Obesity-specific Health-related Quality Of Life Research Articles

Internalized Shame in Treatment-Seeking Adults with Obesity Class II-III and its Association with Quality of Life, Body Image, and Self-Esteem.

Health-related quality of life (HRQoL) may be impaired in individuals living with obesity, possibly due to exposure to obesity-related stigma which may in turn activate shame. Few studies have been conducted on shame in relation to obesity and its potential association with other constructs such as HRQoL, self-esteem, and body image. In this study, internalized shame and the potential association with HRQoL, self-esteem, and body image were investigated in treatment-seeking patients with obesity class II-III. In total, 228 patients referred for obesity treatment at a tertiary clinic in Sweden participated in the study. The cohort was stratified into two groups using a clinical cutoff (≥ 50) indicating pathological levels of shame as reported on the Internalized Shame Scale (ISS): a high shame group (HSG) and low shame group (LSG). The mean ISS score for the overall cohort was 41.6, with a mean of 28.1 for the LSG and 66.5 for the HSG. Compared to the LSG, the HSG reported a lower quality of life in seven of eight HRQoL domains as well as a lower obesity-specific health-related quality of life. Furthermore, a higher shame score was associated with poorer body image and lower self-esteem. Conclusion Taken together, these findings indicate that a substantial number of patients with obesity report high internalized shame and that these individuals could benefit from extra support in treatment settings.

Relations between trajectories of weight loss and changes in psychological health over a period of 2years following bariatric metabolic surgery.

This study aimed to identify trajectories of BMI, obesity-specific health-related quality of life (HR-QoL), and depression trajectories from pre-surgery to 24months post-bariatric metabolic surgery (BMS), and explore their associations, addressing subgroup differences often hidden in group-level analyses. Patients with severe obesity (n = 529) reported their HR-QoL and depression before undergoing BMS, and at 12 and 24months post-operation. Latent Class Growth Analysis was used to identify trajectories of BMI, HR-QoL and depression. BMI and HR-QoL improved significantly for all patients from pre-surgery to 24months post-operation, though some patients deteriorated in their outcomes after 12months. Three distinct trajectories of BMI were identified: Low (35.4%), Medium (45.5%), and High (19.2%), and of HR-QoL: High (38.4%), Medium (43.4%), and Poor (18.1%). Three trajectories of depression were extracted: Low/none (32.4%), Medium-low (45.3%), and Worsening (22.3%). The association between the trajectories of BMI and depression was significant, but not between the BMI and HR-QoL trajectories. Specifically, the Low BMI trajectory patients were more likely to follow the Worsening depression trajectory and reported poorer preoperative psychological health than the other two BMI trajectories. Patients following the most favourable weight loss trajectory may not manifest psychologically favourable outcomes (i.e., Worsening depression), and preoperative characteristics do not consistently describe post-surgical BMI trajectories. Clinicians should tend to patients' mental wellbeing besides weight loss post-BMS. The study findings emphasize the significance of incorporating psychological health as an essential component of surgical outcomes.

Validation of a parent-proxy, obesity-specific Health-Related Quality of Life measure - sizing them up - in Singaporean adolescents seeking obesity treatment

Background Condition-specific measures of Health-Related Quality of Life (HRQoL) are more sensitive than generic tools. Sizing Them Up (STU) is a parent-proxy, obesity-specific HRQoL measure which was found to be reliable and valid internationally, but has yet to be utilised in Singapore. Objectives Our study aims to i) validate STU in adolescents seeking obesity therapy in KK Women’s and Children’s Hospital (KKH); and ii) determine demographic factors associated with STU scores. Methods We recruited 91 adolescents aged between 11 and 17 years old and their parents from KKH between June 2022 and January 2023. Parents completed STU and the generic Pediatric Quality of Life Inventory (PedsQL) upon recruitment, and repeated STU at least 2 weeks later. Results 65% of participants were males, with a mean Body Mass Index (BMI) of 32.3 ± 5.1 kg/m2 and mean age of 13.6 ± 1.8 years old. STU demonstrated strong internal consistency (overall Cronbach’s α = 0.85) and moderate test-retest reliability (intraclass correlation coefficients = 0.30-0.70). There was high correlation between STU scores and i) the adolescents’ BMI; and ii) equivalent domains of PedsQL, suggesting moderate to strong construct and convergent validity respectively. Indian adolescents, lower parental education level and single parents were associated with poorer STU scores. Conclusion STU is a reliable, valid obesity-specific HRQoL measure in a local clinical population of adolescents undergoing obesity therapy, and can help clinicians to understand parents’ impression of the impact of obesity on their child. Knowing the demographic variables associated with STU can enable clinicians to identify adolescents whose HRQoL are disproportionately affected by obesity.

