Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient

Abstract

Objectives: To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight-loss surgery (WLS) to inform clinical care.

Study design: Baseline (preoperative) data from Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational study of 242 adolescents with severe obesity (MedianBMI = 50.5 kg/m(2); Meanage = 17.1; 75.6% female; 71.9% white) undergoing WLS, were used to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids).

Results: WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Male subjects had a greater CLoad (P = .01) and BMI (P = .01), yet less impairment in total WRQOL (P < .01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (vs physical) comorbidities, BMI, and white race were significant predictors of WRQOL impairment. Less prevalent conditions (eg, stress urinary incontinence) also emerged as contributors to lower WRQOL.

Conclusions: WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals before WLS. Furthermore, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes after WLS, as weight and comorbidity profiles change over time.

Figure. IWQOL-Kids Total scores from published studies of healthy weight, overweight, obese, severely obese, and Teen-LABS adolescents

Note: Mean comparisons of each group to Teen-LABS adolescents were made using z-tests. * p ≤ 0.0001; † p = 0.50; ‡ p = 0.22 ^aPublished means and SDs of 216 healthy weight adolescents (BMI=11–84.9 percentile; M_age 14.1 ± 2.29 years; 53.2% female; 53.7% non-Hispanic White, 29.9% African American, 1.9% Hispanic, 14.5% Other), 64 overweight adolescents (BMI =85–94.9 percentile; M_age 13.52 ± 2.20 years; 57.8% female; 51.6% non-Hispanic White, 32.3% African American, 9.7% Hispanic, 6.5% Other), and 362 obese adolescents (BMI ≥ 95^th percentile; M_age 14.04 ± 1.85 years; 63.8% female; 58.0% non-Hispanic White, 35.2% African American, 3.1% Hispanic, 3.7% Other) Kolotkin RL, Zeller MH, Modi AC, Samsa GP, Polanichka Quinlan N, Yanovski JA, et al. Assessing weight-related quality of life in adolescents. Obesity. 2006;14(3):448–57 ^bPublished means and SDs of 111 obese youth (BMI ≥ 95^th percentile) presenting at a Pediatric Metabolic Syndrome clinic (M_age 14.1 ± 2.3 years; 59% female, Mean_BMI 35.6 ± 7.1; 65% Non-Hispanic White, 23% Hispanic, 7% African American, 5% Other). Nadeau K, Kolotkin RL, Boex R, Witten T, McFann KK, Zeitler P, et al. Health-related quality of life in adolescents with comorbidities related to obesity. J Adolesc Health. 2011;49:90–2. ^cPublished means and SDs of 30 severely obese adolescents presenting for pediatric lifestyle modification program (Mean_BMI 51.31 ± 6.0; M_age 15.76 ± 1.2 years; 66.7% female; 83.3% non-Hispanic White, 16.7% non-Hispanic Black) and 30 severely obese adolescents prior to bariatric surgery (Mean_BMI 61.81 ± 8.81; M_age 16.23 ± 1.34 years; 66.7% female; 83.3% non-Hispanic White, 16.7% non-hispanic Black). Modi AC, Loux TJ, Bell SK, Harmon CM, Inge TH, Zeller MH. Weight-specific health-related quality of life in adolescents with extreme obesity. Obesity. 2008;16(10):2266 – 71.