. Tiggemann M, McCourt A. Body appreciation in adult women: relationships with age and body satisfaction. Body Image. 2013;10:624–7.

    Article  Google Scholar 

  37. Voorwinde V, Steenhuis IHM, Janssen IMC, Monpellier VM, van Stralen MM. Definitions of long-term weight regain and their associations with clinical outcomes. Obes Surg. 2020;30:527–36.

    Article  Google Scholar 

  38. Diener E, Lucas RE, Scollon CN. Beyond the hedonic treadmill: revising the adaptation theory of well-being. Am Psychol. 2006;61:305–14.

    Article  Google Scholar 

  39. Hergenroeder AL, Brach JS, Otto AD, Sparto PJ, Jakicic JM. The influence of body mass index on self-report and performance-based measures of physical function in adult women. Cardiopulm Phys Ther J. 2011;22:11–20.

    Article  Google Scholar 

  40. Rogers NT, Power C, Pinto Pereira SM. Birthweight, lifetime obesity and physical functioning in mid-adulthood: a nationwide birth cohort study. Int J Epidemiol. 2020;49:657–65.

    Article  Google Scholar 

  41. Backholer K, Wong E, Freak-Poli R, Walls HL, Peeters A. Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis. Obes Rev. 2012;13:456–68.

    Article  CAS  Google Scholar 

  42. McDonough CM, Jette AM. The contribution of osteoarthritis to functional limitations and disability. Clin Geriatr Med. 2010;26:387–99.

    Article  Google Scholar 

  43. Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD. Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens. 2011;29:179–88.

    Article  CAS  Google Scholar 

  44. Wong E, Backholer K, Gearon E, Harding J, Freak-Poli R, Stevenson C, et al. Diabetes and risk of physical disability in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2013;1:106–14.

    Article  Google Scholar 

  45. Peterhänsel C, Nagl M, Wagner B, Dietrich A, Kersting A. Predictors of changes in health-related quality of life 6 and 12 months after a bariatric procedure. Obes Surg. 2017;27:2120–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands

    Dennis J. S. Makarawung

  2. Department of Plastic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands

    Dennis J. S. Makarawung & Aebele B. Mink van der Molen

  3. Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands

    Claire E. E. de Vries & Ruben N. van Veen

  4. Department of Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Claire E. E. de Vries, Emile B. List, Danny Mou & Andrea L. Pusic

  5. Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), Amersfoortseweg 43, 3712 BA, Huis Ter Heide, the Netherlands

    Valerie M. Monpellier

  6. Department of Pediatrics, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada

    Anne F. Klassen

Authors
  1. Dennis J. S. Makarawung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claire E. E. de Vries
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emile B. List
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valerie M. Monpellier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Danny Mou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne F. Klassen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea L. Pusic
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ruben N. van Veen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Aebele B. Mink van der Molen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dennis J. S. Makarawung.

Ethics declarations

Ethics Approval

‘All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards’.

Consent to Participate

‘Informed consent was obtained from all individual participants included in the study’.

Conflict of Interest

A.F. Klassen and A.L. Pusic are co-developers of the BODY-Q and, as such, obtain a share of any license revenues as royalties based on their institutions inventor sharing policy. All other authors report no relevant conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• Patient-level factors such as current BMI and weight loss are associated with HRQL.

• HRQL scores are highest in the first 3 years after bariatric surgery.

• This study highlights the importance of long-term follow-up regarding weight regain.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Makarawung, D.J.S., de Vries, C.E.E., List, E.B. et al. Patient-Level Factors Associated with Health-Related Quality of Life and Satisfaction with Body After Bariatric Surgery: a Multicenter, Cross-Sectional Study. OBES SURG 32, 3079–3087 (2022). https://doi.org/10.1007/s11695-022-06214-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-022-06214-6

Keywords

Search

Navigation