Obesity and health-related quality of life in men - Effects of Obesity on Different Aspects of Life

Nutrition Research Newsletter, Nov, 2002 by William S. Yancy, Jr., Maren K. Olsen, Eric C. Westman

Overweight is an increasing problem in the United States; recent estimates classify over 50% of Americans as either overweight or obese. Plenty of research shows the health burdens of being overweight and obese, such as type 2 diabetes, hypertension, coronary artery disease, and others, but now there is a growing body of literature describing the effect that being overweight has on lower health-related quality of life (HRQOL) as well.

Several studies have shown that overweight persons have lower HRQOL, especially in the physical aspects of daily life, compared with their normal-weight counterparts. However, these findings may not apply to the medical outpatient population. In addition, the inverse relationship between body weight and HRQOL is established for women, the association is not as clear in men. To help clarify these issues, a recent study measured the independent relationship between, body weight and HRQOL in a population of Veterans' Affairs male outpatients while considering comorbid illness.

This cross-sectional study examined 1168 male outpatients from Durham Veterans' Affairs Medical Center. The Medical Outcomes Study Short Form 36 (SF-36) was used to measure HRQOL. The SF-36 is a self-administered measure that contains brief indices of the following domains: Physical Functioning, Role Limitations due to Physical Functioning (Role-Physical), Bodily Pain, General Health, Vitality, Social Functioning, Role Limitations due to Emotional Functioning (Role-Emotional), and Mental Health. The Kaplan-Feinstein Comorbidity Index was used to assess the presence and severity of comorbid illnesses, while the Center for Epidemiological Studies

Depression Scale (CES-D) was used to evaluate for depressive symptoms. Lastly, the Framingham Physical Activity Index was used to evaluate daily physical activity.

The subjects had a mean age of 54.7 years; 69% were white and 29% were African American. Mean scores on each SF-36 subscale for the entire sample and for each BMI group were lower than the US norms. Subjects with a BMI > 40 kg/ [m.sup.2] had significantly lower scores compared with normal-weight individuals on 5 of the 10 subscales (Physical Functioning, Role-Physical, Bodily Pain, Vitality, and Physical Component Summary). Lower scores were observed at BMI > 35 kg/[m.sup.2] on the physical functioning and Physical Components subscales, while on the Bodily Pain subscale, lower scores were observed at BMI > 25 kg/[m.sup.2]. Two significant interactions existed. Increased BMI had a greater negative association with General Health and Vitality when the physical activity score was low compared with when the physical activity score was high.

The results show an inverse relationship between BMI and physical aspects of HRQOL exists in a population of male outpatients. Because the cohort analyzed did not include patients with diabetes and because the study controlled for other comorbid illnesses, the results are very likely to reflect the independent association between obesity and HRQOL. However, it must be acknowledge that there is likely an attenuation of the association between body weight and HRQOL in this population because SF-36 scores were low regardless of body weight. Further research is necessary but the findings emphasize that obesity not only increases a person's risk of morbidity and mortality, but also may significantly impact individuals' daily lives.

William S. Yancy, Jr., Maren K. Olsen, Eric C. Westman, et al., Relationship between obesity and health-related quality of life in men, Obesity Research 10(10): 1057-1064 (October 2002) [Address correspondence to William S. Yancy, Jr., HSR&D (152), Durham VA Medical Center, 508 Fulton St., Durham, NC 27705. E-mail: yancy006@mc.duke.edu]