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Category 1: Relationship between weight/BMI and HRQoL (baseline/pre‐intervention)
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| 1 |
van Nunen et al., 2007 14
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Meta‐analysis to examine differences in baseline HRQoL among seekers of surgical treatment for obesity, seekers of non‐surgical treatment, non‐treatment‐seeking persons with obesity, general population with obesity and general population
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54 cross‐sectional studies Dutch, English, French and German 1996–2006
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Based on both generic and obesity‐specific measures, populations with obesity experienced reduced HRQoL
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For both SF‐36 and IWQOL‐Lite, the most reduced HRQoL occurred in the surgical patients
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Comparing patients to non‐patients, SF‐36 results varied widely by subscale, with only physical functioning showing consistently reduced HRQoL for surgical patient groups
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However, reduced HRQoL was found on all IWQOL‐Lite subscales for patient groups compared with non‐patients
After adjustment for BMI, surgical patients still demonstrated reduced HRQoL on most SF‐36 subscales, whereas for IWQOL‐Lite differences between populations disappeared after adjustment for BMI likely due to the IWQOL‐Lite being a weight‐related measure of HRQoL
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The general population with obesity is heterogeneous, including those who intend to seek medical intervention, those who plan their own interventions, and those who do not intend to seek treatment -
There is underrepresentation of the intentionally non–treatment‐seeking population
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| 2 |
Ul‐Haq et al., 2013 15
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Physical HRQoL
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Mental HRQoL
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Population studies from Australia, Canada, England, Germany, Sweden, USA Studies included 43 086 participants -
Sophisticated methodology
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Analysed pooled estimates of weighted mean difference in PCS and MCS by BMI in reference to normal weight
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Determined degree of heterogeneity and assessed publication bias
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Applied a statistical method to reduce risk of type I errors
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Limited to articles that assessed HRQoL with a single, generic measure only (SF‐36) 1 of 8 studies was based on male Veteran's Administration patients only
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Category 2: HRQoL after weight loss (varied interventions and/or varied study design)
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| 3 |
Carson et al., 2014 16
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Articles included used both generic (QWB, SF‐36, SF‐12) and obesity‐specific (IWQOL, IWQOL‐Lite) HRQoL measures
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| 4 |
Kroes et al., 2016 17
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20 studies, including RCTs (8), prospective comparative cohorts (5), prospective single‐arm cohorts (5), cross‐sectional (1) and retrospective analyses of RCTs (1) English, US only ≥1‐year follow‐up
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Of the studies that explicitly reported on the association between HRQoL and weight change:
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For lifestyle approach (n = 1): there were significant correlations between weight loss and all IWQOL‐Lite subscales except work
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For pharmaceutical intervention (n = 1): there were larger effect sizes for greater weight reductions for all IWQOL‐Lite subscales, PCS, physical functioning, and general health
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For bariatric surgery at ≥1‐year follow‐up: greater weight loss showed significant correlations with vitality (n = 1), physical functioning (n = 1), PCS (n = 1), and IWQOL‐Lite Total (n = 2)
SF‐36 (generic): improvements in physical aspects reported more frequently than mental/psychosocial aspects IWQOL‐Lite (obesity‐specific): improvements in all or most subscales
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Unique approach: to investigate the impact of weight change on HRQoL, rather than to compare improvements in HRQoL between interventions Studies had ≥1‐year follow‐up
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Included only US, English articles Studies included were heterogeneous in terms of intervention (bariatric surgery [n = 12]; lifestyle approaches [n = 7]; pharmaceutical intervention [n = 1]), as well as study design and outcomes described, making inferences about associations between weight loss and changes in HRQoL challenging Although this review included studies using any HRQoL measurement, reporting was limited to SF‐36 and IWQOL‐Lite
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Category 3: HRQoL after weight loss (RCTs only)
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| 5 |
Maciejewski et al., 2005 18
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Meta‐analysis to estimate the effect of various weight‐loss interventions (e.g. medication, diet, exercise, commercial programme, cognitive behaviour therapy, bariatric surgery) on HRQoL in RCT studies, and a meta‐analysis of the effect of weight‐loss treatment on depressive symptoms
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Articles included used both generic (GHRI, GWB, SF‐36, SIP, VAS) and obesity‐specific (IWQOL, OP) HRQoL measures Study duration varied from 6 to 208 weeks; 8 studies of >52 weeks’ duration and 26 studies of ≤1 year's duration Study quality was assessed according to 6 different criteria: concealment of randomization, blinding, loss to follow‐up, intention‐to‐treat analysis, adjustment for mediating effects of weight loss, and adjustment for multiple comparisons
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| 6 |
Warkentin et al., 2013 12
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Generic measures: 14/36 studies found significant improvements Obesity‐specific measures: 4/15 studies found significant improvements Contingency table approach (included all trials): no significant association between weight‐loss and overall HRQoL Quantitative data pooling approach (included 25% of trials): statistically significant improvements in physical but not mental health
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Articles included used both generic (EQ‐5D, GHQ, QWB, SF‐36, VAS) and obesity‐specific (IWQOL‐Lite, M‐A QoLQII, OAS, OP, ORWELL, WRSM) HRQoL measures -
Different analytical methods were used
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Contingency table approach: incorporates information from all studies examined, but gives them equal weight, such that the magnitude of changes cannot be compared
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Conventional random effects meta‐analytical technique: considered to be more rigorous because uses study‐specific values and inverse‐variance weighting to generate pooled estimates; however, quantitative data pooling was limited to only 25% of available studies due to the poor quality of reporting