Pilot evaluation of obesity-specific health-related quality of life following a 12-week non-randomized lifestyle intervention in youth.

BackgroundHealth‐related quality of life (HRQOL), a multifaceted construct for understanding health and healthcare outcomes, is comprised of eight domains of well‐being and functioning over time and has become an essential factor in assessing outcomes for youth with obesity.AimsTo evaluate the effect of a community based, lifestyle intervention, on obesity‐specific HRQOL using the Sizing Me Up (SMU) in this group of Latino and White youth.Materials and MethodsFor this 12‐week family and community‐based intervention (ACT; Actively Changing Together), HRQOL was measured before and after the intervention concluded using the obesity‐specific HRQOL tool, SMU. This study enrolled 68 youth (10.9 ± 2 years; 54% male; 50% non‐Hispanic white). Paired t‐tests were used to examine the Sizing Me Up sub‐scales: Emotion, Physical, Social Avoidance, Positive Attributes, Teasing, and the total score. A greater change score indicated a larger increase in quality of life sub‐scale.ResultsSignificant improvements from baseline to follow‐up were found in the total SMU (mean change = 5.27, SD 10.76, p = 0.00) and for the sub‐scores of: emotion (mean change = 8.06, SD 16.85, p ≤ 0.00), teasing (mean change = 5.65, SD 16.79, p = 0.01), and social avoidance (mean change = 3.92, SD 11.21, p = 0.01).ConclusionsSizing Me Up provided a clinically meaningful tool for this research study to evaluate obesity‐specific HRQOL among Hispanic and non‐Hispanic White youth with obesity.

FRI080 - Obesity-specific health-related quality of life in patients with non-alcoholic steatohepatitis: results from the regenerate study

FRI080 - Obesity-specific health-related quality of life in patients with non-alcoholic steatohepatitis: results from the regenerate study

Overall Treatment Satisfaction 5Years After Bariatric Surgery.

Up to 30% of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long term. The aim of this study was to examine overall satisfaction with treatment 5years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL). Patients were surveyed 5years after bariatric surgery; 108 patients had duodenal switch (DS) and 153 patients had laparoscopic sleeve gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question, and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference. Five years after surgery, 82.4% of the patients were very satisfied or satisfied, whereas 17.6% were unsure or dissatisfied. The following variables assessed at 5years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95% CI = 2.7-14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95% CI = 1.1-7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95% CI = 0.1-0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95% CI = 1.3-8.8, p = 0.01). Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes 5years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation.

Health-related quality of life after camp-based family obesity treatment: an RCT

ObjectiveTo compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations.DesignRandomised controlled...

Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4Years After Bariatric Surgery: a Cross-Sectional Study.

There seems to exist a belief that weight loss is proportionally associated with improvement of health-related quality of life (HRQoL) after bariatric surgery. HRQoL is a complex multidimensional construct of one's perception of health and well-being and is measured through generic and disease specific questionnaires. This study aimed to test the associations between weight loss after bariatric surgery and both generic and obesity-specific HRQoL, and mental distress, controlling for other patient characteristics. The study was conducted at the Department of Surgery at Haugesund Hospital (Norway) based on a cohort of bariatric surgery patients operated between 2010 and 2013. Primary outcome measures included the SF-36 (generic HRQoL), IWQoL-Lite (obesity-specific HRQoL), and HADS (mental distress). Blocks of variables (time since surgery, personal characteristics, socioeconomics, comorbidities, surgical complications, experienced life crisis, and weight loss) were entered into hierarchical linear regression models with the four outcome measures as dependent variables. Cumulative explained variance (r2) and increase in r2 after the entry of each block of variables is reported. A total of 206 completed the outcome measures with a mean (SD) of 4.4 (1.1)years after surgery. The generic SF-36 physical and mental composite scores were significantly associated (p < .05) with socioeconomics, baseline comorbidities, and surgical complications. Obesity-specific IWQoL-Lite scores were significantly (p < .05) associated with weight loss. The study indicates that post-operative weight loss is associated with obesity-specific HRQoL but demonstrates no associations between weight loss and generic HRQoL, when controlling for other patient characteristics.

