title: Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study.
abstract: BACKGROUND
  Guidelines and experts describe 5% to 10% reductions in body weight as 'clinically important'; however, it is not clear if 5% to 10% weight reductions correspond to clinically important improvements in health-related quality of life (HRQL). Our objective was to calculate the amount of weight loss required to attain established minimal clinically important differences (MCIDs) in HRQL, measured using three validated instruments.
  
  
  METHODS
  Data from the Alberta Population-based Prospective Evaluation of Quality of Life Outcomes and Economic Impact of Bariatric Surgery (APPLES) study, a population-based, prospective Canadian cohort including 150 wait-listed, 200 medically managed and 150 surgically treated patients were examined. Two-year changes in weight and HRQL measures (Short-Form (SF)-12 physical (PCS; MCID = 5) and mental (MCS; MCID = 5) component summary score, EQ-5D Index (MCID = 0.03) and Visual Analog Scale (VAS; MCID = 10), Impact of Weight on Quality of Life (IWQOL)-Lite total score (MCID = 12)) were calculated. Separate multivariable linear regression models were constructed within medically and surgically treated patients to determine if weight changes achieved HRQL MCIDs. Pooled analysis in all 500 patients was performed to estimate the weight reductions required to achieve the pre-defined MCID for each HRQL instrument.
  
  
  RESULTS
  Mean age was 43.7 (SD 9.6) years, 88% were women, 92% were white, and mean initial body mass index was 47.9 (SD 8.1) kg/m2. In surgically treated patients (two-year weight loss = 16%), HRQL MCIDs were reached for all instruments except the SF-12 MCS. In medically managed patients (two-year weight loss = 3%), MCIDs were attained in the EQ-index but not the other instruments. In all patients, percent weight reductions to achieve MCIDs were: 23% (95% confidence interval (CI): 17.5, 32.5) for PCS, 25% (17.5, 40.2) for MCS, 9% (6.2, 15.0) for EQ-Index, 23% (17.3, 36.1) for EQ-VAS, and 17% (14.1, 20.4) for IWQOL-Lite total score.
  
  
  CONCLUSIONS
  Weight reductions to achieve MCIDs for most HRQL instruments are markedly higher than the conventional threshold of 5% to 10%. Surgical, but not medical treatment, consistently led to clinically important improvements in HRQL over two years.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00850356.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Warkentin
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Calypse B
authors.initials: CB
authors.lastname: Agborsangaya
authors.forename: Christian F
authors.initials: CF
authors.lastname: Rueda-Clausen
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
authors.forename: Scott W
authors.initials: SW
authors.lastname: Klarenbach
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Birch
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*