PDF Ebook Health-related quality of life in clinical weight loss studies
The prevalence of obesity is increasing worldwide. Among 25-64 year-old Finns, 19.8% of men and 19.4% of women had a BMI ?30 kg/m in 1997 (Lahti-Koski et al. 2000a). The most alarming trend is the increasing prevalence of abdominal obesity (Lahti-Koski et al. 2000b), which is strongly associated with the metabolic syndrome and type 2 diabetes. Obesity is also associated with several other chronic conditions, such as coronary heart disease, obstructive sleep apnoea, asthma and other pulmonary syndromes, degenerative joint disease, and certain types of cancer. On a societal level the health risks associated with obesity pose a serious and costly public health hazard. On an individual level obesity not only shortens life expectancy but also reduces the number of healthy and functional life-years (WHO 2000).
Quality of life is a broad concept including physical, mental, and social well-being. Health-related quality of life is a narrower concept including attempts to define the impact of diseases and their treatments on functional status and well-being (Testa and Simonson 1996). The basic principle of measuring quality of life is that the patient is asked what he/she can do (functioning) and how he/she feels (well-being). Information on HRQL may influence the development of clinical pathways, service provision, health care expenditures, and public health policy.
If obese, only 5-10% maintained weight loss has been shown to improve metabolism and to reduce the risk of obesity-related chronic conditions. If already diagnosed, weight loss improves the symptoms and clinical findings of these obesity-related chronic conditions (Mustajoki et al. 2002). But how do the patients themselves rate their functioning and well-being?
This thesis is based on self-administered questionnaires and it examines the patient perspective on associations of weight loss and health-related quality of life in clinical weight loss studies. The weight loss methods include very-low-energy diet and behaviour modification, the weight loss drug sibutramine, and weight loss surgery using gastric bypass or vertical banded gastroplasty. First, HRQL in the clinical obese populations entering weight loss programmes is evaluated. Then, the changes in HRQL during active weight loss, and more importantly, during longer-term weight loss maintenance are reported. This thesis also presents data on HRQL measures as predictors of success in weight loss maintenance over 1-2 years.
Content
List Of Original Publications
Abbreviations
Abstract
1 Introduction
2 Review Of The Litterature
2.2 Obesity And Related Health Problems
2.2.1 Metabolic Syndrome And Type 2 Diabetes
2.2.2 Testosterone And Sexual Functions
2.2.3 Chronic Conditions
2.2.4 Psychopathology
2.2.5 Mortality
2.2.6 Costs Of Obesity
1.3 Management Of Obesity
1.3.1 Diet, Physical Activity, And Behaviour Modification
1.3.2 Very-Low-Energy Diet
1.3.3 Pharmacotherapy
1.3.4 Surgery
1.4 Consequences Of Intentional Weight Loss
1.4.1 Cardiovascular Risk Factors And Type 2 Diabetes
1.4.2 Testosterone And Sexual Functions
1.4.3 Symptoms And Findings Of Chronic Conditions
1.4.4 Depression And Anxiety
1.4.5 Mortality
1.4.6 Health-Care Costs
1.1.7 Adverse Effects
1.5 HEalth-Related Quality Of Life
1.5.1 efinition Of Concepts
1.5.2 nstrument Development
1.5.3 lobal Questions And Generic Instruments
1.5.4 Obesity-Specific Questionnaires
1.6 Obesity, Weight Loss, And Health Related Quality Of Life
1.6.1 Population Based Observational Studies
1.6.2 Studies Among The Obese Seeking Weight Loss
1.6.3 Studies Among The Obese Losing Weight
3 Aims Of The Present Study
4 Patients And Methods
4.1 Study Design And Patient Selection
4.1.1Studies I And Ii: A Randomised Clinical Trial
4.1.2 Study Iii: A Single Strand Follow-Up Study
4.1.3 Study Iv: A Double-Blind, Randomised Clinical Trial
4.1.4 Study V: A Single Strand Follow-Up Study
4.2 Weight Loss Methods
4.3 Assessments
4.3.1 Weight And Bmi
4.3.2 The Obesity-Related Problems Scale
4.3.3 The Sf-36/Rand-36 Health Survey
4.3.4 The International Index Of Erectile Function And The Sexual Activity Scale
4.3.5 Biochemical Analyses
4.4 Statistics
4.5 Study Ethics
5 Results
5.1 Baseline Characteristics And Weight Loss
5.2 Hrql In Obese Patients Entering Weight Loss Treatment
5.3 Hrql Changes With Vled And Behaviour Modification
5.4 Testosterone And Sexual Functions With Vled And Behaviour Modification
5.5 Hrql In Sibutramine Treated Obese Type 2 Diabetics
5.6 Hrql After Gastric Bypass Or Vertical Banded Gastroplasty
5.7 Hrql Improvement In Categories Of Weight Loss
5.8 Hrql As A Predictor Of Success In Weight Loss Maintenance
6 Discussion
6.1 Patients And Methods
6.2 Hrql Among Patients Entering Weight Loss Treatment
6.3 Hrql Changes During Weight Loss And Weight Loss Maintenance
6.4 WEight Loss And Sexual Functions
6.5 Hrql And Sibutramine
6.6 Hrql After Gbp Or Vbg
6.7 Are Hrql Changes Related To Weight Loss ?
6.8 How Much Weight Loss Is Needed To Improve Hrql?
6.9 Does Hrql Predict Success In Weight Loss Maintenance ?
7 Summary And Conclusions
Acknowledgements
References
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PDF Ebook Health-related quality of life in clinical weight loss studies
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