Factor Structure of a Spanish Translation of an Obesity-Specific Parent-Report Measure of Health-Related Quality of Life.

Latino youth are disproportionately affected by pediatric obesity and consequently experience impaired health-related quality of life (HRQOL). Although many caregivers of Latino youth do not speak English fluently, no validated Spanish translations of obesity-specific HRQOL measures exist for this population. Therefore, non-English-speaking Latino parents have typically been excluded from analyses related to HRQOL. This study assesses the factor structure of a Spanish translation of a parent-report measure of obesity-specific HRQOL, Sizing Them Up, in a treatment-seeking sample of children with obesity. Structural equation modeling was used to assess the factor structure of the 6-subscale, 22-item Sizing Them Up measure in 154 parents of treatment-seeking Latino youth (5-18 years of age). Analyses exploring internal consistency and convergent validity were also conducted. Acceptable measurement fit was achieved for the six-factor solution. However, the higher-order model assessing Total HRQOL did not reach acceptable levels, as results found that the Positive Social Attributes (PSA) subscale was not representative of Total HRQOL; internal consistency and convergent validity results also supported this finding. The current study provides support for the utility of a modified version of Sizing Them Up, excluding the PSA Scale, as a parent-report measure of obesity-specific HRQOL in treatment-seeking Latino youth with obesity.

Confirmatory Factor Analysis of Sizing Me Up: Validation of an Obesity-Specific Health-Related Quality of Life Measure in Latino Youth.

This study aims to validate an obesity-specific health-related quality of life (HRQOL) measure, Sizing Me Up (SMU), in treatment-seeking Latino youth. Pediatric obesity has been associated with reduced HRQOL; therefore, valid measures are important for use in diverse populations that may be at increased risk for obesity and related comorbidities. Structural equation modeling tested the fit of the 5-subscale, 22-item SMU measure in Latino youth, 5-13 years of age, with obesity ( N = 204). Invariance testing was conducted to examine equivalence between Latino and non-Latino groups ( N = 250). SMU achieved acceptable fit in a Latino population [χ 2 = 428.33, df = 199, p < .001, Root Mean Squared Error of Approximation = 0.072 (0.062-0.082), Comparative Fit Index = 0.915, Tucker-Lewis Index = 0.901, Weighted Root Mean Square Residual = 1.2230]. Additionally, factor structure and factor loadings were invariant across Latino and non-Latino groups, but thresholds were not invariant. SMU is a valid measure of obesity-specific HRQOL in treatment-seeking Latino youth with obesity.

Health-related quality of life in two randomized controlled trials of phentermine/topiramate for obesity: What mediates improvement?

Phentermine/topiramate combination therapy resulted in significant weight loss and improvements in cardiometabolic risk factors in patients with obesity/overweight in two published 56-week randomized, placebo-controlled trials (EQUIP and CONQUER). The purpose of the current study was to examine whether phentermine/topiramate is also associated with greater improvements in health-related quality of life (HRQOL) and whether HRQOL improvements are solely attributable to weight reduction. Patients in EQUIP (n = 751) had a body mass index (BMI) ≥ 35 with no obesity-related comorbidity. Patients in CONQUER (n = 1623) had a BMI ≥ 27 and ≤ 45 and at least two obesity-related comorbid conditions. HRQOL was assessed with Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and Medical Outcomes Study Short Form (SF-36) (CONQUER only). Significant improvements in both obesity-specific and physical HRQOL were observed at 56 weeks in both trials (p < .0001). In EQUIP, BMI reduction fully mediated improvements in IWQOL-Lite total score (p < .0001). In CONQUER, both BMI reduction (all p values < .0001) and change in depressive symptoms (all p values < .025) were significant mediators of improved IWQOL-Lite total score and SF-36 Physical Component Summary score. Gender, psychiatric history, and baseline triglycerides moderated these relationships. Both trials demonstrated that treatment with phentermine/topiramate improved HRQOL compared with placebo. Although reduction in BMI accounted for the majority of improvements in obesity-specific and physical HRQOL, decrease in depressive symptoms was also a significant mediator. Results highlight the predominance of weight reduction as a key factor in improving HRQOL in obesity.

