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Gender-Related Effects of Obesity and Quality of Life
Study Questions:
Do the effects of obesity on health-related quality of life (HRQoL) differ by gender?
Methods:
Data from the French Decennial Health Survey were used for this analysis. This survey is a nationwide cross-sectional study conducted in 2003 and included 21,239 adults, ages 25-64 years. Body mass index (BMI) was calculated using self-reported height and weight. BMI categories including underweight (<18.5 kg/m2), normal weight (18.5 to <25 kg/m2), overweight (25 to ≤30 kg/m2), obesity class I (30 to <35 kg/m2), and obesity class II (>35 kg/m2) HRQoL was assessed by the 36-item short form health survey (SF-36). A mediation analysis based on the counterfactual framework was performed to quantify the proportion of obesity effects on HRQoL mediated by related comorbidities, including cardiometabolic risk factors (diabetes mellitus, hypertension, dyslipidemia) and diseases (ischemic heart disease, cerebrovascular disease, and peripheral vascular disease), musculoskeletal disorders, and asthma.
Results:
A total of 21,239 adults ages 25-64 years of age were included in this study, of which 10,305 were men and 10,934 were women. Differences were observed by BMI categories. Education level was lower and number of comorbidities was higher among those with a BMI overweight or higher. In the underweight category, income was lower for men, education level was lower, and prevalence of smoking was higher. For all SF-36 subscales, individuals in the normal weight BMI class had better scores than those who were in the underweight or obesity classes for both genders, and compared to those who were overweight for women. Mediation analysis revealed that obesity effects were significantly mediated by several comorbidities, more so in men. The proportion of obesity class II total effect mediated via cardiometabolic factors: general health (27.0% [men] vs. 13.6% [women]). The proportion of obesity class II total effect mediated via total count of comorbidities: physical functioning (17.8% [men] vs. 7.7% [women]) and general health (37.1% [men] vs. 20.3% [women]).
Conclusions:
The investigators concluded that women have a greater overall impact of obesity on HRQoL, but with proportionally lower effects mediated by cardiometabolic and other obesity-related conditions, suggesting the possible role of other specific psychosocial processes.
Perspective:
These data suggest that the relationship between BMI and HRQoL can be partially explained by comorbidities, particularly for men. These gender-related differences in the relationship between weight and QoL may be an important part of the prevention and treatment of overweight and obesity.
Keywords: Asthma, Body Mass Index, Body Weight, Comorbidity, Diabetes Mellitus, Dyslipidemias, Hypertension, Metabolic Syndrome, Musculoskeletal Diseases, Myocardial Ischemia, Obesity, Overweight, Quality of Life, Primary Prevention, Risk Factors, Smoking
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