Quality of Life Research

, Volume 6, Issue 4, pp 311–322 | Cite as

Assessing health-related quality-of-life and health state preference in persons with obesity: a validation study

  • Susan D Mathias
  • Cynthia L Williamson
  • Hilary H Colwell
  • Miriam G Cisternas
  • David J Pasta
  • Bradley S Stolshek
  • Donald L Patrick


The objective of this study was to assess the reliability, validity and responsiveness of a new health-related quality-of-life (HRQOL) measure containing global and obesity-specific domains and an obesity-specific health state preference (HSP) assessment. A total of 417 obese and ‘normal’ weight individuals completed these assessments. Internal consistency and test-retest reliability were demonstrated, with Cronbach's ?, intraclass correlation coefficient and ? values well above the acceptable level for most scales. Construct validity hypotheses were confirmed by examining scale correlations. The normal weight individuals reported statistically significantly better functioning and well-being on the majority of the HRQOL scales and HSP than obese individuals. Guyatt's statistic of responsiveness was moderate to high for all the scales and items in the weight-loss and weight-gain groups; however, many of the scales and items in the weight-stable group also displayed responsiveness. The results of this study support the reliability and validity of these assessments. However, further testing is needed to evaluate the responsiveness of both assessments in a weight-stable group.

Key words: Obesity; quality-of-life instrument health state preference validation. 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    NIH Technology Assessment Conference Statement, 30 March-1 April, 1992.Google Scholar
  2. 2.
    Laurier D, Guiguet M, Chau NP, Wells JA, Valleron A-J. Prevalence of obesity: a comparative survey in France, the United Kingdom and the United States. Int J Obesity 1992; 16: 565-572.Google Scholar
  3. 3.
    Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among U.S. adults. JAMA 1994; 272: 205-211.Google Scholar
  4. 4.
    Lissner L. Causes, diagnosis and risks of obesity. PharmacoEconomics 1993; 5(Suppl 1): 8-17.Google Scholar
  5. 5.
    Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final version of a health status measure. Med Care 1981; 1: 787-805.Google Scholar
  6. 6.
    Kaplan RM, Bush JW, Berry CC. Health status: types of validity and the index of well-being. Health Service Res 1976; 11; 478-507.Google Scholar
  7. 7.
    Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Commun Health 1980; 34: 281-286.Google Scholar
  8. 8.
    Sullivan MBE, Sullivan LGM, Kral JG. Quality of life assessment in obesity: physical, psychological, and social function. Gastroenterol Clin North Am 1987; 16: 433-442.Google Scholar
  9. 9.
    Kolotkin R, Head S, Hamilton M, Tse C. Assessing impact of weight on quality of life. Obesity Res 1995; 3:49-56.Google Scholar
  10. 10.
    Davies AR, Sherbourne CD, Peterson JR, Ware JE Jr. Scoring Manual: Adult Health Status and Patient Satisfaction Measures Used in RAND's Health Insurance Experiment.(Santa Monica, Ca: The RAND Corporation): 96-111.Google Scholar
  11. 11.
    Sjöberg L, Svensson E, Persson L-O. The measurement of mood. Scand J Psychol 1979; 20: 1-18.Google Scholar
  12. 12.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370.Google Scholar
  13. 13.
    Sullivan M, Karlsson J, Sjöström et al. Swedish obese subjects (SOS)–an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. Int J Obesity 1993; 17: 503-512.Google Scholar
  14. 14.
    Torrance GW. Utility approach to measuring healthrelated quality of life. J Chronic Dis 1987; 40: 593-600.Google Scholar
  15. 15.
    Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977; 1: 385-401.Google Scholar
  16. 16.
    Fleming J, Courtney B. The dimensionality of self-esteem: II. Hierarchical facet model for revised measurement scales. J Pers Soc Psychol 1984; 46: 404-421.Google Scholar
  17. 17.
    Stewart AL, Greenfield S, Hays RD et al.Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA 1989; 262: 907-913.Google Scholar
  18. 18.
    Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16: 297-334.Google Scholar
  19. 19.
    Scientific Advisory Committee. Instrument review criteria. Med Outcomes Trust Bull 1995: I-IV.Google Scholar
  20. 20.
    Cohen J. A coefficient of agreement for nominal scales. Educat Psychol Measure 1960; 20: 37-46.Google Scholar
  21. 21.
    Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials 1991; 12: 142S-158S.Google Scholar
  22. 22.
    Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials,2nd edition. Philadelphia, PA: Lippincott-Raven Publishers; 1996: 688.Google Scholar
  23. 23.
    Hochberg Y. Asharper Bonferroni procedure for multiple tests of significance. Biometrika 1988; 75: 800-802.Google Scholar
  24. 24.
    Fletcher A. Quality-of-life measurements in the evaluation of treatment: proposed guidelines. Br J Clin Pharmacol 1995; 39: 217-222.Google Scholar
  25. 25.
    Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York: Academic Press, 1977: 24-27.Google Scholar
  26. 26.
    SAS Institute. SAS Statistical Package for Personal Computers, Version 6.10. Cary, NC: SAS Institute.Google Scholar
  27. 27.
    Ware JE. SF-36 Health Survey Manual and Interpretation Guide. Boston, MA: Nimrod Press, 1993.Google Scholar
  28. 28.
    National Center for Health Statistics. Basic data on depressive symptomatology: United States, 1974-1975. In: Sayetta RB, Johnson DP, eds. Vital and Health Statistics. Washington, DC: Government Printing Office, 1980.Google Scholar
  29. 29.
    Radloff LS, Lock BZ. The community mental health assessment survey and the CES-D scale. In: Weissman MM, Myers JK, Ross CE, eds. Community Surveys of Psychiatric Disorders.New Brunswick, NJ: Rutgers University Press, 1986: 177-189.Google Scholar
  30. 30.
    Willett WC, Manson JE, Stampfer MJ, et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range. JAMA 1995: 273: 461-465.Google Scholar
  31. 31.
    Willett W, Stampfer MJ, Bain C, et al.Cigarette smoking, relative weight, and menopause. Am J Epidemiol 1983; 117: 651-658.Google Scholar
  32. 32.
    Stunkard AJ, Albaum JM. The accuracy of self-reported weights. Am J Clin Nutr 1981; 34: 1593-1599.Google Scholar

Copyright information

© Chapman and Hall 1997

Authors and Affiliations

  • Susan D Mathias
    • 1
  • Cynthia L Williamson
    • 1
  • Hilary H Colwell
    • 1
  • Miriam G Cisternas
    • 1
  • David J Pasta
    • 1
  • Bradley S Stolshek
    • 2
  • Donald L Patrick
    • 3
  1. 1.Technology Assessment GroupSan FranciscoUSA
  2. 2.Hoffmann-La RocheNutleyUSA
  3. 3.Department of Health ServicesUniversity of Washington at SeattleSeattleUSA

Personalised recommendations