Factors Associated with Health-Related Quality of Life Among Overweight and Obese Korean Women

Health-related quality of life (HRQOL) tends to be lower among individuals who are overweight and obese than those of normal weight, and women may be more vulnerable to lower HRQOL associated with obesity than men. Identifying factors associated with HRQOL may be crucial for improving HRQOL for overweight/obese women. We aimed to determine the factors associated with obesity-specific HRQOL among overweight/obese Korean women. A cross-sectional study was conducted with 125 women aged 20–64 years, who comprised a baseline sample in the Community-based Heart and Weight Management Trial. The data were collected from September 2010 to November 2011. The Weight Efficacy Lifestyle, Beck Depression Inventory-II, Interpersonal Social Evaluation List, and Impact of Weight on Quality of Life (IWQOL)–Lite scales were used to measure self-efficacy for weight control, depressive symptoms, social support, and HRQOL, respectively. Increased body mass index, lower self-efficacy for weight control, and higher levels of depressive symptoms were significantly associated with greater impairment in total IWQOL in the regression models. However, social support was not significantly associated with IWQOL. Along with weight loss strategies, other strategies for improving self-efficacy and alleviating depressive symptoms may be essential for improving HRQOL among overweight and obese women.

Analysis of Health-Related Quality-of-Life Instruments Measuring the Impact of Bariatric Surgery

The worldwide prevalence of obesity has been steadily rising, reaching alarming levels. Obesity, particularly morbid obesity, carries significant health risks to the lives of affected patients, including physical, psychological, and social co-morbidities. Bariatric surgery provides the only effective and sustainable approach to treat morbid obesity and reverse its adverse effects. The reduction in well-being due to poor health in obesity may have adverse effects on health-related quality of life (HR-QOL). There are numerous studies reporting HR-QOL in bariatric patients; however, there is a paucity of studies examining the psychometric properties of the HR-QOL instruments used. The main aim of this review is to identify the instruments used in assessing HR-QOL in bariatric patients and evaluate their content validity. We believe that this is the first systematic review of its kind to look in depth at various generic- and obesity-specific HR-QOL instruments that were used in bariatric surgery, and to analyze their content validity. A systematic and structured search of Ovid databases (1980-2009) was conducted using terms synonymous with bariatric surgery, combined with terms synonymous with HR-QOL instruments. A total of 112 relevant studies were identified, detailing the use of eight generic, nine obesity-specific, and numerous other condition-specific instruments. A conceptual framework comprising 20 domains pertinent to bariatric surgery and morbid obesity was proposed, against which the identified generic- and obesity-specific instruments were assessed. The results of this assessment showed that neither the generic nor the specific instruments were adequate instruments in terms of content validity. Given the lack of adequate HR-QOL instruments in the rapidly developing field of bariatric surgery, we suggest building a new bariatric-specific instrument informed by the proposed framework, which will then enable clinicians to assess the full impact of morbid obesity and bariatric surgery on HR-QOL.

Perceived Social Support and Its Association With Obesity-Specific Health-Related Quality of Life

To (1) describe type and source of social support perceived by obese youth and examine associations with sociodemographic/anthropometric characteristics, and (2) examine relationships between social support and obesity-specific health-related quality of life (HRQOL). Seventy-four obese youth and their primary caregivers participated. Youth completed the Child and Adolescent Social Support Scale and an obesity-specific HRQOL measure, Sizing Me Up. Close friends and parents provided the most social support and were rated most important, except for teacher informational support. Classmates and schools provided the least social support. Body mass index z-score was correlated with teacher support frequency (r = -.26, p < .05) and minority youth reported more parent support (t(72) = -2.21, p < .05). Compared with other support providers, classmate support significantly predicted most HRQOL scales (p < .001). Close friends, parents, and teachers are significant sources of support to youth with obesity; however, classmates play a unique role in the HRQOL of obese youth.

