Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

Abstract

Objective: To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years. Design: Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese. Subjects: A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMIX34) and women (BMIX38) who completed 10 years of the study. Measurements: HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years. Results: HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1-and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6-to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study. Conclusion: Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.

The effectiveness of bariatric surgery on long term psychosocial quality of life – A systematic review

“…Previous systematic reviews reporting on quality of life (QoL) as a main or secondary outcome, concluded that although BS improves short term (two years) health-related quality of life (HRQoL) in obese adults, longer term (ten years) effects were less clear [39] with some measures showing significantly greater change after surgery, but not others. However, not all the studies included in the systematic reviews assessed QoL and outcome data for QoL was unclear for almost half of the studies reviewed, thus making it difficult to make clear judgements about the impact of weight loss interventions on longer term quality of life [18 & 19].…”

“…The most commonly cited co-morbidities were diabetes and cardiovascular disease. The individual study sample size ranged from 43 to 1276 [52,39]. The majority of participants in the studies were female and mean age ranged from 39 years [55] to 48 years [39] which is representative of the BS population in the UK [14] Group differences in baseline characteristics were noted in most of the studies apart from the four controlled trials [51,52,56,39] and Buddeberg-Fischer et al [54].…”

“…The individual study sample size ranged from 43 to 1276 [52,39]. The majority of participants in the studies were female and mean age ranged from 39 years [55] to 48 years [39] which is representative of the BS population in the UK [14] Group differences in baseline characteristics were noted in most of the studies apart from the four controlled trials [51,52,56,39] and Buddeberg-Fischer et al [54]. The general trend being that the surgery group tended to be significantly younger, with greater weight or BMI than the no surgery group [55] or population based obese control group [57][58][59][60].…”

“…Duration of QoL follow-up ranged from 12 months [51,52,55] to 10 years [39] however, most studies followed up participants between 2 to 6 years (Table 1). To assess long term effectiveness of BS on psychosocial QoL, QoL outcomes between BS and non-surgical interventions were compared over time.…”

“…Four studies were identified in this group, namely two RCTs [51,52], a prospective cohort study [55] and one controlled trial [39], reporting QoL outcomes over a 1 year follow up period [51,52,55] and at 10 years [39]. Canetti et al [55] examined psychosocial factors on the treatment outcomes of BS and a weight-loss program (which combined diet, behaviour modification and exercise).…”