Introduction
Obesity has become a pervasive global health issue, and it is projected that there will be approximately one in five adults with obesity by 2025 [1]. Extensive research has established a clear association between obesity and several chronic diseases, such as cardiovascular disease, type 2 diabetes, and certain types of cancer [2]. This epidemic not only significantly compromises the health-related quality of life (HRQoL) for those afflicted but also imposes considerable economic and healthcare burdens on society. Recent studies have also shed light on the correlation between obesity and pelvic floor dysfunction (PFD), which is considered one of the five major diseases affecting women’s health [3‐5].
Urinary incontinence (UI), a prevalent form of PFD, profoundly compromises the physical and psychological well-being of afflicted women. Previous studies have focused on the relationship between obesity and UI, indicating a substantial increase in UI incidence among overweight or obese individuals [4, 6]. Excessive weight carried by individuals with obesity exerts additional pressure on the pelvic floor tissues, leading to structural changes and functional abnormalities [5]. Furthermore, obesity is associated with chronic low-grade inflammation and insulin resistance, which may affect the nerves and blood vessels that are crucial for bladder control [5]. Previous studies demonstrated that both UI and obesity adversely affect sexual function of affected women [7‐9]. Obesity-induced hormonal imbalances, particularly estrogen and testosterone dysregulation, coupled with its psychological negative influence—body dissatisfaction and depression—substantially impair sexual desire and performance [7]. Moreover, obesity-related inflammation and insulin resistance can also impair nerve function and genital blood flow which are crucial for arousal and orgasm [8]. The occurrence of involuntary UI during sexual activity can lead to profoundly embarrassing situations and the persistent fear of such leakage can intensify into anxiety and depression, significantly diminishing both sexual desire and overall sexual satisfaction [9]. Despite this, the current rate of seeking medical assistance for UI symptoms remains alarmingly low, suggesting that the deleterious effect of UI on HRQoL may be unrecognized and untreated [10, 11]. It is plausible that affected women may conceal their UI due to fear of social rejection, the stigma associated with shame and anxiety, or possibly because they have become accustomed to managing the condition.
Therefore, delving into the condition of UI and its effect on HRQoL and sexual function remains crucial among high-risk populations such as women with obesity. HRQoL can be evaluated via both generic and disease-specific instruments. Although disease-specific questionnaires may capture subtle changes in HRQoL associated with specific illnesses, they often struggle to comprehensively reflect the generic HRQoL. One widely used instrument for measuring generic HRQoL is the European Quality of Life-5 Dimensions 5-Level questionnaire (EQ-5D-5 L), which provides a comprehensive assessment of an individual’s health across multiple dimensions, enabling the calculation of health utility scores across various health states. Recently, studies have demonstrated that the EQ-5D performs well across various dimensions, such as construct validity, responsiveness, and reliability, when used in individuals with UI [12, 13]. However, previous research investigating the influence of UI on the HRQoL of women with overweight or obesity predominantly employs UI-specific tools, with limited exploration delving into the generic HRQoL within this demographic. In this study, we comprehensively evaluated the effect of varying severities of UI on the disease-specific and generic HRQoL and sexual function of women with overweight or obesity, laying the foundation for developing more holistic and integrated management strategies tailored to this specific population.
Methods
Recruitment and data collection
From September 2023 to January 2024, an online survey was conducted among women with overweight or obesity who were seeking weight loss interventions at the clinical nutrition department of Peking Union Medical College Hospital. The weight loss intervention at our center prominently includes physical activities and dietary changes. For participants who visited multiple times, only the first-time response was recorded. For those with UI, a comprehensive dataset was further collected, incorporating fundamental demographic details and validated questionnaires that specifically assess the severity of UI and its repercussions on the HRQoL and sexual function of affected women. Women will be distributed into 3 groups according to the severity of UI symptoms measured by the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF): mild, moderate, and severe. For this study, metabolic syndrome (MetS) was defined according to the International Diabetes Federation [14].
Inclusion and exclusion criteria
Inclusion criteria
(1)
Age ≥ 18 years.
(2)
Body mass index (BMI) ≥ 25 kg/m2.
Exclusion criteria
(1)
Previous PFD treatment.
(2)
Pregnancy or childbirth within the past six months.
(3)
Prolapse beyond the hymen level.
(4)
Urinary tract infection or gynecological reproductive system infection within the past month.
(5)
Mental illness and severe systemic illness.
