Abstract
BackgroundThere is little robust evidence relating to changes in health related quality of life (HRQL) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass (RYGB). The aim of the present study was to describe and compare changes in five dimensions of HRQL in morbidly obese subjects. In addition, we wanted to assess the clinical relevance of the changes in HRQL between and within these two groups after one year. We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program (ILI) with morbidly obese subjects.MethodsA total of 139 morbidly obese patients chose treatment with RYGB (n=76) or ILI (n=63). The ILI comprised four stays (seven weeks) at a specialized rehabilitation center over one year. The daily schedule was divided between physical activity, psychosocially-oriented interventions, and motivational approaches. No special diet or weight-loss drugs were prescribed. The participants completed three HRQL-questionnaires before treatment and 1 year thereafter. Both linear regression and ANCOVA were used to analyze differences between weight loss and treatment for five dimensions of HRQL (physical, mental, emotional, symptoms and symptom distress) controlling for baseline HRQL, age, age of onset of obesity, BMI, and physical activity. Clinical relevance was assessed by effect size (ES) where ES<.49 was considered small, between .50-.79 as moderate, and ES>.80 as large.ResultsThe adjusted between group mean difference (95% CI) was 8.6 (4.6,12.6) points (ES=.83) for the physical dimension, 5.4 (1.5–9.3) points (ES=.50) for the mental dimension, 25.2 (15.0–35.4) points (ES=1.06) for the emotional dimension, 8.7 (1.8–15.4) points (ES=.37) for the measured symptom distress, and 2.5 for (.6,4.5) fewer symptoms (ES=.56), all in favor of RYGB. Within-group changes in HRQOL in the RYGB group were large for all dimensions of HRQL. Within the ILI group, changes in the emotional dimension, symptom reduction and symptom distress were moderate. Linear regression analyses of weight loss on HRQL change showed a standardized beta-coefficient of –.430 (p<.001) on the physical dimension, –.288 (p=.004) on the mental dimension, –.432 (p<.001) on the emotional dimension, .287 (p=.008) on number of symptoms, and .274 (p=.009) on reduction of symptom pressure.ConclusionsMorbidly obese participants undergoing RYGB and ILI had improved HRQL after 1 year. The weaker response of ILI on HRQL, compared to RYGB, may be explained by the difference in weight loss following the two treatments.Trial registrationClinical Trials.gov number NCT00273104
Highlights
Morbid obesity is understood as a body mass index (BMI) ≥40 kg/m2 or BMI ≥35 kg/m2 with comorbidities [1]
This is a preplanned analysis of data from the MOBILstudy (Morbid Obesity treatment, Bariatric surgery versus Intensive Lifestyle intervention, Clinical Trials.gov number NCT00273104), a non-randomized controlled study designed to compare the effects of bariatric surgery and intensive lifestyle intervention on various comorbidities, eating behavior and health related quality of life (HRQL)
Since we aimed to compare the effect of two treatment methods, and since entering both weight loss and type of treatment into the same statistical analysis led to multicollinearity (r=.81), weight loss was excluded from the multiple regression analyses of covariance (ANCOVA)
Summary
Morbid obesity is understood as a body mass index (BMI) ≥40 kg/m2 or BMI ≥35 kg/m2 with comorbidities [1]. Roux-en-Y Gastric Bypass (RYGB) is an effective and commonly used [2] surgical procedure for treatment of morbid obesity. The majority of patients may prefer non-surgical intervention, bariatric surgery has been shown to be more effective than lifestyle intervention at improving weight loss and obesity associated morbidities [3,4]. Improving patients’ health-related quality of life (HRQL) is an important treatment goal. There is little robust evidence relating to changes in health related quality of life (HRQL) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass (RYGB). We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program (ILI) with morbidly obese subjects
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