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Bodyweight, gender, and quality of life: a population-based longitudinal study

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An Erratum to this article was published on 01 December 2011

Abstract

Purpose

The objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III.

Methods

Data come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3,864 men and 4,745 women who were 40+ in 1998/1999 and followed through 2006/2007. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used.

Results

HRQL declined with age. For men, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For women being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise, for women, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III.

Conclusions

Given that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for men are surprising. The HRQL results for women may reflect both the importance of body image on mental health and the health effects of excess weight.

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Abbreviations

BMI:

Body mass index

HRQL:

Health-related quality of life

HUI3:

Health Utilities Index Mark 3

NHANES:

National Health and Nutrition Examination Survey

NPHS:

National Population Health Survey

RR:

Relative risk

SF-36:

Short-Form 36

US:

United States

References

  1. Haslam, D. W., & James, W. P. (2005). Obesity. Lancet, 366(9492), 1197–1209.

    Article  PubMed  Google Scholar 

  2. Wei, M., Kampert, J. B., Barlow, C. E., Nichaman, M. Z., Gibbons, L. W., Paffenbarger, R. S., Jr., et al. (1999). Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA, 282(16), 1547–1553.

    Article  PubMed  CAS  Google Scholar 

  3. Samanic, C., Chow, W. H., Gridley, G., Jarvholm, B., & Fraumeni, J. F., Jr. (2006). Relation of body mass index to cancer risk in 362, 552 Swedish men. Cancer Causes and Control, 17(7), 901–909.

    Article  PubMed  Google Scholar 

  4. Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and update. Obesity (Silver Spring), 17(5), 941–964.

    Article  Google Scholar 

  5. Klarenbach, S., Padwal, R., Chuck, A., & Jacobs, P. (2006). Population-based analysis of obesity and workforce participation. Obesity (Silver Spring), 14(5), 920–927.

    Article  Google Scholar 

  6. Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J., Carnes, B. A., Brody, J., et al. (2005). A potential decline in life expectancy in the United States in the 21st century. New England Journal of Medicine, 352(11), 1138–1145.

    Article  PubMed  CAS  Google Scholar 

  7. Flegal, K. M., Williamson, D. F., Pamuk, E. R., & Rosenberg, H. M. (2004). Estimating deaths attributable to obesity in the United States. American Journal of Public Health, 94(9), 1486–1489.

    Article  PubMed  Google Scholar 

  8. Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293(15), 1861–1867.

    Article  PubMed  CAS  Google Scholar 

  9. Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2007). Cause-specific excess deaths associated with underweight, overweight, and obesity. The Journal of the American Medical Association, 298(17), 2028–2037.

    Article  CAS  Google Scholar 

  10. Muennig, P., Lubetkin, E., Jia, H., & Franks, P. (2006). Gender and the burden of disease attributable to obesity. American Journal of Public Health, 96(9), 1662–1668.

    Article  PubMed  Google Scholar 

  11. Adams, K. F., Schatzkin, A., Harris, T. B., Kipnis, V., Mouw, T., Ballard-Barbash, R., et al. (2006). Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. New England Journal of Medicine, 355(8), 763–778.

    Article  PubMed  CAS  Google Scholar 

  12. Yang, W., Kelly, T., & He, J. (2007). Genetic epidemiology of obesity. Epidemiologic Reviews, 29, 49–61.

    Article  PubMed  Google Scholar 

  13. Bender, R., Zeeb, H., Schwarz, M., Jockel, K. H., & Berger, M. (2006). Causes of death in obesity: Relevant increase in cardiovascular but not in all-cancer mortality. Journal of Clinical Epidemiology, 59(10), 1064–1071.

    Article  PubMed  Google Scholar 

  14. Willcox, B. J., He, Q., Chen, R., Yano, K., Masaki, K. H., Grove, J. S., et al. (2006). Midlife risk factors and healthy survival in men. JAMA, 296(19), 2343–2350.

    Article  PubMed  CAS  Google Scholar 

  15. Freedman, D. M., Sigurdson, A. J., Rajaraman, P., Doody, M. M., Linet, M. S., & Ron, E. (2006). The mortality risk of smoking and obesity combined. American Journal of Preventive Medicine, 31(5), 355–362.

