Quality of Life Outcomes in Bariatric Surgery

Obesity has been characterized as a chronic medical condition and its prevalence is steadily growing worldwide. When approaches such as public health prevention, lifestyle interventions, and pharmacological treatments prove inadequate in addressing morbid obesity, bariatric surgery emerges as an exceptionally effective treatment option. In the present era, characterized by the growing importance of value-based healthcare, the measurement of outcomes following bariatric surgery must extend beyond clinical parameters to encompass patient-centered outcomes, particularly quality of life. Only by measuring the outcomes that matter most to patients, well informed healthcare decisions can be made. This summary provides a comprehensive overview of the main findings of this Ph.D. thesis, focusing on quality of life outcomes in bariatric surgery. In part I, chapter 2 and 3, it was determined how quality of life should be measured in bariatric surgery. The Impact of Weight on Quality of Life-Lite (IWQOL-Lite, self-esteem), BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and Quality of Life for Obesity Surgery (QOLOS, excess skin) were selected for inclusion in both core sets. In part II, chapter 4 and 5, the minimal important difference (MID) values were assessed to enhance the interpretability of quality of life outcomes. The BODY-Q mean change MID ranged from 4-6 points for bariatric surgery and 4-8 points for body contouring surgery, indicating that a change of this magnitude is clinically relevant for patients. In part III, chapter 6 and 7, patient expectations and decision regret in bariatric surgery were evaluated. The findings revealed that higher expectations were associated with younger age (under 40 years old) and white race. The most profound benefits were expected in how bariatric surgery would make people feel better and more energized. In chapter 7, it became clear that less than 2% of patients indicated absolute regret and 15% indicated moderate to strong regret according to the results of the Decision Regret Scale. In part IV, chapter 8, 9 and 10, the core predictors for several quality of life domains in bariatric surgery were assessed. It was found that body image and psychological function improve after bariatric surgery, with the greatest improvement seen after 12 months and a gradual decline thereafter. Weight loss was not associated with body image, and increased weight loss was marginally associated with improved psychological function. In chapter 10, the effect of excess skin and having a desire for body contouring surgery on quality of life was investigated. The patients with a desire for body contouring surgery due to excess skin (approximately 70%) had significantly lower quality of life scores in every domain from one to three years (except for physical function at three years). In part V, chapter 11, a comparative analysis was performed of outcomes across two bariatric surgery procedures after a prior Sleeve Gastrectomy (SG). It was concluded that the Single Anastomosis Duodenoileal Bypass (SADI-S) resulted in significantly more weight loss compared to the Roux-en-Y Gastric Bypass (RYGB) with similar quality of life scores, complication rates and nutritional deficiencies.