(6)
Pelvic or abdominal malignancy.
(7)
History of bariatric surgery or pharmacological interventions for weight loss.
Details of the included questionnaires
Urinary incontinence assessment
In this study, the definitions of UI are in alignment with the standards set forth by the International Continence Society [15]. UI symptoms are characterized as complaints of involuntary loss of urine. To assess the severity of UI, validated Chinese versions of the ICIQ-UI-SF were utilized [16]. The overall ICIQ-UI-SF score is calculated by summing the scores of the first three items, ranging from 0 to 21, and is categorized as mild (0–7), moderate (8–13), or severe (14–21).
Health-related quality of life
The validated Chinese version of the Incontinence Impact Questionnaire-Short Form (IIQ-7) serves as a specific tool to evaluate the unique effects of UI on HRQoL [17, 18]. The questionnaire is composed of seven distinct questions, each rated on a scale from 0 to 3 points. The cumulative score spans a range of 0–21 points, with higher scores reflecting an increased severity to which UI affects the individual’s HRQoL. Moreover, the generic HRQoL was also assessed via the validated Chinese version of the European Quality of Life-5 Dimensions 5-Level questionnaire (EQ-5D-5 L), which consists of a health description system and a visual analog scale [19]. The health description system covers five dimensions of health-related QoL: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression symptoms. Each dimension is rated on a scale from 1 (no problems) to 5 (extreme problems), providing a comprehensive evaluation of the participants’ overall well-being. The associated visual analog scale (EQ-VAS) allows participants to subjectively rate their health status on a scale from 0 to 100, with higher scores indicating better health status.
Sexual function
The validated Chinese version of the Short-form Prolapse Incontinence Sexual Questionnaire (PISQ-12) will be used to assess the effect of UI on sexual function [20]. This questionnaire is composed of 12 items categorized into three domains: behavioral/emotive (items 1–4), physical (items 5–9), and partner-related (items 10–12). Scores on the PISQ-12 range from 0 to 48. Scores are calculated by totalling the scores for each question, with 0 = never, and 4 = always. Reversed scoring is used for items 1–4. The maximum total score is 48, and a higher score indicates a worse sexual function.
Pelvic organ prolapse symptoms
For the evaluation of pelvic organ prolapse symptoms, the validated Chinese version of the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire was used [21]. This questionnaire consists of seven items addressing the frequency of prolapse symptoms experienced in the previous 4 weeks. Each item is scored from 0 (never) to 4 (all of the time), with a total score ranging from 0 to 28. Higher scores indicate greater severity of symptoms.
Data analysis
The data were subjected to analysis via IBM SPSS Statistics version 22.0 (Armonk, NY, USA). Categorical variables are presented as frequencies and proportions, and comparisons were made via the chi-square test. Continuous variables are presented as the means ± standard deviations and were analyzed via univariate analysis of variance. Additionally, a multivariate regression model was constructed to identify factors influencing the severity of UI and to adjust for potential confounders that might distort the relationship between UI severity and the EQ-5D-5 L score. All categorical variables included in the regression are binary variables, with the reference level defined as the absence of the condition. Furthermore, the Spearman rank correlation analysis was performed to detect correlations between the EQ-5D-5 L scores and the severity of UI measured by ICIQ-UI-SF and IIQ-7 scores for the devastation from normal distribution. Correlation coefficients of less than 0.3 are considered very weak, those between 0.3 and 0.5 are considered weak, those between 0.5 and 0.7 are considered moderate, and those greater than 0.7 are considered strong. Statistical significance was set at a p-value of less than 0.05.
Results
Participant recruitment
Out of 1205 valid responses, 564 (46.8%) of whom presented UI symptoms were included in this study (Fig. 1), with a mean age of 36.7 years (range: 18–67) and a BMI of 29.9 kg/m2 (range: 25–46.4) (Table 1).
