Beden Kitle İndeksi ile Sağlıkla İlişkili Yaşam Kalitesi Arasındaki İlişki
Dr.
Hacer GÜRSOY, Dr. İbrahim TÜRKER, Dr. Dilşen ÇOLAK, Dr. Pınar KAYA, Dr. Ömer
DÖNDERİCİ,
Dr. Esin ÖZYILKAN
SB Ankara Eğitim ve Araştırma Hastanesi, İç Hastalıkları Kliniği, ANKARA
ÖZET
Beden Kitle İndeksi ile Sağlıkla İlişkili Yaşam Kalitesi Arasındaki İlişki
Bu çalışmanın amacı beden kitle indeksi ve sağlıkla ilişkili yaşam kalitesi arasında herhangi bir ilişkinin olup olmadığını saptamaktır. Bu sorunun cevabını araştırmak için Kısa Form-36 denen sağlık durum anketi 143 gönüllü kadın ve 35 erkeğe uygulandı. Kişiler beden kitle indeksine göre gruplandı. Yaş ve beden kitle indeksi arasında anlamlı bir ilişki saptandı (r= 0.37, p< 0.001). Subgrup analizinde fonksiyonel iyilik (r= -0.364; p< 0.001) ve genel sağlık durumu (r= -0.187; p< 0.005) ile beden kitle indeksi arasında anlamlı ilişkiler saptandı. Kovaryans analizinde yaşa ve cinsiyete göre düzeltme yapıldığında bu ilişkiler yine devam etti. Obezite yaşam kalitesini bozmaktadır. Bu bozulmanın derecesini saptama klinisyene obezite tedavi rejimini seçmede ve izlemede yol gösterici olabilir.
Anahtar Kelimeler: Beden kitle indeksi, sağlıkla ilişkili yaşam kalitesi, kısa form-36
SUMMARY
Correlation Between Body Mass Index and Health Related Quality of Life
The aim of this study was to determine whether there is a correlation between body mass index (BMI) and health-related quality of life (HR-QOL). To adress this question Short Form-36 (SF-36) a generic health status questionnaire was used. In this study 143 volunteered women and 35 volunteered men were enrolled. They were grouped according to BMI. There was a significant correlation between age and BMI (r= 0.37, p< 0.001). In subgroup analysis functional well-being (r= -0.364; p< 0.001) and genaral health status (r= -0.187; p< 0.005) were correlated to BMI significantly. In covariance analysis after corrected to age and sex, these correlations were still evident. Obesity impaires quality of life. Detecting this degrees of impairment may provides clinician to decide and monitor the obesity treatment regimen.
Key Words: Body mass index, health-related quality of life, short form-36
INTRODUCTION
Obesity has been associated with impaired quality of life. Health-related quality of life (HR-QOL), refers to the overall effects of medical conditions on physical and mental functioning and well-being as sub-jectively evaluated and reported by the patient (1). Several validated and reliable questionnaires are available for assessment of HR-QOL. They include generic health status instruments, generic illness instru-ments, and disease-specific instruments. Standardized assessment instruments on HR-QOL in obese subjects, such as Short Form of the Medical Outcomes Study (SF-36), have been developed. But they are not spesific for a certain condition such as obesity (2). HR-QOL is impaired in obesity and is associated with impaired physical fitness and physical limitations, impaired psychological functioning (poor body image, binge eating, depression), and altered social functioning (stigmatization, discrimination, diminished social interactions, lower socioeconomic status) (3). One study found that obese persons who sought treatment at an outpatient clinic had profound abnormalities in health-related quality of life (HR-QOL), measured by the Medical Outcomes Study Short-Form Health Survey (SF-36). Obesity was associated with negative effects on all eight domains assessed by the SF-36, particularly bodily pain. On all SF-36 domains, higher BMI values were associated with greater adverse effects. Patients with morbid obesity exhibited poor scores in physical function, general health perception, vitality, and bodily pain (4). In a recent study to assess dimensions of HR-QOL in women attending an obesity clinic, medical physical conditions and symptoms, depression scores, and "enjoying life" were not significantly different between physically active and sedantary obese women of similar age. But, the values attributed to their own physical apperance by sedantary obese women were more negative, and physical attributions about the basis of their obesity were less prevalent. Physical activity was associated with diverse facets of HR-QOL. The findings suggest that increasing physical activity of obese women seeking help for their overweight might have a positive effect on their overall health-related quality of life (5). In a Swedish study of obese subjects, a history of psychiatric symptoms, angina pectoris or joint pain, attempts to lose weight, physical activity and physical fitness influence quality of life in obese (6). This study assessed HR-QOL and correlations between BMI and HR-QOL parameters in obese individuals in an outpatient clinic.
