Assessing Quality of Life in Obesity

Transcription

1 Assessing Quality of Life in Obesity Obesity & Mental Health Toronto, June 26-28, 2012 Ronette ( Ronnie ) L. Kolotkin, Ph.D. Owner, Obesity and Quality of Life Consulting Consulting Professor, Duke University School of Medicine Durham, North Carolina U.S.A.

2 Image courtesy of Canadian Obesity Network

3 Health-Related Quality of Life (HRQOL) HRQOL may be defined as the impact of health or disease on: physical, mental, and social well-being of the patient from the patient s point of view

4 GI symptoms bother me! I m worried and concerned Heartburn disturbs my sleep I cannot bend over or exercise Wilklund, 2002 My whole life is affected I cannot eat and drink whatever I like

5 Quality of life is an important health outcome in its own right, representing the ultimate goal of all health interventions. Dr. Richard Rubin: Professor of Medicine at Johns Hopkins School of Medicine; past president of the American Diabetes Association; Rubin et al., 1999)

6 Interest in Quality of Life Has Grown with Obesity Epidemic Published papers 1993: 24 articles on QOL in obesity (mostly anecdotal reports) 2012: over 3000 articles Obesity-specific questionnaires 1993: Obesity-Related Psychosocial Problems (OP Scale) from Swedish Obese Subjects studies 1995: Impact of Weight on Quality of Life (IWQOL) Currently: 14 questionnaires on QOL in obesity

7 Methods of Assessing HRQOL 1-Clinical interviews 2. Qualitative Studies 3-Standardized questionnaires Generic questionnaires Weight-related questionnaires

8 Clinical Interviews What obese U.S. patients in weight loss treatment say about themselves in clinical interviews

9 How does your weight affect your day to day life? Impaired mobility and physical limitations Low energy and fatigue Too big to fit into environment Impaired social life Discrimination and prejudice Impaired selfesteem and body esteem Impaired sexual and romantic life

10 Qualitative Studies Open-ended interviews of obese patients to learn about their experiences of obesity and weight loss E.g. Bocchieri et al, 2002; Meana and Ricciardi, 2008 (Obesity Surgery: Stories of Altered Lives) 31 postoperative gastric bypass patients 6 months to 11 years post-surgery (mean 28 months)

11 Positive Psychosocial Outcomes After Large Weight Reduction Through Bariatric Surgery: Qualitative Study (Bocchieri et al., 2002) Dramatic positive life changes Sense of rebirth and transformation Increase in physical abilities Resolved medical conditions/pain Ability to envision a longer and more satisfying future Improved occupational status Enhanced parenting ability

12 There may be unexpected negative consequences associated with large weight reductions

13 Negative Psychosocial Outcomes After Large Weight Reduction Through Bariatric Surgery (Bocchieri et al., 2002) Tension-Generating Changes: Social Old friends treat you differently Activities associated with old friends no longer desirable (I.e., eating) Changes in marital/relationship dynamics Feelings of resentment toward people who treat them better post-operatively Anger (and relief) at witnessing discrimination of other obese individuals

14 Negative Psychosocial Outcomes After Large Weight Reduction Through Bariatric Surgery (Bocchieri et al., 2002) Tension-Generating Changes: Existential Loss of old identity and confusion about new identity Increased feelings of vulnerability (especially if history of physical or sexual abuse) Angry that old problems persist in spite of weight loss Loss of obesity as an excuse Loss of weight as protection from anxiety-provoking situations Development of new standards and behaviors, e.g. increased assertiveness and expectations

15 Qualitative studies are useful for furthering our understanding of the effects of obesity and weight loss on QOL There is a need for ongoing support for obese persons in treatment (chronic disease model)

16 Standardized Questionnaires Generic measures of HRQOL Broad, general aspects of HRQOL E.g. SF-36 (adults), PedsQL (youth)

17 Physical HRQOL: Sample SF-36 Items (0-100; 100 = Best HRQOL) Does your health now limit you in these activities: E.g., Walking several blocks; lifting or carrying groceries. (Physical Functioning) Have you accomplished less than you would like as a result of your physical health? (Role-Physical) How much bodily pain have you had during the past 4 weeks? (Bodily Pain) In general would you say your health is: e.g., I am as healthy as anybody I know. (General Health) Ware J, et al. Med Care 1992;30:

18 Mental HRQOL: Sample SF-36 Items (0-100; 100 = Best HRQOL) How much of the time did you feel full of pep? (Vitality) How much of the time has your physical health or emotional problems interfered with your normal social activities? (Social Functioning) Have you accomplished less than you would like as a result of any emotional problems? (Role- Emotional) How much of the time have you been a very nervous person? (Mental Health) Ware J, et al. Med Care 1992;30:

19 SF-36 Scores by BMI For Middle Aged Women in Australia (Brown et al, 1998)

20 Mean Physical and Mental Component Summary Scores of the SF-36 by Weight & Illness Category (postal survey in England; Doll et al, 2000)

21 Obese Lap-Band Patients With and Without Depression (Dixon et al., 2001)

22 Standardized Questionnaires Disease-Specific measures Characteristics/complaints of particular disease E.g. IWQOL-Lite (adults), OWLQOL (adults), IWQOL-Kids (youth)

23 Sample IWQOL-Lite Items (0-100; 100 = Best HRQOL) Because of my weight I have trouble putting on or taking off my clothing. (Physical Function) Because of my weight I am afraid of being rejected. (Self-Esteem) Because of my weight I do not enjoy sexual activity. (Sexual Life) Because of my weight I experience ridicule, teasing, or unwanted attention. (Public Distress) Because of my weight I am less productive than I could be. (Work) Kolotkin, et al., 2001

24 Gender and QOL

25 Women experience a greater negative impact of weight on quality of life

26 IWQOL-Lite Scales by Gender Adjusted for BMI (n=9,991) (Zabelina et al., 2009) * * * * *

27 Women are Five Times More Likely to Seek Bariatric Surgery than Men (Samuel et al., 2006) Data from 137 bariatric surgeons and >41,000 patients internationally indicate that 85% of patients are women

28 Treatment-Seeking Status and Quality of Life

29 Obese individuals who do not seek weight loss treatment report better QOL than those seeking weight loss treatment QOL also varies according to type of weight loss treatment sought

30 IWQOL-Lite Total Score by BMI Group and Treatment Modality (n=3,353) (Kolotkin et al., Obesity Research, 2002) Community Volunteers Clinical Trials Weight Programs/Studies Day Treatment Gastric Bypass 80 Mean +/- SD BMI Group Note: Patients with chronic schiz/bipolar and mean BMI = 38 scored between GB and Day Treatment (Kolotkin et al., Obesity, 2008)

31 Binge Eating Disorder

32 Binge Eating Disorder (BED) Eating unusually large amount of food in short period, occurring on average 2 days/week for 6 mos. Sense of lack of control Rapid eating Uncomfortably full Eating this way when not feeling hungry Eating alone because embarrassed Feeling disgusted, depressed, guilty afterward No purging, fasting, excessive exercise BED associated with depression, emotional distress

33 BED Vs. Non-BED on IWQOL-Lite Scores (Rieger et al., IJED, 2005) 120 BED Non-BED ** * * * ** 90 Mean +/- SD * p<.05 ** p< Physical Function Self- Esteem Sexual Life Public Distress Work Total

34 Weight loss improves QOL

35 Changes in IWQOL-Lite and SF-36 at 1-Year by Weight Loss/Gain Categories (n = 926) (Kolotkin, Norquist, et al., Health & QOL Outcomes, 2009)

36 Future Directions for Assessment of QOL General quality of life (not HRQOL) E.g. Frisch QOLI ( Pearson Assessments) Assesses importance and satisfaction of 16 areas of life Includes friends, family, community, learning, play, creativity, money, love, goals/values

37 Future Directions for Assessment of QOL Satisfaction With Life Scale (Diener, et al., 1985) 5 items, 7 response options Scale is in public domain Provides overall satisfaction score

38 Future Directions for Assessment of QOL Authentic Happiness Inventory Questionnaire ( 2005 Chris Peterson, University of Michigan) 24 items Pleasure, meaning, engagement in life

39 Conclusions/Implications Different assessment methods provide different kinds of information about the QOL of our patients Beneficial to use more than one method Important to go beyond HRQOL Life satisfaction, general QOL, happiness

40 Conclusions/Implications Important to address patients QOL concerns in clinical practice Keeping in mind that women, individuals seeking bariatric surgery, those with BED or schizophrenia/bipolar disorder have the poorest QOL Help patients set specific QOL goals rather than weight loss goals Discussing/assessing QOL may help motivate patients to adopt a healthier lifestyle Offering ongoing support to deal with tension-generating changes associated with weight loss will be beneficial

41 Disclosure: Receive royalties for use of IWQOL-Lite (for adults) and IWQOL-Kids (for adolescents) THANK YOU VERY MUCH FOR YOUR ATTENTION!