The associations between overweight, weight change and health related quality of life: Longitudinal data from the Stockholm Public Health Cohort 2002–2010

Highlights

• Overweight and obesity are associated with lower HRQoL.

• Weight gain leads to impairment in HRQoL irrespective of baseline BMI category.

• There is no evidence for a preventive effect of weight loss over 8 years on HRQoL.

• The results emphasize the importance of primary prevention of weight gain.

Abstract

Objective

Cross-sectional studies have shown that people with obesity and overweight report lower health related quality of life (HRQoL). With a lack of longitudinal studies, this study aims to assess the association between eight-year weight change and HRQoL measured by the EQ-5D instrument and to investigate whether the association differs with regard to baseline body mass index (BMI).

Method

A population-based survey was conducted among a random sample of 31,182 individuals from Stockholm County aged 18–84 years in 2002 and reassessed in 2010 and supplemented by record linkage with regional and national registers. Multivariate Poisson regression and linear regression were conducted with adjustments for socio-demographic and health-related variables and baseline BMI category as effect modifier for the association between weight change and HRQoL.

Results

Individuals with overweight and obesity respectively have 0.014 and 0.039 lower EQ-5D indexes compared to those being normal weight. Over the eight-year follow-up, 17.6% gained moderately (≥ 5% body weight) and 13.9% gained heavily (≥ 10% body weight) in weight. In the fully adjusted analysis, heavy weight gain was associated with a significantly lower overall EQ-5D index and an increased risk of reporting impairment in all but one EQ-5D dimensions irrespective of baseline BMI category. Weight reduction had no significant preventive effect.

Conclusion

Next to obesity status itself, weight gain leads to impairment in HRQoL irrespective of BMI category at baseline while eight year weight loss seems not to have the reversed effect on HRQoL, emphasizing the importance of primary prevention of weight gain.

Introduction

Overweight and in particular obesity are a major public health concern. In Sweden, the estimated prevalence of overweight (35.2%) and obesity (11.7%) are at the highest level in recent history (SCB, 2012). Once people are overweight, they are at higher risk of developing a wide range of chronic diseases such as diabetes (Seidell, 2000), cardiovascular diseases (Hubert et al., 1983), musculoskeletal complaints (Anandacoomarasamy et al., 2008) and some types of cancer (Bianchini et al., 2002). Overweight and obesity can be considered as one of the leading preventable causes of death (Neovius et al., 2009). Preceding cross-sectional studies from both the general population and disease specific populations have consistently shown that people with obesity and overweight report lower health related quality of life (HRQoL) compared to those with normal weight (de Zwaan et al., 2009, Dey et al., 2013, Hassan et al., 2003, Hopman et al., 2007, Huang et al., 2006, Jia and Lubetkin, 2005, Kearns et al., 2013, Kortt and Dollery, 2011, Larsson et al., 2002, Renzaho et al., 2010, Soltoft et al., 2009). While there are a few observational studies on the association between weight change and HRQoL based on selected populations (e.g. with underlying diseases, high risk profile or derived from an earlier intervention study) (Cameron et al., 2012, Leon-Munoz et al., 2005, Muller-Nordhorn et al., 2014, Seppälä et al., 2014, Verkleij et al., 2013), longitudinal analyses on the influence of weight change on HRQoL in the general population remain scarce and results are somewhat inconsistent, partly due to varying study populations, HRQoL instruments or statistical modeling (Laxy et al., 2014, Milder et al., 2014).

In the present study we estimated the associations of overweight status and weight change over eight years and HRQoL in individuals from the large population-based Stockholm Public Health Cohort followed from 2002 to 2010. Furthermore, we investigated whether the association of weight change and HRQoL differs with regard to baseline body mass index (BMI).