    Article  PubMed  Google Scholar 

  16. Lantz, P. M., Golberstein, E., House, J. S., & Morenoff, J. (2010). Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Social science & Medicine, 70(10), 1558–1566.

    Article  Google Scholar 

  17. Whitlock, G., Lewington, S., Sherliker, P., Clarke, R., Emberson, J., Halsey, J., et al. (2009). Body-mass index and cause-specific mortality in 900,000 adults: Collaborative analyses of 57 prospective studies. Lancet, 373(9669), 1083–1096.

    Article  PubMed  Google Scholar 

  18. Berrington de Gonzalez, A., Hartge, P., Cerhan, J. R., Flint, A. J., Hannan, L., MacInnis, R. J., et al. (2010). Body-mass index and mortality among 1.46 million white adults. The New England Journal of Medicine, 363(23), 2211–2219.

    Article  PubMed  CAS  Google Scholar 

  19. Mehta, N. K., & Chang, V. W. (2009). Mortality attributable to obesity among middle-aged adults in the United States. Demography, 46(4), 851–872.

    Article  PubMed  Google Scholar 

  20. Orpana, H. M., Berthelot, J. M., Kaplan, M. S., Feeny, D. H., McFarland, B., & Ross, N. A. (2010). BMI and mortality: Results from a national longitudinal study of Canadian adults. Obesity (Silver Spring), 18(1), 214–218.

    Article  Google Scholar 

  21. Trakas, K., Oh, P. I., Singh, S., Risebrough, N., & Shear, N. H. (2001). The health status of obese individuals in Canada. International journal of obesity and related metabolic disorders, 25(5), 662–668.

    Article  PubMed  CAS  Google Scholar 

  22. Hopman, W. M., Berger, C., Joseph, L., Barr, S. I., Gao, Y., Prior, J. C., et al. (2007). The association between body mass index and health-related quality of life: Data from CaMos, a stratified population study. Quality of Life Research, 16(10), 1595–1603.

    Article  PubMed  Google Scholar 

  23. Kortt, M. A., & Clarke, P. M. (2005). Estimating utility values for health states of overweight and obese individuals using the SF-36. Quality of Life Research, 14(10), 2177–2185.

    Article  PubMed  Google Scholar 

  24. Renzaho, A., Wooden, M., & Houng, B. (2010). Associations between body mass index and health-related quality of life among Australian adults. Quality of Life Research, 19(4), 515–520.

    Article  PubMed  Google Scholar 

  25. Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343.

    Article  PubMed  CAS  Google Scholar 

  26. Soltoft, F., Hammer, M., & Kragh, N. (2009). The association of body mass index and health-related quality of life in the general population: Data from the 2003 Health Survey of England. Quality of Life Research, 18(10), 1293–1299.

    Article  PubMed  CAS  Google Scholar 

  27. Bentley, T. G. K., Palta, M., Paulsen, A., Cherepanov, D., Dunham, N. C., Feeny, D., et al. (2011). Race and gender associations between obesity and nine health related quality of life measures. Quality of Life Research, 5(20), 655–674.

    Google Scholar 

  28. Strandberg, T. E., Strandberg, A., Salomaa, V. V., Pitkala, K., & Miettinen, T. A. (2003). Impact of midlife weight change on mortality and quality of life in old age. Prospective cohort study. International Journal of Obesity and Related Metabolic Disorders, 27(8), 950–954.

    Article  PubMed  CAS  Google Scholar 

  29. Hays, R. D., & Morales, L. S. (2001). The RAND-36 measure of health-related quality of life. Annals of Medicine, 33(5), 350–357.

    Article  PubMed  CAS  Google Scholar 

  30. Pinto, A.M., Kuppermann, M., Nakagawa, S., Vittinghoff, E., Wing, R.R., Kusek, J.W. et al. (2011). Comparison and correlates of three preference-based health-related quality-of-life measures among overweight and obese women with urinary incontinence. Quality of Life Research. doi:10.1007/s11136-011-9896-5.

