The negative effects of obesity on HRQL are clearly demonstrated. Both physical and mental components of HRQL are remarkably impaired when compared with population norms, particularly in subjects seeking treatment  and in those with psychological or psychiatric distress [22,23].Also in subjects where obesity is superimposed on other chronic illnesses, a further deleterious impact is observed , limited to physical components. Behavior therapy produces a systematic improvement in all scales of HRQL, largely outweighing the effects on body weight and resulting in a significant change in self-perceived health status . Several uncontrolled studies have consistently demonstrated that physical exercise can positively influence the quality of life in obese adolescents, at risk of psychological distress for the stigma of obesity. Walker et al. investigated the change in body image, self-esteem, and worries in 57 obese adolescents attending a residential, weight-loss camp . Obese adolescents had low self-worth and great body dissatisfaction at the start of the camp, and the intervention improved athletic competence and physical appearance, as well as psychological state, in strict correlation with weight loss.
Comprehensive treatments, including diet and exercise, are also effective. In a 15-month randomized study , the intervention SHAPEDOWN program of adolescent obesity, employing a variety of cognitive, behavioral, and affective techniques adapted to make successive small modifications in diet, exercise, communication, proved effective in improving weight, weight- related behavior, and depression. Self-esteem also increased significantly.
Similar data are available in adults. A higher level of physical activity in an obese female clinical population was positively associated with several dimensions of HRQL, although no cause-effect relationship can be derived from cross-sectional analysis .
In the Italian QUOVADIS study on nearly 2,000 obese subjects seeking treatment at medical centers, regular physical activity was associated with a lower prevalence of diabetes, hypertension, and metabolic syndrome [29, 30]. The study was specifically aimed at measuring HRQL in obesity, and the results of the SF-36 and PGWBI questionnaires have recently been analyzed (G Marchesini, personal communication). Both questionnaires confirmed that HRQL was significantly impaired when compared to the normative values of the Italian population by the use of Z- score [31,32], with effect sizes larger for the physical domains of SF-36 (Figs. 1,2). In subjects exercising regularly, at minimum levels of 1h per week, HRQL was systematically better than in sedentary persons, and significantly so in the four physical and two mental domains of SF-36, as well as in two domains of General Health and Vitality of PGWBI.
Physical activity is an essential component of the behavioral treatment of obesity, and is pivotal in weight loss maintenance . A specific program to implement physical activity, set at a light-to-moderate daily physical activity (brisk walking), markedly increases the probability of losing weight, contributing to the long-term control of obesity . In particular, the probability of losing from 5% to 10% of initial body weight increased by 20% for any 1,000 steps/day (OR, 1.20; 95% CI (confidence interval), 1.07-1.35), and that of losing more than 10% by over 30% (OR, 1.33; 95% CI, 1.19-1.49).
Fig. 1 Values of individual domains of the SF-36 questionnaire in the obese population of the QUOVADIS study , in relation to regular exer-cise.The results are presented as mean and 95% confidence interval of Z-score, calculated on the basis of the Italian normative sample , corrected for age and gender. All values are significantly different from population norm. Closed circles represent subjects involved in regular exercise (n = 274), open circles are sedentary people (n = 1,601).Asterisks indicate a significant difference between active and sedentary obese subjects
General Health -Vitality
Global Index -
General Health -Vitality
Global Index -
Fig. 2 Values of individual domains and global index of the PGWB inventory in the obese population of the QUO-VADIS study ,in relation to regular exercise.The results are presented as mean and 95% confidence interval of Z-score, calculated on the basis of the Italian normative sample , corrected for age and gender. All values are significantly different from population norm. Closed circles represent subjects involved in regular exercise (n = 274), open circles are sedentary people (n = 1,601). Asterisks indicate a significant difference between active and sedentary obese subjects
The benefits on weight loss maintenance are accompanied by a remarkable reduction of laboratory and clinical features of the metabolic syndrome.
Drop-out from weight loss programs is almost invariably associated with weight regain, and weight cycling is associated with reduced self-esteem and self-efficacy , leading to poor HRQL . Specific studies addressing the relationship between physical activity, long-term weight loss maintenance, and HRQL are eagerly needed in obesity.
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