clinical topic updates

Durable Weight Loss Leads to Improved Quality-of-Life Measures

by Louis J. Aronne, MD

Overview

In patients with overweight and obesity, the benefits of even small amounts of weight loss may extend far beyond all that is measurable. Our featured expert considers the impact of durable weight loss on quality of life—a composite measurement reflecting many different aspects of well-being that are important to patients.

Expert Commentary

Louis J. Aronne, MD

Sanford I. Weill Professor of Metabolic Research
Director, Comprehensive Weight Control Center
Weill Cornell Medicine
New York, NY

“These results illustrate the power of losing even a small amount of weight and keeping it off: weight loss maintained over time improves weight-related comorbidities and quality of life.”

Louis J. Aronne, MD

We know that long-term weight loss in patients with overweight or obesity has a durable impact on quality of life, and this makes sense to us intuitively. With respect to measuring and demonstrating such impact in clinical trials, however, there are several important points to consider.

First, in our weight-loss trials, the “placebo” group typically receives an effective weight-loss intervention such as a diet and exercise program. So, to be effective, the intervention being studied actually needs to exceed the benefits that are achieved with a good weight-loss program. The second point is that different measures are used to capture quality of life. The objective measures used to study the impact of weight loss on a patient’s quality of life include questionnaires such as the 36-Item Short Form Health Survey (SF-36) and the Impact of Weight on Quality Of Life-Lite questionnaire. Achieving improvement on the SF-36 has traditionally been difficult, except in cases involving bariatric surgery. However, data from multiple recent studies, show that significant improvements in physical, mental, and emotional health accompany the weight loss achieved through behavioral modification and adjunctive pharmacotherapy.

I often compare weight loss to a late-night commercial, whereby you get the product (eg, Ginsu knives) in addition to a host of other benefits for “just 1 low price.” It seems too good to be true, but, in the case of weight loss, it is in fact the truth—you do get all of the benefits. Treating hyperlipidemia improves cholesterol levels, but not high blood pressure, and may worsen glucose. Treating hypertension improves blood pressure, but not elevated glucose levels. With obesity treatment, however, studies show that patients do not just lose weight—they also experience improvements in all of these health risks, as well as in their physical and mental functioning. These results illustrate the power of losing even a small amount of weight and keeping it off: weight loss maintained over time improves weight-related comorbidities and quality of life.

For this reason, we begin treating many of our patients on a weight-maintenance basis as soon as they start to regain weight; we do not wait until after they have regained all of the weight that they had previously lost. Clinicians must be persistent, and treatment for obesity must be long-term, such as treatment for diabetes, hypertension, and hyperlipidemia. A patient with diabetes whose glucose begins to rise would be treated with a more aggressive intervention. The same approach should be taken in patients with obesity. Those who maintain weight loss have more durable impacts on their quality of life.

References

Dagsland V, Andenæs R, Karlsen TI. Generic health-related quality of life may not be associated with weight loss 4 years after bariatric surgery: a cross-sectional study. Obes Surg. 2018;28(10):3142-3150.

Forhan M, Gill SV. Obesity, functional mobility and quality of life. Best Pract Res Clin Endocrinol Metab. 2013;27(2):129-137.

Kolotkin RL, Crosby RD. Psychometric evaluation of the impact of weight on quality of life-lite questionnaire (IWQOL-lite) in a community sample. Qual Life Res. 2002;11(2):157-171.

Kolotkin RL, Fujioka K, Wolden ML, Brett JH, Bjorner JB. Improvements in health‐related quality of life with liraglutide 3.0 mg compared with placebo in weight management. Clin Obes. 2016;6(4):233-242.

Pearl RL, Wadden TA, Tronieri JS, et al. Short- and long-term changes in health-related quality of life with weight loss: results from a randomized controlled trial. Obesity (Silver Spring). 2018;26(6):985-991.

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