  31. Sullivan, P. W., Ghushchyan, V. H., & Ben-Joseph, R. (2008). The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Quality of Life Research, 17(8), 1063–1071.

    Article  PubMed  Google Scholar 

  32. Serrano-Aguilar, P., Munoz-Navarro, S. R., Ramallo-Farina, Y., & Trujillo-Martin, M. M. (2009). Obesity and health related quality of life in the general adult population of the Canary Islands. Quality of Life Research, 18(2), 171–177.

    Article  PubMed  CAS  Google Scholar 

  33. Sach, T. H., Barton, G. R., Doherty, M., Muir, K. R., Jenkinson, C., & Avery, A. J. (2007). The relationship between body mass index and health-related quality of life: Comparing the EQ-5D, EuroQol VAS and SF-6D. International journal of obesity (London), 31(1), 189–196.

    Article  CAS  Google Scholar 

  34. Jia, H., & Lubetkin, E. I. (2005). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health (Oxford), 27(2), 156–164.

    Article  Google Scholar 

  35. Minet, K. J., & Morris, S. (2010). Socioeconomic variation in the impact of obesity on health-related quality of life. Social Science and Medicine, 71(10), 1864–1871.

    Article  Google Scholar 

  36. Dixon, J. B. (2010). The effect of obesity on health outcomes. Molecular and Cellular Endocrinology, 316(2), 104–108.

    Article  PubMed  CAS  Google Scholar 

  37. Tambay, J. L., & Catlin, G. (1995). Sample design of the national population health survey. Health Reports, 7(1), 29–42.

    PubMed  CAS  Google Scholar 

  38. Ezzati, M., Martin, H., Skjold, S., Vander, H. S., & Murray, C. J. (2006). Trends in national and state-level obesity in the USA after correction for self-report bias: Analysis of health surveys. Journal of the Royal Society of Medicine, 99(5), 250–257.

    Article  PubMed  Google Scholar 

  39. St-Pierre, M., & Beland, Y. (2004). Mode effects in the Canadian community health survey: A comparison of CAPI and CATI, Proceedings of the American Statistical Association. 2004 Proceedings of the American Statistical Association Meeting. Survey Research Methods. Alexandria, VA: American Statistical Association.

    Google Scholar 

  40. Horsman, J., Furlong, W., Feeny, D., & Torrance, G. (2003). The Health Utilities Index (HUI®): Concepts, measurement properties and applications. Health and Quality of Life Outcomes, 1(1), 54.

    Article  PubMed  Google Scholar 

  41. Asakawa, K., Rolfson, D., Senthilselvan, A., Feeny, D., & Johnson, J. A. (2008). Health Utilities Index Mark 3 showed valid in Alzheimer Disease, arthritis, and cataracts. Journal of Clinical Epidemiology, 61(7), 733–739.

    Article  PubMed  Google Scholar 

  42. Feeny, D., Huguet, N., McFarland, B. H., & Kaplan, M. S. (2009). The construct validity of the Health Utilities Index Mark 3 in assessing mental health in population health surveys. Quality of Life Research, 18(4), 519–526.

    Article  PubMed  Google Scholar 

  43. Kaplan, M. S., Berthelot, J. M., Feeny, D. H., McFarland, B., & Kahn, S. (2007). The predictive validity of two measures of health-related quality of life: Mortality in a longitudinal population-based study. Quality of Life Research, 16(9), 1539–1546.

    Article  PubMed  Google Scholar 

  44. Maddigan, S. L., Feeny, D. H., Majumdar, S. R., Farris, K. B., & Johnson, J. A. (2006). Health Utilities Index mark 3 demonstrated construct validity in a population-based sample with type 2 diabetes. Journal of Clinical Epidemiology, 59(5), 472–477.

    Article  PubMed  Google Scholar 

  45. Maddigan, S. L., Feeny, D. H., Majumdar, S. R., Farris, K. B., & Johnson, J. A. (2006). Understanding the determinants of health for people with type 2 diabetes. American Journal of Public Health, 96(9), 1649–1655.

    Article  PubMed  Google Scholar 

  46. Orpana, H. M., Ross, N., Feeny, D., McFarland, B., Bernier, J., & Kaplan, M. (2009). The natural history of health-related quality of life: A 10-year cohort study. Health Reports, 20(1), 1–7.