Predictors of Psychological Well-Being during Behavioral Obesity Treatment in Women

This study examined the association of autonomy-related variables, including exercise motivation, with psychological well-being and quality of life, during obesity treatment. Middle-aged overweight/obese women (n = 239) participated in a 1-year behavioral program and completed questionnaires measuring need support, general self-determination, and exercise and treatment motivation. General and obesity-specific health-related quality of life (HRQOL), self-esteem, depression, and anxiety were also assessed. Results showed positive correlations of self-determination and perceived need support with HRQOL and self-esteem, and negative associations with depression and anxiety (P < .001). Treatment autonomous motivation correlated positively with physical (P = .004) and weight-related HRQOL (P < .001), and negatively with depression (P = .025) and anxiety (P = .001). Exercise autonomous motivation was positively correlated with physical HRQOL (P < .001), mental HRQOL (P = .003), weight-related HRQOL (P < .001), and self-esteem (P = .003), and negatively with anxiety (P = .016). Findings confirm that self-determination theory's predictions apply to this population and setting, showing that self-determination, perceived need support, and autonomous self-regulation positively predict HRQOL and psychological well-being.

Factors Contributing to Weight Misperception in Obese Children Presenting for Intervention

To assess weight stigma, self-perception of weight status, and factors contributing to accurate self-perception of weight status in obese youth presenting for treatment at a hospital-based multidisciplinary weight management program. Participants (N = 97; mean age = 8.56 +/- 1.66 years) used a figural rating scale to assess weight stigma and their current and ideal body type, and Sizing Me Up, a measure of obesity-specific health-related quality of life (HRQOL). The majority endorsed negative/stereotypical attributes toward an obese body type, chose an average or underweight figure as their ideal, and 39% misperceived their weight status. Older child age and greater HRQOL impairment were significant predictors (P < .01) of correct self-perception. Pediatricians may find that talking with the elementary school-aged patient and family about whether weight/size affects their day-to-day life will prove to be a salient and neutral opening to discussing the child's obesity and need for intervention.

Parenting Stress Impacts Obesity-Specific Health-Related Quality of Life in a Pediatric Obesity Treatment-Seeking Sample

To document parenting stress in caregivers of treatment-seeking youth with obesity and examine whether parenting stress is a predictor of pediatric health indicators, including body mass index and weight or obesity-specific health-related quality of life. Youth (5-18 years) and their caregivers presenting to a pediatric medical weight management program initial visit completed several self-report questionnaires assessing demographics, parenting stress, and weight or obesity-specific health-related quality of life. Youth's height and weight were measured by trained clinic nurses and abstracted from the patient medical records. Study staff measured caregiver's height and weight. Participants included 120 caregivers and their youth (Mage = 11.0, 65.8% female, and 50% African-American). At treatment initiation, caregivers were primarily obese (Mbody mass index = 35.8). One fifth of caregivers of school-aged children (18%) had clinically increased levels of parenting stress, and 25% reported increased spousal discord specific to parenting. Parenting stress did not significantly predict youth body mass index. Parenting stress significantly predicted obesity-specific parent-proxy health-related quality of life for school-aged children but not self-reported obesity-specific health-related quality of life. Given that caregivers are critical components of pediatric weight management interventions, those with clinically increased levels of parenting stress would likely benefit from brief problem-solving interventions and anticipatory guidance to address common obstacles when fostering healthier lifestyles for their youth.

Development and Initial Validation of an Obesity‐specific Quality‐of‐life Measure for Children: Sizing Me Up

The present study describes the development and initial validation of a new obesity-specific, self-report measure of health-related quality of life (HRQOL) for children aged 5-13 years. Participants included 141 obese children (mean age=9.2 years, 67% female, 55% black, mean zBMI=2.52) and their primary caregivers. Children completed Sizing Me Up (obesity-specific HRQOL) and the PedsQL (generic HRQOL). Item content for Sizing Me Up was based on the published child obesity and HRQOL literatures and expert opinion. Items use phrasing to orient children to respond to questions in context of his/her size (e.g., "were teased by other kids because of your size"). Caregivers completed Sizing Them Up, a parallel parent-proxy, obesity-specific HRQOL measure. Initial psychometric evaluation of Sizing Me Up was completed by conducting a factor analysis and determining internal consistency, test-retest reliability, and convergent and construct validity. Sizing Me Up is a 22-item measure with five scales (i.e., Emotional Functioning, Physical Functioning, Social Avoidance, Positive Social Attributes, and Teasing/Marginalization) that account for 57% of the variance and a total HRQOL score. Internal consistency coefficients range from 0.68 to 0.85. Test-retest reliabilities range from 0.53 to 0.78. Good convergent validity was demonstrated with the PedsQL (rs=0.35-0.65) and the parent-proxy Sizing Them Up (rs=0.22-0.44). Sizing Me Up represents the first obesity-specific HRQOL measure developed specifically for younger school-aged children (aged 5-13 years) with preliminary evidence of strong psychometric properties that likely has both clinical and research utility in a variety of settings.

Validation of a Parent‐proxy, Obesity‐specific Quality‐of‐life Measure: Sizing Them Up

The aims of the present study were to develop and validate a new obesity-specific, parent-proxy measure of health-related quality of life (HRQOL), Sizing Them Up. Participants included 220 obese youth (M(age) = 11.6 years, 68% female, 53% African American, M(BMI) = 36.7) and their primary caregivers (88% mothers). Primary caregivers completed a demographics questionnaire and two HRQOL measures: Sizing Them Up (obesity-specific) and PedsQL (generic). Youth height and weight were measured. Psychometric evaluation of Sizing Them Up was completed by conducting a factor analysis and determining internal consistency coefficients, test-retest reliability, convergent and discriminant validity, predictive validity, responsiveness to change, and minimal clinically important difference (MCID) scores. Sizing Them Up is a 22-item measure with six scales (i.e., Emotional Functioning, Physical Functioning, Teasing/Marginalization, Positive Social Attributes, Mealtime Challenges, and School Functioning) that account for 66% of the variance. The measure also includes an Adolescent Developmental Adaptation module. Sizing Them Up had internal consistency coefficients ranging from 0.59 to 0.91 and test-retest reliabilities ranging from 0.57 to 0.80. Validity was demonstrated by significant relations between a majority of Sizing Them Up scales and BMI z-scores. Sizing Them Up also demonstrated good convergent validity with other HRQOL measures and responsiveness to change related to weight loss for adolescents who had undergone bariatric surgery. Overall, Sizing Them Up is a reliable and valid parent-proxy measure of obesity-specific HRQOL that can be used in both clinical and research settings.

Health and health-related quality of life: differences between men and women who seek gastric bypass surgery

Background The aim of this study was to examine the differences between male and female bariatric surgery candidates with respect to health-related quality of life (HRQOL), health, sociodemographic variables, and interactions among these variables in a bariatric surgery practice in the United States. Women seek bariatric surgery 5 times more often than men. Research on gender differences in HRQOL is limited, and the results are conflicting. Methods A total of 794 surgery candidates (mean age 42.2 y; body mass index 46.9 kg/m 2; 84.8% women) completed both a weight-related (Impact of Weight on Quality of Life-Lite questionnaire) and a generic (Medical Outcomes Study Short-Form-36) measure of HRQOL. Health was evaluated by questionnaire and clinical interviews. Results Compared to men, women reported reduced HRQOL on 3 of the 5 scales assessing obesity-specific HRQOL and also the physical aspects of general HRQOL. Women also had double the rate of depression (48.5% versus 22.5%), and men had double the rate of sleep apnea (80.3% versus 40.2%). Women were younger, less obese, and were less likely to be married. No gender differences were found in the association between HRQOL and co-morbidities. However, an increasing number of co-morbidities was associated with decreasing physical and mental HRQOL. Additionally, depression was associated with decreased mental HRQOL, and coronary heart disease was associated with decreased physical HRQOL. Conclusion Women's reduced HRQOL, particularly in self-esteem, sexual life, and physical functioning, and their greater rates of depression, might play a role in their decision to seek bariatric surgery. Although we could not determine causality, this study is a first step toward understanding why women seek surgery 5 times more often than men.