Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds

Abstract

Background: Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship.

Methods: The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998).

Results: Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group.

Conclusions: Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.

FIG. 1.

Odds ratios for poor physical HRQOL by weight category for the total sample. Poor physical HRQOL is defined as a physical health composite score of <42 in the RAND-36 Health Survey. Weight categories are defined in terms of body mass index (kg/m²): normal weight 18.5–24.9, overweight 25–29.9, class 1 obesity 30–34.9, class 2 obesity 35–39.9, class 3 obesity ≥40. Model 1 adjusted for age. Model 2 adjusted for sociodemographic data and smoking behavior (age, marital status, education, income, employment, insurance, and current smoking). Model 3 adjusted for model 2 variables plus emotional/psychological factors (having a history of mood disorder, having good social support, being active in groups, having a strong religious affiliation, having a pet, living alone, having a caregiver role, and experiencing ≥5 negative life events). Model 4 adjusted for Model 3 plus physical health variables (comorbidities, pain, and self-rated health status). HRQOL, health-related quality of life.