Karlsson J, Sjöström L, Sullivan M
Health Care Research Unit, Sahlgrenska University Hospital, University of Göteborg, Sweden.
Int J Obes Relat Metab Disord. 1998 Feb;22(2):113-26. doi: 10.1038/sj.ijo.0800553.
To examine the effects of weight loss on health-related quality of life (HRQL) in subjects with severe obesity.
Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment.
The first 487 surgical cases and their conventionally treated, matched controls were followed for two years in the Swedish Obese Subjects (SOS) intervention study.
A battery of generic and study-specific self-assessment instruments or subscales was used to characterize HRQL in the severely obese (BMI) > or = 34 kg/m2 for males and BMI > or = 38 kg/m2 for females). Measures of general health perceptions (general health rating index; current health), mental well-being (mood adjective check list; pleasantness, activation and calmness), mood disorders (hospital anxiety and depression scale; anxiety and depression) and social interaction (sickness impact profile), were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior (three-factor eating questionnaire; restrained eating, disinhibition and perceived hunger). Assessments were conducted prior to treatment and repeated after 6, 12 and 24 months.
Poor HRQL before intervention was dramatically improved after gastric restriction surgery, while only minor fluctuations in HRQL scores were observed in the conventionally treated controls. Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up. The positive changes in HRQL after two years were related to the magnitude of weight loss, that is, the greater the weight reduction, the greater the HRQL improvements. Eating behavior improved accordingly.
Quality of life in the severely obese is improved by substantial weight loss. Most patients benefit from weight reduction surgery, while HRQL in surgical patients with minor reduction in overweight is less positive. Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained.
研究体重减轻对重度肥胖患者健康相关生活质量（HRQL）的影响。
手术减重治疗与传统减重治疗效果的对照临床试验。
在瑞典肥胖受试者（SOS）干预研究中，对首批487例接受手术治疗的病例及其接受传统治疗的匹配对照进行了为期两年的随访。
使用一系列通用和特定研究的自我评估工具或分量表来描述重度肥胖者（男性BMI≥34kg/m²，女性BMI≥38kg/m²）的HRQL。一般健康感知指标（一般健康评级指数；当前健康状况）、心理健康（情绪形容词检查表；愉悦感、活跃度和平静度）、情绪障碍（医院焦虑抑郁量表；焦虑和抑郁）以及社会交往（疾病影响概况），还补充了关于肥胖相关心理社会问题和饮食行为的肥胖特定模块（三因素饮食问卷；克制饮食、去抑制和感知饥饿）。在治疗前进行评估，并在6、12和24个月后重复评估。
胃限制手术后，干预前较差的HRQL得到显著改善，而传统治疗的对照组中HRQL评分仅出现轻微波动。手术组在干预后6或12个月时观察到峰值，在两年随访时略有至中度下降。两年后HRQL的积极变化与体重减轻的幅度有关，即体重减轻越多，HRQL改善越大。饮食行为也相应改善。
大幅减重可改善重度肥胖者的生活质量。大多数患者从减重手术中获益，而超重减轻较少手术患者的HRQL改善则不太明显。需要进一步研究以确定重度肥胖手术治疗的结果预测因素，并确保HRQL的改善得以维持。
