Health-Related Quality of Life in Bariatric and Metabolic Surgery

Abstract

Purpose of Review This review describes the latest evidence for the impact of bariatric surgery on health-related quality of life (HRQL). Recent Findings The impact of bariatric surgery on HRQL is less well-understood than its clinical effectiveness on weight and co-morbidities. Poor-quality study design and different HRQL measures challenge systematic reviews and meta-analyses. Available limited evidence suggests that physical aspects of HRQL may improve more than mental health aspects of HRQL after bariatric surgery, reaching maximal benefits 1-2 years post-surgery. Comparative HRQL analyses between bariatric procedures cannot be made due to a lack of randomised data. Qualitative research highlights the tensions patients experience after bariatric surgery, which provides insights to observed changes in HRQL. Summary Standardized HRQL measures are being developed and agreed to improve future evidence synthesis. Two multi-centre randomised trials of bariatric surgical procedures including detailed HRQL assessment are in progress. It is hoped that the combination of comparative high-quality HRQL data and information from qualitative studies will provide new insights into patient well-being and health after bariatric surgery.

Quality of Life after Bariatric Surgery—A Systematic Review

“…All these conditions contribute to the deterioration of health-related quality of life (HRQOL), commonly defined as “a multidomain concept that represents the patient’s general perception of the impact of an illness and its treatment on physical, psychological, and social aspects of life” [ 21 ]. Therefore, HRQOL and other patient-reported outcomes are increasingly recognized as important endpoints in research on the effectiveness of bariatric treatment [ 22 ]. It should be remembered that objective clinical outcome measures, such as excess weight loss (EWL), do not necessarily accurately reflect the subjective feelings of the patient [ 23 ].…”

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial

“…One year post-surgery has been identified as a critical period when weight trajectories diverge, and initial improvements in health-related quality of life particularly within the mental health domain begin to decline within 2 years following surgery [ 41 – 43 ]; thus, psychosocial interventions are recommended early in the post-operative period to support the development of coping skills to maintain long-term improvements following surgery [ 25 , 26 ]. The COVID-19 pandemic resulted in the closure or reduced capacity of many bariatric surgery programs as staff were redeployed and resources were reallocated to other departments with urgent need, and as a result, most bariatric patients had limited access to bariatric care and psychosocial supports during a period of increased vulnerability to psychosocial distress, disordered eating, and weight regain.…”

Confirmatory psychometric evaluations of the Impact of Weight on Quality of Life–Lite Clinical Trials Version (IWQOL‐Lite‐CT)

“…Among individuals with obesity, weight reduction is commonly accompanied by improvements in health‐related quality of life (HRQOL), with subsequent changes in HRQOL generally matching long‐term patterns of weight loss, gain, and stability 4 . Because treatment has the potential to improve various aspects of functioning and HRQOL among patients with obesity, these concepts are important outcomes in evaluations of weight‐loss and weight‐management interventions, including behavioural, psychological, surgical, and pharmaceutical treatments 4–10 …”

“…4 Because treatment has the potential to improve various aspects of functioning and HRQOL among patients with obesity, these concepts are important outcomes in evaluations of weight-loss and weight-management interventions, including behavioural, psychological, surgical, and pharmaceutical treatments. [4][5][6][7][8][9][10] In their review of patient-reported outcome (PRO) measures used to assess HRQOL in the context of obesity, Wadden and Phelan (2002) describe several generic measures, including the Short Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the Sickness Impact Profile (SIP), which have demonstrated the ability to capture improvements associated with weight loss. 11 While recommending use of the SF-36 among the generic measures of HRQOL, the authors note that by capturing impacts most salient to patients, disease-specific measures tend to be more sensitive to change than generic measures.…”

“… 4 Because treatment has the potential to improve various aspects of functioning and HRQOL among patients with obesity, these concepts are important outcomes in evaluations of weight‐loss and weight‐management interventions, including behavioural, psychological, surgical, and pharmaceutical treatments. 4 , 5 , 6 , 7 , 8 , 9 , 10 …”