University of Birmingham The Association between Adiposity, Mental Well- Being, and Quality of Life in Extreme Obesity

Objectives: To explore the cross-sectional association between adiposity, mental well-being, and quality of life in extreme obese individuals entering a UK specialist weight management service prior to treatment commencement. Methods: The sample comprised 263 extreme obese individuals who were referred to the service as a result of having a body mass index (BMI) $40 kg/m or $35 kg/m with a co-morbid health condition. In a retrospective analysis, routinely collected baseline clinical examination data and self-report questionnaires (Impact of Weight on Quality of Life: IWQOL-Lite, EQ5D-3L, and Hospital Anxiety and Depression Scale: HADS) were analysed to examine the cross-sectional association between adiposity and quality of life. Results: The sample was predominantly female (74.8%) with mean BMI 47.067. 9 kg/m. Increasing adiposity was significantly negatively associated with quality of life, with an increase of 1 BMI unit associated with decreases of 1.93 in physical function (95% CI 22.86 2 21.00, p,0.001), 1.62 in self-esteem (95% CI 22.67 2 20.57, p,0.05), 2.69 in public distress (95% CI 23.75 2 21.62, p,0.001), 1.33 in work (95% CI 22.63 2 20.02, p,0.05), and 1.79 in total IWQOL-Lite scores (95% CI 22.65 2 20.93, p,0.001). Adiposity was associated with significantly increased risk of problems in mobility (OR = 3.44, 95% CI 1.4728.05), and performing usual activities (OR = 2.45, 95% CI 1.1025.46) in highest relative to lowest BMI tertile. The prevalence of experience of symptoms of anxiety (70.3%) and depression (66.2%) as measured by HADS was consistently high. Conclusions: We identified a high prevalence of psychological co-morbidity, including widespread experience of symptoms of anxiety and depressive disorders and reduced quality of life among these extreme obese individuals seeking weight management treatment. Clinical implications include the need for the incorporation of strategies to improve mental wellbeing into multi-disciplinary weight management interventions. Citation: Jagielski AC, Brown A, Hosseini-Araghi M, Thomas GN, Taheri S (2014) The Association between Adiposity, Mental Well-Being, and Quality of Life in Extreme Obesity. PLoS ONE 9(3): e92859. doi:10.1371/journal.pone. 0092859 Editor: Yijun Liu, University of Florida, United States of America Received October 17, 2013; Accepted February 26, 2014; Published March 26, 2014 Copyright: 2014 Jagielski et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: AJ, MHA and ST were supported by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme. NIHR disclaimer: This paper presents independent work supported by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: gneilthomas@yahoo.co.uk (GNT); staheri@me.com (ST)