MATERIALS and METHODS
In this study 143 volunteered women aged 42.9 ± 13.4 and 35 volunteered man aged 48.7 ± 14.9 were randomly chosen from the Ankara Training and Research Hospital Internal Medicine Outpatient Clinic list. They gave their informed consent to participate. Body mass index (BMI, the weight in kilograms divided by the square of the height in meters) and the waist circumference were measured. They were grouped according to BMI as lean (BMI < 18.5), normal weight (BMI ≥ 18.5 and < 25), overweight (BMI ≥ 25 and < 30) and obese (BMI ≥ 30 and < 40) and morbid obese (BMI ≥ 40). In order to evaluate the HR-QOL, Medical Outcomes Study Short-Form Health Survey (SF-36) was applied to all patients. This self-administered questionnaire contains 36 questions measuring eight domains of functioning: physical functioning, role-physical, social functioning, bodily pain, mental health, role emotional, vitality and general healh status. For all measures of the eight SF-36 domains, scores were transformed linearly to scales of 0 (maximally impairement) to 100 (no impairement). The Turkish version of SF-36 form which had been shown to be valid by compairing with Nottingham Health Profile for use in Turkey (7). Turkish version of SF-36 confidence co-efficient (Cronbach alpha co-efficient) has been calculated as 0.73-0.76 but it has been used generally in romatology. The effect of BMI on these QOL parameters were determined individually. Statistical testing involved the Student's t-test and correlation analysis was done using SPSS software, version 11.0 (SPSS, Inc., Chicago, Illionis, USA). All results were expressed as mean ± SEM, and p values less than 0.05 were considered significant. Correlations were expressed as Pearson Correlation Coefficient (r). Co-variance analysis was used to calculate adjusted correlations according to age and sex.
RESULTS
Grouping all patients to BMI yielded that 6 (3.4%) lean, 42 (23.6%) normal weight, 43 (24.2%) overweight, 67 (37.6%) obese and 20 (11.2%) were morbid obese. There was a significant correlation between age and BMI (r= 0.37, p< 0.001). Since BMI in men and women groups were different (p< 0.001) the correlations between HR-QOL instruments and BMI were corrected to age and sex. In subgroup analysis physical functioning (r= -0.364; p< 0.001) and general health status (r= -0.187; p< 0.005) were related to BMI significantly. In covariance analysis after corrected to age and sex, these correlations were still evident (r= -0.272; p< 0.001 and; r= -0.201; p< 0.001 respectively). No correlation was found between BMI and role physical (r= -0.065; p> 0.05), BMI and bodily pain (r= -0.068; p> 0.05), BMI and vitality (r= -0.048; p> 0.05), BMI and social functioning (r= 0.020; p> 0.05), BMI and role-emotional (r= -0.037; p> 0.05), and BMI and mental health (r= -0.095; p> 0.05).
DISCUSSION
In this study we detected that as BMI incresed the general health status and physical function parameteres of SF-36 test impaired negatively. But some scales of this HR-QOL assessment test didn't change with obesity. This confirms previous studies that obesity impaires mostly physical function rather that pschological status and social adjustment (8). In a study to examine the relationship between BMI and HR-QOL in male outpatients showed that inverse relationship between BMI and physical aspects of HR-QOL exists in a population of male outpatients (9). It may be possible that ethnical and socio-cultural differences of obese people play an important role in this manner. In a study to investigate the HR-QOL, and psychological well-being in obese women there was no difference in HR-QOL between African American (AA) and white obese women and this study suggests that menopausal status may have an impact on HR-QOL, especially in AA women (10). In previous studies sex difference were also important to evaluate HR-QOL. In a study using The Obesity-Related Problems scale to measure the impacts of obesity on psychosocial functioning, obese women reported more weight-related psychosocial problems than obese men and weight reduction in obese is followed by improvements in both psychosocial functioning and mental well-being (11). There are studies that obesity effects pscycologically and emotionally and sociocultural life of obese subjects severely (4,5). It is also possible that this tests like SF-36 to measure HR-QOL may not valid enough to measure early changes in pscho-social life of this obese people. The standardization and validation of this HR-QOL assessment tests for different languages and different communities are also difficult and they might be not appropriate for all diseases. The Turkish version of SF-36 for example mostly used in rheumatolgy and validation of using in obese subjects have not known yet. Obesity impaires quality of life. Detecting this degrees of impairment may provides clinician to decide and monitor the obesity treatment regimen. HR-QOL assessment tests should be used carefully in different ethnical and sociocultural populations.
REFERENCES
YAZIŞMA ADRESİ
Dr. Hacer GÜRSOY
SB Ankara Eğitim ve Araştırma Hastanesi
İç Hastalıkları Kliniği
ANKARA