Fig. 1
Flow diagram of participant enrolment and screening
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Table 1
Comparison of basic clinical characteristics among women with overweight or obesity with varying severities of urinary incontinence
Study characteristics | Mild (n = 354) | Moderate (n = 179) | Severe (n = 31) | P | Adj-OR* | Adj-P |
|---|---|---|---|---|---|---|
Age (years) | 35.81 ± 8.03 | 37.62 ± 8.73 | 40.65 ± 10.94 | 0.002 | 1.03 | 0.002 |
Body mass index (kg/m2) | 29.71 ± 4.09 | 29.98 ± 4.3 | 31.54 ± 4.08 | 0.061 | 1.05 | 0.019 |
History of vaginal delivery | 116(32.8%) | 72(40.2%) | 16(51.6%) | 0.044 | 1.54 | 0.021 |
History of instrument delivery | 14(4%) | 8(4.5%) | 2(6.5%) | 0.792 | ||
History of cesarean delivery | 101(28.5%) | 65(36.3%) | 11(35.5%) | 0.165 | ||
POP-SS | 4.3 ± 3.24 | 5.39 ± 3.95 | 5.55 ± 4.65 | 0.002 | 1.1 | <0.001 |
Menopause | 32(9%) | 24(13.4%) | 5(16.1%) | 0.191 | ||
Smoker | 25(7.1%) | 15(8.4%) | 2(6.5%) | 0.841 | ||
Asthma | 15(4.2%) | 10(5.6%) | 6(19.4%) | 0.002 | 2.02 | 0.052 |
Allergic rhinitis | 112(31.6%) | 52(29.1%) | 7(22.6%) | 0.52 | ||
Metabolic syndrome | 41(11.6%) | 25(14%) | 9(29%) | 0.022 | 1.7 | 0.037 |
Diabetes | 40(11.3%) | 24(13.4%) | 9 (29%) | 0.018 | ||
Dyslipidemia | 59(16.7%) | 44(24.6%) | 9(29%) | 0.04 | ||
Hypertension | 43(12.1%) | 30(16.8%) | 6(19.4%) | 0.237 | ||
Pelvic floor muscle training | ||||||
None | 294(83.1%) | 146(81.6%) | 26(83.9%) | 0.896 | ||
Occasionally | 60(16.9%) | 33(18.4%) | 5(16.1%) | |||
Sexual frequency | 0.844 | |||||
None or occasionally | 246(67.2%) | 130(72.6%) | 21(67.7%) | |||
< 2 per week | 90(25.4%) | 38(21.2%) | 8(25.8%) | |||
≥ 2 per week | 18(5.1%) | 11(6.1%) | 2(6.5%) | |||
Toilet way | 0.837 | |||||
Squatting | 44(12.4%) | 24(13.4%) | 3(9.7%) | |||
Sitting | 310(87.6%) | 155(86.6%) | 28(90.3%) | |||
Occupation mode | 0.263 | |||||
Brainwork mainly | 331(93.5%) | 162(90.5%) | 27(87.1%) | |||
Physical work mainly | 23(6.5%) | 17(9.5%) | 4(12.9%) | |||
Physical labor | 0.922 | |||||
Light | 271(76.6%) | 132(73.7%) | 23(74.2%) | |||
Moderate | 80(22.6%) | 45(25.1%) | 8(25.8%) | |||
Heavy | 3(0.8%) | 2(1.1%) | 0 | |||
Educational background | 0.94 | |||||
High school and below | 14(4%) | 9(5%) | 1(3.2%) | |||
Undergraduate and Junior college | 244(68.9%) | 124(69.3%) | 23(74.2%) | |||
Graduate student | 96(27.1%) | 46(25.7%) | 7(22.6%) |
Basic clinical characteristics of individuals with varying severities of urinary incontinence
We compared the basic clinical characteristics of participants according to the severity of UI. Participants were stratified into three distinct categories: 354 subjects (62.77%) classified as having mild UI, 179 (31.74%) with moderate UI, and 31 (5.50%) with severe UI according to the ICIQ-UI-SF. As shown in Table 2, significant differences were observed among the three groups in terms of age, history of vaginal delivery, POP-SS score, asthma, and MetS. All potential indicators identified with a p-value less than 0.1 in the univariate analysis were subsequently incorporated into the multivariate ordinal logistic regression analysis, and the results indicate that age (OR = 1.03, 95% CI: 1.01–1.05, P = 0.002), BMI (OR = 1.05, 95% CI: 1.01–1.10, P = 0.019), history of vaginal delivery (OR = 1.54, 95% CI: 1.07–2.22, P = 0.021), POP-SS (OR = 1.1, 1.04–1.15, P<0.001), and MetS (OR = 1.70, 95% CI: 1.03–2.79, P = 0.037) emerged as independent predictors of increased risk of severe UI.