    Google Scholar 

  47. Asakawa, K., Feeny, D., Senthilselvan, A., Johnson, J. A., & Rolfson, D. (2009). Do the determinants of health differ between people living in the community and in institutions? Social Science and Medicine, 69(3), 345–353.

    Article  PubMed  Google Scholar 

  48. Garster, N. C., Palta, M., Sweitzer, N. K., Kaplan, R. M., & Fryback, D. G. (2009). Measuring health-related quality of life in population-based studies of coronary heart disease: Comparing six generic indexes and a disease-specific proxy score. Quality of Life Research, 18(9), 1239–1247.

    Article  PubMed  Google Scholar 

  49. Feeny, D. H., Furlong, W., Torrance, G. W., Goldsmith, C. H., Zhu, Z., DePauw, S., et al. (2002). Multi-attribute and single-attribute utility functions for the health utilities index mark 3 system. Medical Care, 40(2), 113–128.

    Article  PubMed  Google Scholar 

  50. Drummond, M. (2001). Introducing economic and quality of life measurements into clinical studies. Annals of Medicine, 33(5), 344–349.

    Article  PubMed  CAS  Google Scholar 

  51. Grootendorst, P., Feeny, D., & Furlong, W. (2000). Health Utilities Index Mark 3: Evidence of construct validity for stroke and arthritis in a population health survey. Medical Care, 38(3), 290–299.

    Article  PubMed  CAS  Google Scholar 

  52. Bernier, J., Feng, Y., & Asakawa, K. (2011). Using multilevel growth model for assessing the variation of HUI3 trajectories. Health Reports, in press.

  53. Maddigan, S. L., Feeny, D. H., & Johnson, J. A. (2005). Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey. Quality of Life Research, 14(5), 1311–1320.

    Article  PubMed  Google Scholar 

  54. Bowker, S. L., Pohar, S. L., & Johnson, J. A. (2006). A cross-sectional study of health-related quality of life deficits in individuals with comorbid diabetes and cancer. Health Quality of Life Outcomes, 4, 17.

    Article  Google Scholar 

  55. Welch, K. C., & Scharf, S. M. (2007). Construct validity for the Health Utilities Index in a sleep center. Sleep Breath, 11(4), 295–303.

    Article  PubMed  Google Scholar 

  56. Zajacova, A., Dowd, J. B., & Burgard, S. A. (2011). Overweight adults may have the lowest mortality–do they have the best health? American Journal of Epidemiology, 173(4), 430–437.

    Article  PubMed  Google Scholar 

  57. Visser, M., Bouter, L. M., McQuillan, G. M., Wener, M. H., & Harris, T. B. (1999). Elevated C-reactive protein levels in overweight and obese adults. The Journal of the American Medical Association, 282(22), 2131–2135.

    Article  CAS  Google Scholar 

  58. Puhl, R. M., Andreyeva, T., & Brownell, K. D. (2008). Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. International Journal of Obesity (London), 32(6), 992–1000.

    Article  CAS  Google Scholar 

  59. Gorber, S., Shields, M., Tremblay, M. S., & McDowell, I. (2008). The feasibility of establishing correction factors to adjust self-reported estimates of obesity. Health Reports, 19(3), 71–82.

    Google Scholar 

  60. Janssen, I., Shields, M., Craig, C.L., & Tremblay, M.S. (2011). Changes in the obesity phenotype within Canadian children and adults, 1981 to 2007–2009. Obesity (Silver Spring). doi:10.1038/oby.2011.122.

  61. Shields, M., Tremblay, M. S., Laviolette, M., Craig, C. L., Janssen, I., & Gorber, S. C. (2010). Fitness of Canadian adults: Results from the 2007–2009 Canadian Health Measures Survey. Health Reports, 21(1), 21–35.

    PubMed  Google Scholar 

  62. Swain, L., Catlin, G., & Beaudet, M. P. (1999). The National Population Health Survey–its longitudinal nature. Health Reports, 10(4), 69–82.

