title: The association between adiposity, mental well-being, and quality of life in extreme obesity.
abstract: OBJECTIVE
  To explore the cross-sectional association between adiposity, mental well-being, and quality of life in extreme obese individuals entering a UK specialist weight management service prior to treatment commencement.
  
  
  METHODS
  The sample comprised 263 extreme obese individuals who were referred to the service as a result of having a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with a co-morbid health condition. In a retrospective analysis, routinely collected baseline clinical examination data and self-report questionnaires (Impact of Weight on Quality of Life: IWQOL-Lite, EQ5D-3L, and Hospital Anxiety and Depression Scale: HADS) were analysed to examine the cross-sectional association between adiposity and quality of life.
  
  
  RESULTS
  The sample was predominantly female (74.8%) with mean BMI 47.0±7.9 kg/m2. Increasing adiposity was significantly negatively associated with quality of life, with an increase of 1 BMI unit associated with decreases of 1.93 in physical function (95% CI -2.86 - -1.00, p<0.001), 1.62 in self-esteem (95% CI -2.67 - -0.57, p<0.05), 2.69 in public distress (95% CI -3.75 - -1.62, p<0.001), 1.33 in work (95% CI -2.63 - -0.02, p<0.05), and 1.79 in total IWQOL-Lite scores (95% CI -2.65 - -0.93, p<0.001). Adiposity was associated with significantly increased risk of problems in mobility (OR = 3.44, 95% CI 1.47-8.05), and performing usual activities (OR = 2.45, 95% CI 1.10-5.46) in highest relative to lowest BMI tertile. The prevalence of experience of symptoms of anxiety (70.3%) and depression (66.2%) as measured by HADS was consistently high.
  
  
  CONCLUSIONS
  We identified a high prevalence of psychological co-morbidity, including widespread experience of symptoms of anxiety and depressive disorders and reduced quality of life among these extreme obese individuals seeking weight management treatment. Clinical implications include the need for the incorporation of strategies to improve mental well-being into multi-disciplinary weight management interventions.
authors.affiliation: Birmingham and Black Country NIHR CLAHRC, Birmingham, United Kingdom.
authors.forename: Alison C
authors.initials: AC
authors.lastname: Jagielski
authors.affiliation: Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Brown
authors.affiliation: Birmingham and Black Country NIHR CLAHRC, Birmingham, United Kingdom.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Hosseini-Araghi
authors.affiliation: Birmingham and Black Country NIHR CLAHRC, Birmingham, United Kingdom; Public Health, Epidemiology and Biostatistics, University of Birmingham, United Kingdom; Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany.
authors.forename: G Neil
authors.initials: GN
authors.lastname: Thomas
authors.affiliation: Birmingham and Black Country NIHR CLAHRC, Birmingham, United Kingdom; Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, United Kingdom; Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America, and Doha, Qatar; Department of Medicine, King's College London, London, United Kingdom.
authors.forename: Shahrad
authors.initials: S
authors.lastname: Taheri
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D015992:Body Mass Index; D003710:Demography; D003863:Depression / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology*; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care; D055815:Young Adult