Effect of urinary incontinence severity on health-related quality of life and sexual function
As shown in Fig. 2, women with elevated UI severity presented statistically significant worse UI-specific HRQoL (IIQ-7 scores: 1.59 ± 2.39, 3.77 ± 4.08, and 5.9 ± 4.92 respectively; P<0.001) and sexual function (PISQ-12 scores: 12.88 ± 2.52, 14.58 ± 4.38, and 17.7 ± 3.14 respectively; P<0.001). Furthermore, we also evaluated the generic HRQoL via the EQ-5D-5 L among the three groups. Women with more severer UI severity showed significant worse generic HRQoL manifesting in lower mean utility (0.987 ± 0.015, 0.984 ± 0.016, and 0.976 ± 0.021 respectively; P < 0.001) and EQ-VAS scores (73.97 ± 15.2, 71.12 ± 15.55, and 68.45 ± 18.67 respectively; P = 0.039) of EQ-5D-5 L especially in domains of usual activities (P < 0.001) and anxiety/depression symptoms (P = 0.044).
Fig. 2
The effect of varying severities of urinary incontinence on disease-specific health-related quality of life and sexual function. A: Incontinence Impact Questionnaire-Short Form (IIQ-7), B: Short-form Prolapse Incontinence Sexual Questionnaire (PISQ-12), C: Three specific domains of the PISQ-12. The number of participants who completed the PISQ-12 in the three groups was 229, 106, and 23, respectively. *P<0.05, **P<0.01, **P<0.001
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Multivariate logistic regression analysis was subsequently conducted to control for potential confounders, including age, BMI, history of vaginal delivery, POP-SS, asthma, and MetS (Supplementary Tables 1 and Table 2). We found that the results, except for those of the EQ-VAS (adjusted P = 0.135), remained consistent with the univariate analysis results. Regarding the generic HRQoL, the effect of UI severity was notably pronounced in the domains of usual activities (OR = 3.02, 95% CI: 1.49–6.09, P = 0.002) and anxiety/depression symptoms (OR = 1.03, 95% CI: 1.02–1.78, P = 0.034) of EQ-5D-5 L.
Table 2
The effect of varying severities of urinary incontinence on generic health-related quality of life measured by the EQ-5D-5 L
EQ-5D-5 L | Mild (n = 354) | Moderate (n = 179) | Severe (n = 31) | P | Adj- Statistic | Adj-P |
|---|---|---|---|---|---|---|
Mobility | 0.461 | 1.11(0.57,2.15) # | 0.768 | |||
No problems | 341(96.3%) | 171(95.5%) | 28(90.3%) | |||
Slight problems | 11(3.1%) | 7(3.9%) | 3(9.7%) | |||
Moderate problems | 2(0.6%) | 1(0.6%) | 0 | |||
Self-care | 0.589 | 0.58(0.12–2.73) # | 0.493 | |||
No problems | 350(98.9%) | 177(98.9%) | 30(96.8%) | |||
Slight problems | 4(1.1%) | 2(1.1%) | 1(3.2%) | |||
Usual activities | ||||||
No problems | 343(98.3%) | 171(95.5%) | 25(80.6%) | <0.001 | 3.02(1.49,6.09) # | 0.002 |
Slight problems | 4(1.1%) | 7(3.9%) | 4(12.9%) | |||
Moderate problems | 2(0.6%) | 1(0.6%) | 2(6.5%) | |||
Pain/discomfort | 0.446 | 1.11(0.81,1.53) # | 0.506 | |||
None | 246(69.5%) | 113(63.1%) | 17(54.8%) | |||
Slight | 96(27.1%) | 57(31.8%) | 11(35.5%) | |||
Moderate | 8(2.3%) | 6(3.4%) | 2(6.5%) | |||
Severe | 4(1.1%) | 3(1.7%) | 1(3.2%) | |||
Anxiety/depression symptoms | 0.044 | 1.03(1.02,1.78) # | 0.034 | |||
None | 149(42.1%) | 59(33%) | 6(19.4%) | |||
Slight | 159(44.9%) | 90(50.3%) | 17(54.8%) | |||
Moderate | 41(11.6%) | 27(15.1%) | 6(19.4%) | |||
Severe | 5(1.4%) | 3(1.7%) | 2(6.5%) | |||
Mean utility value | 0.987 ± 0.015 | 0.984 ± 0.016 | 0.976 ± 0.021 | <0.001 | -0.084* | 0.038 |
EQ-VAS | 73.97 ± 15.2 | 71.12 ± 15.55 | 68.45 ± 18.67 | 0.039 | -0.064* | 0.131 |
The correlation between the generic health-related quality of life and the severity of urinary incontinence symptoms
Next, we detected the relationships between the generic HRQoL measured by EQ-5D-5 L and the severity of UI symptoms measured by ICIQ-UI-SF and IIQ-7 (Table 3). Although the correlations were weak, the ICIQ-UI-SF and IIQ-7 scores were significantly correlated with the mean utility values (r=-0.335, and − 0.351, P<0.001) of EQ-5D-5 L especially in the domains of anxiety/depression symptoms (r = 0.339 and 0.322, P<0.001).
