title: Quality of life among obese patients seeking weight loss surgery: the importance of obesity-related social stigma and functional status.
abstract: BACKGROUND
  Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown.
  
  
  METHODS
  We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients' health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients' willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients' health utility.
  
  
  RESULTS
  Our study sample (n = 574) had a mean body mass index of 46.5 kg/m(2) and a mean health utility of 0.87, reflecting the group's average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients' utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients' utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients' health utility.
  
  
  CONCLUSIONS
  Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a 10 % risk of death to achieve their most valued health/weight state. Interference with role functioning due to physical limitations and obesity-related social stigma were strong determinants of reduced health utility.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. cwee@bidmc.harvard.edu
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wee
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Karen W
authors.initials: KW
authors.lastname: Huskey
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.forename: Mary B
authors.initials: MB
authors.lastname: Hamel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D050110:Bariatric Surgery; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D011594:Psychometrics; D057545:Social Stigma; D014850:Waiting Lists; D055815:Young Adult