    PubMed  CAS  Google Scholar 

  63. Moorehead, M. K., Ardelt-Gattinger, E., Lechner, H., & Oria, H. E. (2003). The validation of the Moorehead-Ardelt quality of life questionnaire II. Obesity Surgery, 13(5), 684–692.

    Article  PubMed  Google Scholar 

  64. Kolotkin, R. L., Head, S., Hamilton, M., & Tse, C. K. (1995). Assessing impact of weight on quality of life. Obesity Research, 3(1), 49–56.

    PubMed  CAS  Google Scholar 

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Acknowledgments

The authors acknowledge the contributions of Jillian Oderkirk and Kathy Easter to the research reported here. The authors also acknowledge the constructive comments and suggestions made by three anonymous reviewers. This study was supported by National Institutes of Health grants AG027129 from the National Institute on Aging and DK080277 from the National Institute of Diabetes and Digestive and Kidney Diseases. The funding source had no involvement in the collection, analysis, and interpretation of the data, in the writing of the paper, and did not review or approve of the manuscript prior to its submission for publication. The work reported here was previously presented at the Canadian Institute for Health Information and Statistics Canada Data Users Conference 2010 in Ottawa, September 20–21, 2010; Department of Clinical Epidemiology and Biostatistics CE & B Rounds, McMaster University, Hamilton, Ontario, September 22, 2010; and 17th Annual Meeting of the International Society for Quality of Life Research, London, October 27–30, 2010. The authors are grateful for the constructive comments received at those three presentations.

Conflict of interest

It should be noted that David Feeny has a proprietary interest in Health Utilities Incorporated (HUInc.), Dundas, Ontario, Canada. HUInc. distributes copyrighted Health Utilities Index (HUI) materials and provides methodological advice on the use of HUI. It should be noted that HUInc. received no payment for the use of HUI in the study reported in this manuscript. None of the other authors declare any competing interests.

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Authors and Affiliations

  1. Health Analysis Division, Statistics Canada, Ottawa, ON, Canada

    Rochelle E. Garner & Julie Bernier

  2. The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227-1110, USA

    David H. Feeny

  3. Institute of Health Economics, University of Alberta, Edmonton, Canada

    David H. Feeny

  4. Health Utilities Incorporated, Dundas, ON, Canada

    David H. Feeny

  5. Department of Psychology, University of Ottawa, Ottawa, ON, Canada

    Amanda Thompson & Heather Orpana

  6. Departments of Psychiatry and Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA

    Bentson H. McFarland

  7. School of Community Health, Portland State University, Portland, OR, USA

    Nathalie Huguet & Mark S. Kaplan

  8. Department of Geography, McGill University, Montreal, QC, Canada

    Nancy A. Ross

  9. Department of Medicine, Dalhousie University, Halifax, NS, Canada

    Chris Blanchard

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  1. Rochelle E. Garner
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  2. David H. Feeny
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  3. Amanda Thompson
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Corresponding author

Correspondence to David H. Feeny.

Appendix

Appendix

As noted in the main text of the paper, overall HUI3 scores were highly skewed and were transformed using the arcsine transformation to achieve normally distributed residuals.

The methods are explained in detail in Bernier et al. [52]. The formula used to adjust HUI3 values is given below:

$$ {\text{HUI}}3 = \left[ {\left( {\sin \left( {\arcsin \,{\text{HUI}}3_{\text{adj}} } \right) + 1} \right) \times \left( {\frac{1.36}{2}} \right)} \right] - 0.36 $$

Due to this adjustment and transformation, coefficients from growth curve models cannot be interpreted directly as changes in HUI3. Therefore, it was necessary to back-transform predicted values to the original metric prior to graphing the results.

$$ \arcsin \,{\text{HUI}}3_{\text{adj}} = \arcsin \left[ {2\left( {\frac{{{\text{HUI}}3 + 0.36}}{1.36}} \right) - 1} \right] $$

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Garner, R.E., Feeny, D.H., Thompson, A. et al. Bodyweight, gender, and quality of life: a population-based longitudinal study. Qual Life Res 21, 813–825 (2012). https://doi.org/10.1007/s11136-011-9989-1

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