title: The effect of weight loss on changes in health-related quality of life among overweight and obese women with urinary incontinence.
abstract: OBJECTIVE
  To estimate the effect of change in weight and change in urinary incontinence (UI) frequency on changes in preference-based measures of health-related quality of life (HRQL) among overweight and obese women with UI participating in a weight loss trial.
  
  
  METHODS
  We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a randomized clinical trial comparing a behavioral weight loss intervention to an educational control condition. At baseline, 6, and 18 months, health utilities were estimated using the Health Utilities Index Mark 3 (HUI3), a transformation of the SF-36 to the preference-based SF-6D, and the estimated Quality of Well-Being (eQWB) score (a summary calculated from the SF-36 physical functioning, mental health, bodily pain, general health perceptions, and role limitations-physical subscale scores). Potential predictors of changes in these outcomes were examined using generalized estimating equations.
  
  
  RESULTS
  In adjusted multivariable models, weight loss was associated with improvement in HUI3, SF-6D, and eQWB at 6 and 18 months (P < 0.05). Increases in physical activity also were independently associated with improvement in HUI3 (P = 0.01) and SF-6D (P = 0.006) scores at 18 months. In contrast, reduction in UI frequency did not predict improvements in HRQL at 6 or 18 months.
  
  
  CONCLUSIONS
  Weight loss and increased physical activity, but not reduction in UI frequency, were strongly associated with improvements in health utilities measured by the HUI3, SF-6D, and eQWB. These findings provide important information that can be used to inform cost-utility analyses of weight loss interventions.
authors.affiliation: Psychology Department, Baruch College, CUNY, 55 Lexington Avenue, B8-215, New York, NY 10010, USA. Angela.Pinto@baruch.cuny.edu
authors.forename: Angela Marinilli
authors.initials: AM
authors.lastname: Pinto
authors.forename: Leslee L
authors.initials: LL
authors.lastname: Subak
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Delia Smith
authors.initials: DS
authors.lastname: West
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000523:psychology*; D050177:Overweight / Q000523:psychology*; D011788:Quality of Life; D014549:Urinary Incontinence / Q000523:psychology*; D015431:Weight Loss