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Data from most studies could not be quantitatively pooled for meta‐analysis In 35/53 RCTs, study duration was <1 year
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Category 4: HRQoL after bariatric surgery
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| 7 |
Magallares and Schomerus, 2015 19
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Compared to pre‐surgery, patients scored higher in physical and mental components of the SF‐36 1 year after bariatric surgery
There was a large variability/heterogeneity in amount of improvement in both PCS and MCS
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| 8 |
Lindekilde et al., 2015 20
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Articles included used 22 HRQoL measures, including generic (EQ‐5D, SF‐36), obesity‐specific (IWQOL, IWQOL‐Lite, M‐A QoLQII, WRSM), combined generic/obesity‐specific (HRQoL‐HSP) and gastrointestinal‐specific (GIQLI) HRQoL measures Follow‐up ranged from 3 to 120 months Controlled for multiple other factors (baseline BMI, age, type of measure, type of surgery, months to follow‐up, year of publication and country of study) Provided effect sizes of changes in HRQoL
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HRQoL scales and subscales were categorized into 5 domains (physical, mental, social, functional and total), but authors do not indicate how they assigned scores to the domains Majority of included studies used a non‐randomized design; none of the randomized studies used a non‐surgical control group
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| 9 |
Andersen et al., 2015 21
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6/7 studies showed improvements in 9 aspects of HRQoL Peak improvements in HRQoL observed during first 1–2 postoperative years (characterized by the most meaningful amount of weight loss), followed by a gradual decline that stabilized at 5 years -
5‐year postoperative scores were an improvement from preoperative scores, but lower than the population norm
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Review focuses exclusively on high‐quality, long‐term (5–10 years), prospective studies of bariatric surgery All studies included were high quality, defined as attrition rate <50%, and 90% power to detect >0.5 standard deviation change from baseline using a two‐sided paired test Articles included used both generic (15D, GHRI scale, GWB, NHPII, SF‐36) and obesity‐specific (IWQOL‐Lite, OP, Weight Distress) HRQoL measures
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Attrition rates in included studies ranged from 8 to 39.2% Included studies were heterogeneous with respect to baseline BMI, HRQoL instruments and surgical methods
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| 10 |
Jumbe, 2015 22
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Systematic review to assess psychosocial HRQoL of bariatric surgery patients at a minimum of 1‐year follow‐up compared to: Individuals receiving non‐surgical interventions Non‐treated comparison groups
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Articles included both generic (SF‐36, SF‐12, EQ‐5D, SIP), and obesity‐specific measures (IWQOL‐Lite, OP) Follow‐up ranged from 1 to 10 years Study quality was evaluated
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2 studies assessed HRQoL in individuals with both obesity and diabetes 23, 24
4 studies 25, 26, 27, 28 used data from the Utah Obesity Study; thus, reporting these studies separately may skew the conclusions Conclusion of “persistent psychological issues post‐surgery” is an overstatement of the data presented in the reviewed studies Despite better outcomes reported in 3 of the 4 studies comparing bariatric surgery with non‐surgical treatment, authors state that, overall, these studies show moderate evidence of similar improvements in HRQoL in these 2 groups Despite reporting of improvements in mental/psychosocial HRQoL in several of the studies, authors state that long‐term psychosocial HRQoL does not improve after bariatric surgery compared to controls
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| 11 |
Hachem et al., 2016 29
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13 studies
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7 studies (1 RCT, 6 quasi‐experimental studies): bariatric surgery vs. an alternative weight‐loss intervention
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6 studies (5 RCTs, 1 quasi‐experimental study): 1 type of bariatric surgery vs. another
English
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Significant HRQoL improvements following bariatric surgery
Significant HRQoL improvements in gastric bypass and laparoscopic sleeve gastrectomy vs. vertical banding gastroplasty and laparoscopic adjustable gastric banding, respectively No differences in HRQoL between variations of the same type of surgery (e.g. gastric bypass vs. mini gastric bypass)
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Articles included used generic (SF‐36, M–A QoLQII, SIP, GHRI), obesity‐specific (IWQOL‐Lite, OWLQOL, WRSM, GIQLI, QOLOD) and gastrointestinal‐specific HRQoL measures Follow‐up ranged from 2 months to 10 years
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2 studies measured HRQoL post‐surgery only 6 studies reported follow‐ups of ≤1 year Results were not included for the 10‐year follow‐up of Karlsson et al. 30 or the 6‐year follow‐up of Adams et al. 27
Only 2 studies evaluated between‐group differences Each comparison of different surgery types was made in only a single study Reporting of HRQoL results was inconsistent, with some reporting overall scores, some reporting composite scores, and some reporting selected subscale scores 2 included studies 31, 32 (studies by Canetti et al. in 2009 and 2013) used the same study sample
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| 12 |
Driscoll et al., 2016 33
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9 studies, including cross‐sectional studies (7), prospective cohort study (1), and non‐randomized controlled trial (1)
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Systematic review of all studies and measures
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Greater improvements were noted in both the physical and mental domains of HRQoL for the surgical groups compared with the control groups; however, there were inconsistencies in results (i.e. favouring surgical group, favouring control group, and no difference) in both physical and mental domains
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Meta‐analysis of SF‐36 results
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Inconsistencies that had been seen in the systematic review were not seen in the meta‐analysis
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Significant improvement in all mental domains after 5 years favouring the surgical group compared with the controls; and 3/4 physical domains
The magnitude of improvement in surgical groups vs. control groups was greater for the physical than mental domains
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Articles included used both generic (SF‐36, EQ‐5D, Current Health Scale from the GHRI and obesity‐specific (IWQOL‐Lite, OP) measures Studies had follow‐up periods of 5 to 25 years
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