The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study

Abstract

Background The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight. Methods Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term conditions were tested as both covariates and mediating factors on the causal pathway between obesity and HRQoL. Results Increasing levels of obesity are associated with reduced HRQoL, although this difference is negligible between those of normal weight and those who are overweight. Individuals with obesity and morbid obesity score 4.9 and 11.3 percentage points less on the EQ-5D summary scale respectively than those of normal weight. Concurrent physical, and particularly mental health-related long-term conditions are substantively related to HRQoL: those with 3 or more reported mental or physical health conditions score 29.8 and 14.6 percentage points less on the EQ-5D summary scale respectively than those with fewer conditions. Long-term conditions can be conceptualised as lying on the causal path between obesity and HRQoL, but there is weak evidence for a partial mediating relationship only. Conclusions To conclude, in agreement with the established literature we have found a clear inverse relationship between increasing weight status and decreasing HRQoL and confirmed the mediating role of long-term conditions in the reduction of HRQoL in people with obesity. Nevertheless, a high BMI remains independently related to HRQoL, suggesting that ‘healthy people with obesity’ may be in transition to an unhealthy future.

Effects of a 3-Week Inpatient Multidisciplinary Body Weight Reduction Program on Body Composition and Physical Capabilities in Adolescents and Adults With Obesity

“…The improvements in body composition and physical capacities is reported to exert a positive effects on metabolic and cardiovascular risk profiles ( 20 , 21 ), as well on both lower limb muscle power and functionality ( 17 – 19 ) and on performing ADL ( 13 ). However, the presence of a lower limb function and ability to perform ADL is often overlooked in adolescents and adults with obesity ( 22 ), even if their poor physical abilities actually worsen their quality of life, as it happens elderly obese ( 22 ).…”

Morbid obesity, multiple long-term conditions, and health-related quality of life among Australian adults: Estimates from three waves of a longitudinal household survey

“…The relationship between BMI and HRQoL has been investigated in several population-based studies, confirming a negative association between BMI and perceived quality of life, with a higher risk of poorer HRQoL frequently observed in overweight and obese persons ( Busutil et al, 2017 , Audureau et al, 2016 , Jia and Lubetkin, 2005 , Kolotkin et al, 2001 , Renzaho et al, 2010 , Song et al, 2015 ). According to the findings of a study conducted in the UK, for instance, an increasing level of BMI is associated with a statistically significant deterioration in the quality of life ( Stephenson et al, 2021 ). There is additional evidence that persons with morbid obesity (i.e., a body mass index of 40 or over) are likely to have the worse health utility scores within a population ( Slagter et al, 2015 ).…”

Worse health‐related quality of life, impaired functioning and psychiatric comorbidities are associated with excess mortality in patients with severe chronic pain

“…Poor diet, overweight, low levels of physical activity and smoking have consistently been concluded to mediate the relationship between chronic pain and excess mortality (Andersson, 2009; Macfarlane et al, 2017; Owen‐Smith et al, 2019; Smith, Wilkie, Croft, Parmar, et al, 2018). These lifestyle factors are also associated with decreased HRQoL (Ford et al, 2014; Lau et al, 2021; Stephenson et al, 2021; Vogl et al, 2012). Since poor lifestyle habits are common in chronic pain patients also in Finland (Shiri et al, 2020), they probably mediate the association of HRQoL and mortality also in the present study population.…”