Abstract
The relationship between BMI and health-related quality of life (HRQoL) critically affects regulatory approval of interventions for weight loss, but evidence of the association is inconsistent. A higher standard of evidence than that available was sought with an IPD meta-analysis of 10,884 people enrolled in five randomized controlled trials of intentional weight loss interventions. Cross-sectional and longitudinal associations of BMI and HRQoL were estimated in mixed effects models specifying a latent variable for HRQoL. Spline regressions captured nonlinear associations across the range of BMI. In cross-sectional spline regressions, BMI was not associated with HRQoL for people with a BMI < 30 kg/m2 but was for those with a higher BMI. In longitudinal spline regressions, decreases in BMI were positively associated with HRQoL for people with a BMI ≥ 25 kg/m2 . The impact of change in BMI was larger for people with higher BMIs than for those with BMIs under 30 kg/m2 . Lower BMI and decreases in BMI were related to higher HRQoL for people living with obesity but not in the population without excess weight. HRQoL gains from weight loss are greater for more severe obesity. Commissioners should use these estimates for future decision making.
Highlights
health-related quality of life (HRQoL) was treated as a latent variable within a system of equations
Structural equations were specified with the latent variable for HRQoL as the dependent variable
HRQoL was regressed on BMI, the group mean of BMI, individual characteristics, trial fixed effects, and time-from-baseline fixed effects. (A model with intervention arm fixed effects was tested, but the main coefficient of interest was consistent; the reported specification was retained to make use of data of all individuals in all arms, all of whose BMI/HRQoL varied.) A random effect for individuals was specified
Summary
The relationship between BMI and health-related quality of life (HRQoL) critically affects regulatory approval of interventions for weight loss, but evidence of the association is inconsistent. A higher standard of evidence than that available was sought with an IPD meta-analysis of 10,884 people enrolled in five randomized controlled trials of intentional weight loss interventions. Another issue is that gains in HRQoL from weight loss are often assumed to be sustained, which may not be the case, after nonsurgical interventions. We estimate the association between BMI and HRQoL using longitudinal data from five large RCTs of behavioral weight loss interventions in an individual participant data (IPD) meta-analysis, where weight loss can be assumed to be intentional and not arising from disease. Studies were identified using existing systematic reviews in obesity,[2,16] reference mining of systematic reviews, and consultation with experts in the field
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