Health-related quality of life and symptoms of depression in extremely obese persons seeking bariatric surgery

Background: Extreme obesity, defined by a body mass index (BMI) >= 40 kg/m(2), is associated with increased risk of depression and with impairments in health-related quality of life (HRQoL). This study examined the relationships among BMI, HRQoL, and symptoms of depression in persons with extreme obesity. Method: Participants were 306 patients who sought bariatric surgery (mean +/- SD age 43.8 +/- 9.4 years, BMI 52.8 +/- 9.3 kg/m(2)) and who completed questionnaires to assess symptoms of depression and HRQoL prior to surgery. We defined HRQoL impairment as a score >= 1 SD below national means. Results: Impairments in HRQoL were common: >40% of participants scored in the impaired ranges of physical functioning, physical role limitations, and bodily pain. Results of analyses of variance (ANOVAs) indicated that impairments in HRQoL were significantly related to symptoms of depression. Patients with impaired HRQoL scored above the cut-off point for clinically significant depression, while those without such impairment scored below that cut-off, regardless of BMI. The contribution of BMI to depression was not significant in any ANOVA. Conclusion: HRQoL is more strongly and more directly related to symptoms of depression than is BMI. These findings highlight the need to assess HRQoL in patients with extreme obesity and suggest that interdisciplinary strategies to address HRQoL impairments may be beneficial in this population.