ABSTRACT
BACKGROUND
Patients with obesity face widespread social bias, but the importance of this social stigma to patients relative to other quality of life (QOL) factors is unclear.
OBJECTIVE
Our aim was to examine the importance of obesity-related social stigma relative to other QOL factors on reducing patients’ overall well-being.
DESIGN
We used a cross-sectional telephone interview.
SETTING
The study was conducted at four diverse primary care practices in Greater Boston.
PARTICIPANTS
Three hundred and thirty-seven primary care patients aged 18–65 years and with a body mass index (BMI) of 35 kg/m2 or higher participated in the study.
MAIN MEASURES
Patients’ health utility (preference-based QOL measure) was determined via responses to a series of standard gamble scenarios assessing willingness to risk death to lose various amounts of weight or to achieve perfect health. We used the Impact of Weight on Quality of Life-lite instrument to assess QOL domains specific to obesity (physical function, self-esteem, sexual life, public distress or social stigma, and work), and we examined variation in utility explained by these domains.
KEY RESULTS
Depending on patients’ race/ethnicity, mean health utilities ranged from 0.92 to 0.99 among men and from 0.89 to 0.93 among women. After adjustment for race, BMI, and education, none of the QOL domains explained much of the variation in utility among men, except for work function among Hispanic men. In contrast, social stigma was the leading QOL contributor to utility for Caucasian women (explaining 6 % of the marginal variation beyond demographics and BMI). In contrast, sexual function was the most important contributor among African American women (3 % marginal variation), and work life was most important among Hispanic women (> 20 % in variation). Lower scores in one domain did not always translate into lower well-being. Moreover, QOL summary scores often explained less of the variation than some individual domains.
CONCLUSION
Obesity-related social stigma had disproportionate adverse effects on Caucasian women patients’ well-being, whereas weight-related impairment in work function was particularly important among Hispanic patients and impaired sexual function was important to diminished well-being among African American women although its impact appeared modest.
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Acknowledgements
This study was funded by the National Institute of Diabetes, Digestive and Kidney Diseases (R01 DK073302, PI Wee). Dr. Wee is also supported by an NIH midcareer mentorship award (K24DK087932). The sponsor had no role in the design or conduct of the study; the collection, management, analysis, and interpretation of the data, and the preparation, review or approval of the manuscript. Dr. Wee conceived the research question, designed the study, obtained funding, supervised the conduct of the study and drafted the manuscript. Ms. Chiodi and Ms. Huskey had full access to all the data, conducted all analyses, and take responsibility for the integrity of the data and accuracy of the data analysis. Dr. Davis provided statistical expertise, and along with Drs. Hamel and Wee, interpreted the data. All authors provided critical revision of the manuscript for intellectual content and approved the final manuscript. We thank the patients for participating in our study.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Wee, C.C., Davis, R.B., Chiodi, S. et al. Sex, Race, and the Adverse Effects of Social Stigma vs. Other Quality of Life Factors Among Primary Care Patients with Moderate to Severe Obesity. J GEN INTERN MED 30, 229–235 (2015). https://doi.org/10.1007/s11606-014-3041-4
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DOI: https://doi.org/10.1007/s11606-014-3041-4