title: Obesity and symptoms and quality of life indicators of individuals with disabilities.
abstract: BACKGROUND
  Health risks of obesity are well known, but effects of obesity on health-related quality of life (HRQOL) have not been well-studied in people with physical disabilities.
  
  
  OBJECTIVE
  We examined the association between obesity and HRQOL in people with disabilities relative to the general US population. We hypothesized (a) overall, individuals with disabilities will report worse HRQOL than the general US population and (b) obese individuals with disabilities will report worse HRQOL than non-obese individuals.
  
  
  METHODS
  Individuals with muscular dystrophy, multiple sclerosis, post-polio syndrome, and spinal cord injury (N = 1849) completed Patient Reported Outcomes Measurement Information System (PROMIS) measures of fatigue, pain interference, physical and social function, depression, sleep disturbance, and sleep-related impairment. Participants were classified as obese or non-obese based on self-reported weight and height (BMI) and/or waist circumference (WC). PROMIS T-scores were compared to norms and between obesity groups.
  
  
  RESULTS
  Mean BMI was 26.4 kg/m(2) with 23.4% classified as obese. Mean WC was 37.5 inches (males) and 34.0 inches (females); 26.4% reported abdominal obesity. Based on BMI and/or WC, 33.3% (n = 616) were classified obese. Compared to PROMIS norms, obese individuals reported worse HRQOL on all domains (p < 0.0001). Compared to non-obese individuals, obese individuals reported worse functioning on all domains except depression (p < 0.01). Obese individuals with MS and MD reported worse outcomes than non-obese counterparts.
  
  
  CONCLUSIONS
  Obesity in people with physical disabilities is associated with poorer HRQOL. More research is needed to inform clinicians in identifying obese patients and helping them achieve healthy weight, reduce symptom burden, and improve QOL.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. Electronic address: rsalem@uw.edu.
authors.forename: Rana
authors.initials: R
authors.lastname: Salem
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Bamer
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Alschuler
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Kurt L
authors.initials: KL
authors.lastname: Johnson
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Amtmann
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003863:Depression; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009136:Muscular Dystrophies / Q000150:complications; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012016:Reference Values; D057566:Self Report; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference
keywords: Body mass index; Obesity; Physical disabilities; Quality of life; Waist circumference