Table 3
The correlation between the EQ-5D-5 L and urinary incontinence severity measured by ICIQ-UI-SF and IIQ-7
EQ-5D-5 L | ICIQ-UI-SF | IIQ-7 | ||
|---|---|---|---|---|
r | P | r | P | |
Mobility | 0.057 | 0.175 | 0.083 | 0.049 |
Self-care | 0.078 | 0.062 | 0.134 | <0.001 |
Usual activities | 0.225 | <0.001 | 0.215 | <0.001 |
Pain/discomfort | 0.173 | <0.001 | 0.234 | <0.001 |
Anxiety/depression symptoms | 0.339 | <0.001 | 0.322 | <0.001 |
Mean utility value | -0.335 | <0.001 | -0.351 | <0.001 |
EQ-VAS | -0.167 | <0.001 | -0.294 | <0.001 |
Discussion
In the current study, we established that the incidence of UI is notably high, reaching 46.8% (564/1205) among women seeking weight loss with overweight or obesity. Individuals with more severe symptoms of UI exhibited correspondingly lower levels of UI-specific HRQoL, sexual function, and generic HRQoL. Among these populations, multivariate analysis revealed that age, BMI, history of vaginal delivery, POP-SS, and MetS emerged as independent predictors of increased risk of severer UI. Although the correlations were weak, the severity of UI symptoms was significantly correlated with the generic HRQoL measured by EQ-5D-5 L especially in the domain of anxiety/depression symptoms.
Despite our current study being a single-center study, we found that nearly half of the women with overweight or obesity experience UI. This figure significantly surpasses the incidence rate reported in the general population, as evidenced by a national epidemiological analysis revealing a rate of 30.9% among Chinese adult women [22]. Obesity and UI are increasingly significant social issues that severely affect the well-being of women [23, 24]. Our findings underscore the multifaceted effect of UI, extending beyond its disease-specific effect on HRQoL and sexual function to encompass a substantial effect on generic HRQoL, especially in the domain of anxiety/depression symptoms among those with overweight or obesity. As UI symptoms increase, their detrimental effects on HRQoL and sexual function become progressively more pronounced.
Previous studies demonstrated that both UI and obesity adversely affect sexual function of affected women [7‐9]. Obesity’s adverse effects—hormonal imbalances, psychological strain, and neurovascular harm—all conspire toward sexual dysfunction [7]. Similarly, UI also profoundly affects sexual function [9, 25]. Physical discomfort during intercourse and decreased sexual satisfaction are common. Psychological stress linked to UI can diminish libido and prompt avoidance of sexual activity. Anxiety over incontinence can distract from pleasure, further impairing sexual function. Our study also corroborates that more severe UI symptoms are accompanied by poorer sexual function among women with overweight and obesity.
Extensive research has identified obesity as a substantial risk factor for UI, prompting recommendations for integrated interventions from nutritional and gynecological departments for affected individuals [6, 26]. Nevertheless, contemporary surveys reveal a striking paucity of public awareness concerning the heightened risk of UI associated with obesity, coupled with a considerable gap in public understanding and education on this critical issue [11]. Our investigation revealed that only 98 out of 564 patients (17.38%) with UI sporadically engage in pelvic floor muscle training. Previous research has demonstrated that the severity of UI symptoms tends to worsen with prolonged obesity and that age and weight management should be supported throughout one’s lifetime [10]. Therefore, increased public education and individual counseling are necessary to enhance related knowledge among this high-risk population, especially those with elevated age, BMI and POP-SS, vaginal delivery history, and metabolic syndrome, as found in the present study, thereby facilitating the implementation of early preventive strategies [27]. As technology advances, the concept of artificial intelligence is gaining traction, presenting promising prospects in the early identification and prevention of diseases [28]. In the future, the application of deep learning to identify characteristics and high-risk factors of UI could potentially contribute to early disease prevention and control.
