© Springer International Publishing Switzerland 2015
Andrea Lenzi, Silvia Migliaccio and Lorenzo Maria Donini (eds.)Multidisciplinary Approach to Obesity10.1007/978-3-319-09045-0_1919. Impairment of Quality of Life in Obesity
(1)
Department of Biomedical and Experimental Sciences, Obesity Agency, Careggi University Hospital, Florence, Italy
(2)
Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Viale Pieraccini 6, Florence, 50134, Italy
(3)
Endocrinology Unit, Careggi University Hospital, Viale Pieraccini 6, Florence, 50134, Italy
19.1 Which Quality of Life?
The complications of obesity possibly determining premature mortality include cardiovascular diseases, diabetes mellitus, dyslipidemia, sleep apnea and respiratory failure, osteoarthritis, infertility, some forms of cancer (colon, breast, prostate, endometrium), depression, and impairment of health-related quality of life [1]. Improvement of quality of life is recognized as a relevant measure of treatment outcome in obese patients, both in medically and surgically treated cases [2]. There is an open discussion about the meaning of quality of life and what issues are really important for patient well-being. The concept of quality of life is a major point when discussing measures aimed at defining the impact of diseases (obesity in this case) on functional status and well-being. The quality of life concept is multifaceted and can be approached from different perspectives. Many terms have been used interchangeably: quality of life, health status, and health-related quality of life (HRQL). Anyway, quality of life refers not only to health status but also to environmental and economic factors that can obviously affect well-being. HRQL is the functional effect of a medical condition and/or its therapy on a patient. Therefore, HRQL is subjective and multidimensional, including physical and occupational function, psychological state, social interaction, and somatic sensations [3]. Therefore, we can imagine how difficult it is to try and measure someone’s quality of life. As a result, for a long time, hundreds of tests have been designed to measure different aspects of quality of life [4].
19.2 Why Do We Need to Assess Quality of Life?
First, HRQL assessments are commonly administered initially to assess the overall impact of a particular condition on functioning and well-being. This provides additional information beyond those offered by traditional medical and clinical measures; this can help to understand the wide variability in individual responses to similar conditions [5]. Second, HRQL measures can be used as an outcome esteem to evaluate the effects of treatment. HRQL can also be used to assess the efficacy and cost-effectiveness of treatment interventions [6, 7]. Finally, on a wider perspective, information on quality of life may also influence the development of clinical pathways, healthcare expenditures, and public health policy.
19.3 Measuring Quality of Life: Instruments
HRQL can be measured by either generic or obesity-specific instruments.
19.3.1 Generic HRQL Instruments
Generic instruments are designed to measure broad aspects of quality of life. These instruments are not designed to assess quality of life relative to a particular medical condition but rather provide a generalized assessment.
The SF-36 Health Survey3 is the most widely used and validated HRQL instrument [8]. The scores are standardized from 0 for poor health to 100 for good health. Scores from the SF-36 Health Survey can be compared with established scores of healthy persons in the USA (US norms). There are eight health domains within the SF-36: physical functioning (measures the limitation in performance of physical activities), role-physical (measures the limitation in daily activities as a result of physical health), role-emotional (measures limitation in daily activities as a result of emotional problems), bodily pain (measures the pain-related functional limitations), vitality (measures the energy level), mental health (measures the presence and degree of depression and anxiety), social functioning (measures the limitations in social functioning), and general health (measures an individual’s perception of his/her health).
Other generic instruments have been used with obese patients [9], such as the Satisfaction with Life Scale, the Extended Satisfaction with Life Scale and the Quality of Life Inventory, the Nottingham Health Profile (38 questions), and the Sickness Impact Profile (136 items).
The major advantage of generic measures is that they allow for comparisons of HRQL across a variety of medical conditions. Moreover, generic instruments can be administered to different populations to examine the impact of various healthcare/therapeutic programs on HRQL. On the other hand, the major limitation of generic HRQL instruments is that they do not assess potential condition-specific domains of HRQL. Because of this, they may not be sufficiently sensitive to detect subtle treatment effects. [10].
19.3.2 Specific Instruments
The second approach to HRQL assessment involves the use of instruments that are specific to a disease, population, or specific clinical problems. Measures designed for specific diseases or populations will probably be more sensitive and therefore have greater relevance in medical practice. A commonly used specific tool is the Obesity-Related Well-Being (ORWELL 97) questionnaire [11], which has been developed and validated by our group. The ORWELL 97 is a self-reported measure of obesity-related, perceived, quality of life, measuring obesity-related domains such as social activities, self-esteem, and sexual attractiveness. The novelty of the ORWELL 97 questionnaire is that it takes into consideration not only the intensity but also the subjective relevance of physical and psychosocial distress. In fact, a group of obese patients was asked to describe the effects of being overweight in their everyday life and to indicate the most distressing physical and psychological symptoms; on the basis of the most commonly voiced concerns, the authors identified 18 items.
The Impact of Weight on Quality of Life (IWQOL) scale [12] and the Health State Preference (HSP) scale in persons with obesity [13] are other examples of obesity-specific HRQL instruments. The IWQOL is a 74-item measure that assesses the effect of weight along eight domains of functioning: health, social/interpersonal, work, mobility, self-esteem, sexual life, activities of daily living, and comfort with food.
Other obesity-specific instruments are the Moorehead-Ardelt Quality of Life Questionnaire (5 questions) [14], the Obesity-Specific Quality of Life questionnaire (11 questions) [15], and the Quality of Well-Being Scale (50 questions) [16]. In particular, the Moorehead-Ardelt QoL Questionnaire is a simple bariatric-specific questionnaire, used effectively as part of the Bariatric Analysis and Reporting Outcome System (BAROS). The Moorehead-Ardelt Quality of Life Questionnaire assesses self-esteem, physical activity, social life, work conditions, and sexual activity/interest. Points are added for positive changes and subtracted for negative changes.
Even if disease-specific instruments probably provide a better assessment of HRQL than generic instruments, the major variable is based on the goals and aims of the research. In fact, it has been shown that disease-specific instruments are more powerful in detecting treatment effects than generic instruments [17]. Moreover, it has also been demonstrated that obesity-specific measures of psychological distress correlate more highly with relative body weight than general measures of psychological distress [18].
The “fair” consensus reached among quality of life researchers is that both generic and disease-specific instruments should be used to provide the most comprehensive assessment of HRQL possible, even if this could be of more difficult management for the patient (patient burden) and also for the inquirer (data management, discrepancies between the results, etc.).
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