INGESTIVE BEHAVIOR AND OBESITY Obesity and Quality of Life Robert F. Kushner, MD and Gary D. Foster, PhD From the Department of Medicine, Northwestern University, Chicago, Illinois; and the Department of Psychiatry, University of Pennsylvania, USA The focus of this review is the impact of obesity and weight loss on quality of life. A focus on quality of life broadens the scope of treatment efficacy beyond weight loss and provides a patient-centered perspective. The concept of quality of life is defined, and both general and obesity-specific measures are reviewed. It is clear that obesity confers negative consequences on both the physical and psychosocial aspects of quality of life, especially among the severely obese. The effects of weight loss appear to be favorable, although few studies have examined non-surgical interventions. Future studies would be enhanced by assessing a variety of approaches to weight loss by using both general and obesity-specific measures of quality of life and conducting follow-up studies to assess the effects of weight regain on quality of life. Nutrition 2000;16:947–952. ©Elsevier Science Inc. 2000 Key words: obesity, quality of life INTRODUCTION The other articles in this special issue of Nutrition provide a thorough review of the literature on key topics, including genetic and metabolic control systems, that govern regulation of body weight, the biological systems that control hunger and satiety, the use of current and future pharmacologic agents, and obesity- related morbidity and mortality. In contrast, this review provides a unique perspective on obesity from the patient’s point of view. By using health-related quality of life (HRQL) instruments, we are able to gain insight to the patients’ subjective experience of being overweight: to capture their feelings, values, abilities, and expec- tations. We can use these instruments to assess their perceptions of what it is like to be obese and the changes that result from various weight-reduction interventions. Over the past decade, evaluation of HRQL has become an essential clinical and research outcome measurement. It is important to remember that the primary thera- peutic goal of any obesity intervention is to improve the patient’s outlook and not simply promote weight loss. MEASUREMENT OF HEALTH STATUS AND QUALITY OF LIFE When patients are asked why they are seeking treatment for obesity, their responses are generally related to disappointment with their appearance or difficulty with daily physical functioning due to shortness of breath, pain of the weight-bearing joints, low energy levels, and/or reduced mobility. Other patients may present with psychological concerns such as low self-esteem and distur- bance of body image. Occasionally, patients will relay other health-related concerns, such as newly diagnosed illnesses or fear of acquiring such diseases. In summary, a self-perceived reduction in quality of life is one of the major personal consequences of obesity and constitutes one of the main reasons for seeking med- ical attention. 1 Furthermore, daily functioning and quality of life can be severely diminished without having an impact on morbidity or other metabolic and physiologic markers. 2 Although these quality-of-life issues may be recorded in the patient’s medical chart, they are not routinely measured and quantified. The devel- opment of health-assessment instruments over the past 20 y have allowed researchers and clinicians to measure these concerns of functioning and well-being. By capturing and analyzing these subjective data, we are able to advance understanding and appre- ciate the meaningfulness of obesity from the patient’s point of view. The term quality of life encompasses standard of living, quality of housing and neighborhood, job satisfaction, family relation- ships, health, and other factors. 3 Quality of life is the individual’s overall satisfaction with his life, based on his own values, goals, abilities, and needs. 4 Because clinicians and health-care research- ers are most interested in those aspects of life that are more closely related to health status, e.g., vitality, physical and mental function- ing, measurement of these HRQL factors has been called health- related quality of life. 5 In general, HRQL instruments are catego- rized as either generic or disease specific. Generic measurements are designed for administration to people with any underlying health problems and cover all relevant areas of HRQL. These instruments address issues that essentially all people would con- sider important to their health, such as mobility, self-care, and physical, emotional, and social function. 6 The major advantages of using these measurements are their simplicity and ability to com- pare the relative HRQL of one disease or condition to another. Well-established and validated examples of generic HRQL mea- surements are the Medical Outcomes Study. The Short-Form Health Survey (SF-36) 7 and the Sickness Impact Profile. 8 The SF-36 contains 36 questions measuring eight domains of function- ing: physical functioning, role limitations due to physical health problems, social functioning, bodily pain, general mental health, role limitations due to emotional problems, vitality, and general health perceptions. In contrast to generic measurements that may be poorly adapted to a particular patient population, disease-specific instruments are designed to capture information that is relevant to a specific illness. The major advantage of using a well-structured disease-specific devise is the ability to assess and record quality-of-life issues that are most meaningful to a particular population. For example, inquiring about daytime sleepiness, preoccupation with food, or hatred of one’s body may be pertinent questions for an obesity- outcomes trial but not particularly relevant to other disease con- ditions. Several obesity HRQL measurements have been devel- oped and are reviewed. The most important decision for clinicians and researchers to make is to choose the best instrument(s) for Correspondence to: Robert Kushner, MD, Professor of Medicine, North- western University, 240 East Ontario Street, Suite 400, Chicago, IL 60611, USA. E-mail: rkushner@nmh.org Date accepted: May 19, 2000. Nutrition 16:947–952, 2000 0899-9007/00/$20.00 ©Elsevier Science Inc., 2000. Printed in the United States. All rights reserved. PII S0899-9007(00)00404-4