Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss

doi:10.1016/j.surg.2004.01.007

Surgery

Volume 135, Issue 5, May 2004, Pages 489-497

https://doi.org/10.1016/j.surg.2004.01.007 Get rights and content

Abstract

Background

Physical, emotional, and social functioning are impaired in obesity. It is unknown whether and, if so, to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels. Our objective was to compare the health-related quality-of-life (HRQL) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric banding.

Methods

An HRQL questionnaire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy, normal-weight subjects, matched for age, gender, education, and vocational training. In addition to weight loss and health gain, the influences of achieved weight loss goals, satisfaction with outcome and operative approach (laparoscopy/laparotomy) were assessed.

Results

Quality-of-life was significantly impaired in obese subjects. With a substantial weight loss of 35 kg and 42% loss of excessive weight, and correction of disturbed metabolic parameters, they significantly improved in general well-being, health distress, and perceived attractiveness, approaching halfway the values of a normal-weight reference group. Improvement in values for depression and self-regard lagged behind. In physical activity, they bypassed the reference group. Days of sick leave decreased to the level of the reference group. Improvements in HRQL paralleled the rate of weight loss. Personal satisfaction and surgical approach were of minor influence.

Conclusions

The obese subjects' impaired physical and social functioning improved considerably, catching up midway to normal-weight reference values after weight loss. Psychologic amelioration lagged behind. Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies.

Section snippets

Patients

Fifty consecutive patients randomized to undergo laparoscopic or open adjustable silicone gastric banding (ASGB) were asked to fill out HRQL questionnaires at the start and after 1 year of treatment.²⁵ They fulfilled the inclusion criteria of being between 18 and 55 years of age, and being morbidly obese (body mass index [BMI] ≥40 kg/m²) for at least 5 years. Obesity related to a hormonal or genetic disorder had to be excluded. Documentation of at least 10% body weight loss after previous

Results

Fifty patients (16 males and 34 females) entered the study. Eight males and 17 females were randomized to either laparoscopic or open ASGB. Both groups were comparable in age, body weight, and BMI (Table II). Postoperative hospital stay was significantly prolonged after open ASGB, the number of readmissions was higher and the overall hospital stay was longer. One patient dropped out of the study due to a gastric perforation a few days after the operation; she never returned the questionnaire.

Discussion

The unrealistic and unachievable weight loss goals of the past have been replaced by realistic therapeutic goals, with emphasis on improved health and HRQL. Before treatment, obese subjects had poor health although it was not always subjectively perceived and sometimes established only by blood sampling, sleep apnea, and cardiac monitoring. After 1 year of participation in a weight loss program that included gastric banding, diet, behavioral therapy, and physical exercise, a substantial weight

Acknowledgements

The authors are much indebted to J. B. Reitsma, MD, PhD, Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, for his help with the statistical data and J. C. J. M. de Haes, MD, PhD, Department of Medical Psychology, for her help with setup of the normal-weight subjects and the clinimetrics.

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Patients who underwent body contouring procedures after bariatric surgery had significantly better long-term weight loss than a matched cohort of patients. This finding likely has many contributing factors, and the association between long-term weight loss and body contouring procedures after bariatric surgery requires more detailed study.
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Surgical outcomes researchHealth-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Discussion

Acknowledgements

Gastroenterol Clin N America

Am J Prev Med

Am J Clin Nutr

J Clin Epidemiol

Am J Clin Nutr

J Am Coll Surg

J Gatrointest Surg

Am J Clin Nutr

Addict Behav

Social and economic consequences of overweight in adolescence and young adulthood

N Engl J Med

Obesity and stature in adolescence and earnings in young adulthood. Analysis of a British birth cohort

Arch Pediatr Adolesc Med

Weight-based discrimination in employment: psychological and legal aspects

Personnel Psychology

Randomized trial of diet and gastroplasty compared with diet alone in morbid obesity

N Engl J Med

Bariatric surgery vs. conventional dieting in the morbidly obese

Obes Surg

Quality of life measures in health care. I: applications and issues in assessment

BMJ

Quality of life measures in health care. II: design, analysis, and interpretation

BMJ

Measuring health-related quality of life

Ann Intern Med

Issues in quality-of-life measurement in clinical trials

Control Clin Trials

Quality-of-life assessment: can we keep it simple?

J R Statist Soc

Assessing Impact of Weight on Quality of Life

Obes Res

Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined

Int J Obes Relat Metab Disord

Rapid translation of quality of life measures for international clinical trials: avoiding errors in the minimalist approach

Qual Life Res

Assessing heath-related quality-of-life and health state preference in persons with obesity: a validation study

Qual Life Res

Surgical outcomes research
Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss