Wee Christina C, Davis Roger B, Jones Dan B, Apovian Caroline A, Chiodi Sarah, Huskey Karen W, Hamel Mary B
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
Division of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Obes Surg. 2016 Jun;26(6):1308-16. doi: 10.1007/s11695-015-1956-4.
Evidence suggests obesity-related social stigma and impairment in work function may be the two most detrimental quality of life (QOL) factors to overall well-being among patients seeking weight loss surgery (WLS); whether the relative importance of QOL factors varies across patient sex and race/ethnicity is unclear.
We interviewed 574 patients seeking WLS at two centers. We measured patient's health utility (preference-based well-being measure) as determined via standard gamble scenarios assessing patients' willingness to risk death to achieve weight loss or perfect health. Multivariable models assessed associations between patients' utility and five weight-related QOL domains stratified by gender and race: social stigma, self-esteem, physical function, public distress (weight stigma), and work life.
Depending on patients' sex and race/ethnicity, mean utilities ranged from 0.85 to 0.91, reflecting an average willingness to assume a 9-15 % risk of death to achieve their most desired health/weight state. After adjustment, African Americans (AAs) reported higher utility than Caucasians (+0.054, p = 0.03), but utilities did not vary significantly by sex. Among Caucasian and AA men, impairment in physical functioning was the most important factor associated with diminished utility; social stigma was also a leading factor for Caucasian men. Among Caucasian women, self-esteem and work function appeared equally important. Social stigma was the leading contributor to utility among AA women; QOL factors did not appear as important among Hispanic patients.
AAs reported higher utilities than Caucasian patients. Individual QOL domains that drive diminished well-being varied across race/ethnicity and sex.
有证据表明，肥胖相关的社会耻辱感和工作功能受损可能是寻求减肥手术（WLS）的患者总体幸福感中对整体健康最具损害的两个生活质量（QOL）因素；生活质量因素的相对重要性是否因患者性别和种族/民族而异尚不清楚。
我们在两个中心采访了574名寻求减肥手术的患者。我们通过标准博弈情景测量患者的健康效用（基于偏好的幸福感测量），该情景评估患者为实现体重减轻或完美健康而冒死亡风险的意愿。多变量模型评估了患者效用与按性别和种族分层的五个与体重相关的生活质量领域之间的关联：社会耻辱感、自尊、身体功能、公众困扰（体重耻辱感）和工作生活。
根据患者的性别和种族/民族，平均效用范围为0.85至0.91，这反映出患者平均愿意承担9%-15%的死亡风险以达到他们最期望的健康/体重状态。调整后，非裔美国人（AAs）报告的效用高于白种人（+0.054，p=0.03），但效用在性别上没有显著差异。在白种人和非裔美国男性中，身体功能受损是与效用降低相关的最重要因素；社会耻辱感也是白种男性的一个主要因素。在白种女性中，自尊和工作功能似乎同样重要。社会耻辱感是导致非裔美国女性效用降低的主要因素；生活质量因素在西班牙裔患者中似乎不那么重要。
非裔美国人报告的效用高于白种患者。导致幸福感降低的个体生活质量领域因种族/民族和性别而异。