Several studies have employed the EQ-5D-5 L to investigate the effect of UI on HRQoL, suggesting a significant association between UI experiences and issues in overall health status, especially in the domain of anxiety/depression symptoms [12, 13, 29]. Among women who are overweight or obese and whose physical and mental well-being is already compromised, the concurrence of UI warrants heightened concern. Our current investigation initially examined the extent to which UI affects the generic HRQoL among women seeking weight loss with overweight or obesity. Among these populations, we also observed a decline in the generic HRQoL corresponding to the severity of UI symptoms especially in the domain of anxiety/depression symptoms. However, the correlations between the scores of ICIQ-UI-SF/IIQ-7 and EQ-5D-5 L are weak in the present study which may be attributed to a complex interplay of factors. Firstly, individual perception variations are a key reason for this weak correlation. Additionally, psychological factors, such as coping strategies, social support, and personal adaptability, can partly offset the impact of UI on HRQoL. Therefore, despite severe UI symptoms, if well-managed, their real-life impact may be less prominent. Lastly, the influence of comorbid health conditions and environmental factors on HRQoL can diminish the apparent effect of UI, potentially masking its true significance.
Recognizing the dearth of public awareness regarding UI prevention among women with overweight or obesity, we strongly advocate for a holistic strategy that amplifies public awareness and educational efforts. The messaging should be tailored to emphasize the importance of lifestyle modifications, such as diet and exercise adjustments, alongside pelvic muscle exercises, for effective obesity management and UI prevention. During obesity consultations, healthcare professionals should elevate the focus on UI, making UI education a routine part of patient care. Community engagement is also crucial, local health clinics should host interactive programs that provide practical guidance and foster supportive communities for lifestyle adjustments. Social media platforms and influential public figures can play pivotal roles in reducing stigma, thereby amplifying public engagement.
Our research holds clinical significance for several reasons. First, we conducted a comprehensive assessment of the condition of UI and its effect of UI severity on HRQoL and sexual function especially among women seeking weight loss with overweight or obesity with a relatively large sample size. In addition to the UI-specific effect, we also focused on the influence of UI on generic HRQoL for the first time and further explored the most affected aspects in multiple dimensions. Second, the use of all validated questionnaires ensured the reliability of the data collection. Together, these strengths contribute to a robust understanding of the condition and effect of UI among this high-risk population, thereby heightening public awareness in this domain. However, it is crucial to acknowledge the limitations of our study. Firstly, the cross-sectional nature of the research restricts our capacity to ascertain a causal link. Moreover, we did not take overweight or obese women without UI as a control group. Second, relying on self-reported surveys and the existence of non-respondents may cause response bias and other errors, which might undermine the validity of the results. Although certain measures have been taken, the accuracy of some data such as UI severity assessment may still be affected by recall bias or social desirability bias. Thirdly, focusing solely on individuals actively seeking weight loss may not adequately represent those not actively trying to lose weight amongst the women with overweight or obesity. Among them, motivation and other psychological factors may act as confounding variables and greatly limit the generalizability of the results. Furthermore, a critical limitation was the omission of UI symptom duration due to recall bias and incomplete data—this prevented controlling for the confounding effect of the time factor on HRQoL and sexual function. Lastly, psychological burdens linked to disclosing UI and answering sensitive questions, such as those about sexual function, likely triggered underreporting, influencing UI prevalence and HRQoL assessments. In future investigations, multi-center studies encompassing a more representative demographic and employing a prospective design will be essential to circumvent these limitations.
Conclusion
The incidence of UI is high among women seeking weight loss with overweight or obesity, which significantly affects HRQoL and sexual function. Elevated age, BMI, POP-SS,, history of vaginal delivery, and the presence of MetS emerged as independent predictors of increased risk for more severe UI. Although the correlation was weak, the severity of UI symptoms is significantly correlated with the generic HRQoL measured by EQ-5D-5 L, especially in the domain of anxiety/depression symptoms. However, awareness and prevention of the risk of UI among these high-risk populations are relatively inadequate, and there is an imperative to enhance relevant awareness campaigns and educational initiatives.
Acknowledgements
We would like to thank the participants for their input in the current study.
Declarations
Ethics approval and consent to participate
Ethics approval was obtained from the Ethics Committee of Peking Union Medical College Hospital (K4278, July 19, 2023). Written informed consent was obtained from the participants.
Consent for publication
Not needed.
Conflict of interest
All the authors declare no competing interests.
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