Health related quality of life associated with extreme obesity in adolescents - results from the baseline evaluation of the YES-study.

BACKGROUND: Obesity can significantly reduce health-related quality of life (HRQoL) and may lead to numerous health problems even in youths. This study aimed to investigate whether HRQoL varies among youths with obesity depending on grade of obesity and other factors. METHODS: For the Youths with Extreme obesity Study (YES) (2012-2014), a prospective multicenter cohort study, a baseline sample of 431 obese and extremely obese adolescents and young adults (age 14 to 24 years, BMI ≥30 kg/m2) was recruited at four German university medical centers and one job center. Obesity grade groups (OGG) were defined according to BMI (OGG I: 30-34.9 kg/m2, OGG II: 35-39.9 kg/m2, OGG III (extreme obesity): ≥40 kg/m2). HRQoL was measured with the Euroqol-5D-3 L (EQ-5D-3 L), DISABKIDS chronic generic (DCGM-31) and the KINDLR obesity module. Differences between OGGs were assessed with logistic and linear regression models, adjusting for age, sex, and study center in the base model. In a second regression analysis, we included other characteristics to identify possible determinants of HRQoL. RESULTS: Three hundred fifty-two adolescents (mean age: 16.6 (±2.4), mean BMI: 39.1 (±7.5) kg/ m2) with available HRQoL data were analysed. HRQoL of youths in all OGGs was markedly lower than reference values of non-obese adolescents. Adjusting for age and sex, HRQoL of youths in OGG III significantly impaired compared to OGG I. Youths in OGG III were 2.15 times more likely to report problems with mobility in the EQ-5D-3 L than youths in OGG I. A mean difference of 9.7 and 6.6 points between OGG III and I were found for DCGM-31 and KINDL respectively and 5.1 points between OGG II and I for DCGM-31. Including further variables into the regression models, showed that HRQoL measured by DCGM-31 was significantly different between OGGs. Otherwise, female sex and having more than 4 h of daily screen time were also associated with lower HRQoL measured by DCGM-31 and KINDL. CONCLUSION: HRQoL of adolescents with obesity is reduced, but HRQoL of adolescents with extreme obesity is particularly affected. Larger and longitudinal studies are necessary to understand the relation of extreme obesity and HRQoL, and the impact of other lifestyle or socioeconomic factors. TRIAL REGISTRATION: Clinicaltrials.gov NCT01625325; German Clinical Trials Register (DRKS) DRKS00004172.

The association between BMI and health-related quality of life in the US population: sex, age and ethnicity matters.

BACKGROUND: Obesity is a major public health problem. Detailed knowledge about the relationship between body mass index (BMI) and health-related quality of life (HRQL) is important for deriving effective and cost-effective prevention and weight management strategies. This study aims to describe the sex-, age- and ethnicity-specific association between BMI and HRQL in the US adult population. METHODS: Analyses are based on pooled cross-sectional data from 41 459 participants of the Medical Expenditure Panel Survey (MEPS) Household Component (HC) for the years 2000-2003. BMI was calculated using self-reported height and weight, and HRQL was assessed with the EuroQol five-dimensional questionnaire. Generalized additive models were fitted with a smooth function for BMI and a smooth-factor interaction for BMI with sex adjusted for age, ethnicity, poverty, smoking and physical activity. Models were further stratified by age and ethnicity. RESULTS: The association between BMI and HRQL is inverse U-shaped with a HRQL high point at a BMI of 22 kg m-2 in women and a HRQL high plateau at BMI values of 22-30 kg m-2 in men. Men aged 50 years and older with a BMI of 29 kg m-2 reported on average five-point higher visual analog scale (VAS) scores than peers with a BMI of 20 kg m-2. The inverse U-shaped association is more pronounced in older people, and the BMI-HRQL relationship differs between ethnicities. In Hispanics, the BMI associated with the highest HRQL is higher than in white people and, in black women, the BMI-HRQL association has an almost linear negative slope. CONCLUSIONS: The results show that a more differentiated use of BMI cutoffs in scientific discussions and daily practice is indicated. The findings should be considered in the design of future weight loss and weight management programs.

[Costs of illness for asthma and COPD in adults in Germany]. / Krankheitskosten für Asthma und COPD bei Erwachsenen in der Bundesrepublik Deutschland.

UNLABELLED: BACKGROUND; Asthma and COPD have a high and growing epidemiological impact worldwide, and it is often indicated that significant economic costs are linked to this. The aim of this review is to estimate the cost-of-illness for both diseases for adults in Germany. METHODS: A systematic search of Pubmed, Embase, EconLit and Business Source Complete was performed for the years 1995-2012 to identify German cost-of-illness studies for asthma and COPD in German or English language. 6 studies for asthma, 7 studies for COPD and 1 for both diseases met the inclusion criteria. The results of the identified studies were extrapolated to 2010 prices and compared within the same disease. RESULTS: In spite of the heterogeneity in methodology and results, medication was identified as the most important component of direct costs and work loss as the most important component of indirect costs. All in all, the estimated costs per case of illness and year for asthma sum up to 445 to 2 543 € and for COPD to 1 212 to 3 492 €. CONCLUSION: The analysed cost-of-illness studies confirm that asthma and COPD are costly but results vary markedly. COPD due to its higher costs per case and its similar prevalence causes higher macroeconomic costs. Our results emphasise the economic relevance of prevention and disease management for these lung diseases.

[Direct costs of diabetes mellitus in Germany: first estimation of the differences related to educational level]. / Direkte Krankheitskosten von Diabetes mellitus in Deutschland: erste Abschätzung der Unterschiede zwischen Bildungsgruppen.

OBJECTIVE: There are many studies on health inequalities, but these are rarely combined with cost-of-illness analyses. If the cost-of-illness were to be calculated for the individual status groups, it would be possible to assess the economic potential of preventive measures aimed specifically at people from low status groups. The objective of this article is to demonstrate for the first time the preventive potential by taking the example of diabetes mellitus (DM) from an economic perspective. METHODS: Based on a systematic literature review, the average direct costs per patient with DM were assessed. Then, the prevalence of DM among adults with different educational levels was estimated based on the nationwide survey 'German Health Update' (GEDA), conducted by the Robert Koch-Institute in Germany in 2009. Finally, the cost and prevalence data were used to calculate the direct costs for each educational level. RESULTS: The direct costs of DM amount to about 13.1 billion € per year; about 35% of these costs can be attributed to patients with a low educational level. Thus, their share of the total costs is about 67% higher than their share of the total population. If the prevalence in the group with 'low educational level' (14.8%) could be reduced to the prevalence in the group with 'middle educational level' (7.9%), this would save about 2.2 billion (about 16.5%) € of direct costs. DISCUSSION: The analysis provides a first estimate of the potential savings from an effective status specific prevention programme. However, the direct costs per patient used were only an average for all people with DM, as a breakdown by educational level was not available. Since education can also affect health behaviour and compliance, which are also determinants of cost, the analyses presented here are probably conservative.