Abstract
ObjectivesTo explore the cross-sectional association between adiposity, mental well-being, and quality of life in extreme obese individuals entering a UK specialist weight management service prior to treatment commencement.MethodsThe sample comprised 263 extreme obese individuals who were referred to the service as a result of having a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with a co-morbid health condition. In a retrospective analysis, routinely collected baseline clinical examination data and self-report questionnaires (Impact of Weight on Quality of Life: IWQOL-Lite, EQ5D-3L, and Hospital Anxiety and Depression Scale: HADS) were analysed to examine the cross-sectional association between adiposity and quality of life.ResultsThe sample was predominantly female (74.8%) with mean BMI 47.0±7.9 kg/m2. Increasing adiposity was significantly negatively associated with quality of life, with an increase of 1 BMI unit associated with decreases of 1.93 in physical function (95% CI −2.86 − −1.00, p<0.001), 1.62 in self-esteem (95% CI −2.67 − −0.57, p<0.05), 2.69 in public distress (95% CI −3.75 − −1.62, p<0.001), 1.33 in work (95% CI −2.63 − −0.02, p<0.05), and 1.79 in total IWQOL-Lite scores (95% CI −2.65 − −0.93, p<0.001). Adiposity was associated with significantly increased risk of problems in mobility (OR = 3.44, 95% CI 1.47−8.05), and performing usual activities (OR = 2.45, 95% CI 1.10−5.46) in highest relative to lowest BMI tertile. The prevalence of experience of symptoms of anxiety (70.3%) and depression (66.2%) as measured by HADS was consistently high.ConclusionsWe identified a high prevalence of psychological co-morbidity, including widespread experience of symptoms of anxiety and depressive disorders and reduced quality of life among these extreme obese individuals seeking weight management treatment. Clinical implications include the need for the incorporation of strategies to improve mental well-being into multi-disciplinary weight management interventions.
Highlights
The prevalence of obesity among adults, and in particular extreme obesity, has risen rapidly over previous decades [1]
There were no significant differences in Hospital Anxiety and Depression Scale (HADS) anxiety and depression scores, with prevalence of anxiety and depressive symptoms consistently high across the body mass index (BMI) groups, with data for the combined sample indicating prevalence rates of anxiety symptoms (70.3%) and depressive symptoms (66.2%), which are far greater than the UK general population rates of 33.0% for anxiety disorders and 11.4% for depressive disorders [15]
Levels of severe anxiety and depressive symptoms defined by the higher cutpoint scores of $11 are substantial, with severe anxiety symptoms experienced by 48.3% of the sample and 40.4% of the sample experiencing symptoms of severe depressive disorders
Summary
The prevalence of obesity among adults, and in particular extreme obesity, has risen rapidly over previous decades [1]. The physical co-morbidities of extreme obesity are well documented and research suggests that there are substantial negative impacts of adiposity on depression [5], anxiety [6] and reduced quality of life [7]. In the extreme obese current understanding is limited as studies have focused on those individuals seeking bariatric surgery [9], and have not included a range of assessments of putative psychological co-morbidities. In order to improve service provision for patients with extreme obesity, it is important to understand the extent of psychological co-morbidity and the impact on quality of life. Baseline data from treatment-seeking individuals at a community-based UK specialist weight management service were analysed as part of the service evaluation to examine the association between adiposity and psychological health
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