title: Sex, Race, and the Quality of Life Factors Most Important to Patients' Well-Being Among Those Seeking Bariatric Surgery.
abstract: Evidence suggests obesity-related social stigma and impairment in work function may be the two most detrimental quality of life (QOL) factors to overall well-being among patients seeking weight loss surgery (WLS); whether the relative importance of QOL factors varies across patient sex and race/ethnicity is unclear.
  
  
  
  We interviewed 574 patients seeking WLS at two centers. We measured patient's health utility (preference-based well-being measure) as determined via standard gamble scenarios assessing patients' willingness to risk death to achieve weight loss or perfect health. Multivariable models assessed associations between patients' utility and five weight-related QOL domains stratified by gender and race: social stigma, self-esteem, physical function, public distress (weight stigma), and work life.
  
  
  
  Depending on patients' sex and race/ethnicity, mean utilities ranged from 0.85 to 0.91, reflecting an average willingness to assume a 9-15 % risk of death to achieve their most desired health/weight state. After adjustment, African Americans (AAs) reported higher utility than Caucasians (+0.054, p = 0.03), but utilities did not vary significantly by sex. Among Caucasian and AA men, impairment in physical functioning was the most important factor associated with diminished utility; social stigma was also a leading factor for Caucasian men. Among Caucasian women, self-esteem and work function appeared equally important. Social stigma was the leading contributor to utility among AA women; QOL factors did not appear as important among Hispanic patients.
  
  
  
  AAs reported higher utilities than Caucasian patients. Individual QOL domains that drive diminished well-being varied across race/ethnicity and sex.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA. cwee@bidmc.harvard.edu.
authors.forename: Christina C
authors.identifier: 0000-0002-0439-5746
authors.initials: CC
authors.lastname: Wee
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.affiliation: Division of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Dan B
authors.initials: DB
authors.lastname: Jones
authors.affiliation: Evans Department of Medicine and Department of Surgery, Boston Medical Center, Boston, MA, USA.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Apovian
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Chiodi
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Huskey
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Hamel
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D001294:Attitude to Health / Q000208:ethnology*; D050110:Bariatric Surgery / Q000523:psychology*; D001900:Boston / Q000453:epidemiology; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009767:Obesity, Morbid / Q000208:ethnology / Q000523:psychology* / Q000601:surgery*; D057240:Patient Preference / Q000208:ethnology; D011594:Psychometrics; D011788:Quality of Life; D018570:Risk Assessment; D012649:Self Concept; D012737:Sex Factors; D057545:Social Stigma; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology
keywords: Bariatric surgery; Health utility; Obesity; Quality of life; Race