Karlsson J, Taft C, Rydén A, Sjöström L, Sullivan M
Health Care Research Unit, Institute of Medicine, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
Int J Obes (Lond). 2007 Aug;31(8):1248-61. doi: 10.1038/sj.ijo.0803573. Epub 2007 Mar 13.
To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years.
Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese.
A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMI>or=34) and women (BMI>or=38) who completed 10 years of the study.
HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years.
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.
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.
研究10年间减肥治疗对重度肥胖者健康相关生活质量（HRQL）的趋势及影响。
瑞典肥胖受试者（SOS）干预研究是一项关于重度肥胖者减肥对健康影响的对照纵向试验。
851名接受手术治疗的肥胖男性（体重指数，BMI≥34）和女性（BMI≥38）中有655名，852名接受传统治疗的肥胖者中有621名完成了10年的研究。
在治疗前以及治疗后0.5、1、2、3、4、6、8和10年评估HRQL。
在10年观察期内，HRQL的变化在很大程度上遵循体重减轻、体重反弹和体重稳定阶段。HRQL的改善和恶化与体重减轻或反弹的幅度相关，但焦虑方面除外。手术组在体重减轻的第一年观察到HRQL的最大改善，而体重反弹阶段（主要在1至6年随访期间）伴随着HRQL的逐渐下降。6至10年随访期间体重和HRQL的观察结果相对稳定。10年时，与基线相比，所有HRQL领域均有净改善。10年后手术组与传统治疗组对HRQL治疗效果的比较显示，手术组在当前健康认知、社交互动、心理社会功能和抑郁方面的结果明显更好，而在总体情绪和焦虑方面未发现显著差异。该研究的长期结果表明，维持约10%的体重减轻足以对HRQL产生积极的长期影响，在完成10年研究的约三分之二接受手术治疗的患者中达到了这一限度。
重度肥胖者长期体重减轻对HRQL具有普遍的长期积极影响。减肥手术是治疗重度肥胖的有利选择，可使大多数患者长期体重减轻并改善HRQL。然而，不应忽视一些手术患者长期难以控制和维持体重减轻的问题。未来的研究应探讨在患者术后管理中实施生活方式改变技术是否可进一步提高减肥手术的长期疗效。
