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MANUAL

FOR THE IMPACT OF WEIGHT ON QUALITY OF LIFE (IWQOL AND


IWQOL-LITE) MEASURE

Obesity and Quality of Life Consulting


762 Ninth Street #563
Durham, NC 27705
(919) 493-9995 telephone
(919) 493-9925 fax
www.qualityoflifeconsulting.com

Ross D. Crosby, Ph.D.


Neuropsychiatric Research Institute
University of North Dakota School of Medicine and Health Sciences
Fargo, North Dakota
rcrosby@nrifargo.com

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Health-Related Quality of Life (HRQOL)
In its 1946 Constitution, the World Health Organization defined health as a state of
complete physical, mental, and social well-being and not merely the absence of disease or
infirmity (1). This definition of health was a departure from the old notion that health
pertained only to death and disease, and it paved the way for later exploration of health-
related quality of life. Ware, developer of the most widely used health-related quality of
life instrument (SF-36), emphasizes that health has dimensionalityphysical health,
mental health, everyday functioning in social and in role activities, and general
perceptions of well-beingand can range from the negative states of disease to more
positive states of well-being (2). The terms quality of life, and more specifically,
health-related quality of life, (HRQOL) are used to refer to the physical,
psychological, and social domains of health, seen as distinct areas that are influenced by a
persons experiences, beliefs, expectations, and perceptions (3). HRQOL reflects an
individuals subjective evaluation and reaction to health or illness (4).

Obesity and HRQOL


The dramatic rise in the prevalence of obesity worldwide has stimulated interest in the
health and quality of life consequences of this phenomenon. The body of research on the
quality of life of obese individuals has grown considerably. Indeed, four review papers on
obesity and HRQOL have been written in recent years (6-9), indicating that obesity is
associated with impaired quality of life in many dimensions. Population studies (10-12)
as well as studies of obese treatment-seekers (13, 14) demonstrate a strong connection
between increasing BMI and impairment in quality of life. This association holds whether
generic instruments are used to assess quality of life or whether obesity-specific
instruments are used (15). In addition, weight loss has been associated with
improvements in generic (12, 16) and obesity-specific quality of life (17, 18).

History of the IWQOL


The IWQOL was the first instrument specifically developed to assess the effects of the
obese condition on the quality of life of persons who are seeking treatment for this
condition. The Impact of Weight on Quality of Life (IWQOL; Duke University, 1995)
questionnaire was developed in the mid-1990s by clinicians (Ronette L. Kolotkin, Ph.D.
and Michael A. Hamilton, M.D.) at an intensive treatment program for obesity, the Duke
University Diet and Fitness Center. During intake interviews with patients, patients
frequently expressed concern about and dissatisfaction with various aspects of their lives,
attributing this dissatisfaction to their obesity. Complaints centered on the following
issues: health and physical functioning, social/interpersonal life, work, mobility, self-
esteem, sexual life, activities of daily living, and comfort with food. At the time of this
work, the impact of obesity on physiological health was well established, but less was
known about the effects of weight on psychosocial issues and daily functioning. When a
literature review on quality of life issues in obesity revealed few articles on this subject
and no validated instruments to assess quality of life in this population, it was clear that
there was a need to develop an instrument to assess the impact of weight on quality of
life.

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Since the time of the initial development of the IWQOL, interest in the quality of life of
obese persons has grown considerably. In June of 1999 the North American Association
for the Study of Obesity convened a task force--Task Force on Developing Obesity
Outcomes and Learning Tools (TOOLS)--whose charge was to choose outcome measures
to be used by obesity clinicians and researchers (19). The task force recommended the
use of the IWQOL-Lite (a short-form of the IWQOL that will be described in detail later)
in clinical practice and in research studies on obesity.

Item Development of the IWQOL


Items for the IWQOL reflected the most commonly expressed concerns by patients in
treatment for obesity. Patients (individually and in groups) were asked to describe the
effects of being overweight in their everyday lives. Their responses were recorded, re-
written in the form of items, and grouped by category. In addition, clinicians who
specialized in the treatment of obese persons wrote and categorized items based on their
clinical experience. Items were tested for clarity and modified as needed. The result of
this process was a 74-item IWQOL questionnaire, with 14 items relating to physical
health, 11 relating to social/interpersonal life, 7 relating to work, 10 relating to mobility,
10 relating to self-esteem, 6 relating to sexual life, 7 relating to activities of daily living,
and 9 relating to comfort with food. Scores for each scale were computed by summing
scores on individual items, with 1=never true and 5=always true. With the exception
of the Comfort With Food scale, the higher the score, the poorer the quality of life in that
area. The initial publication on the IWQOL consisted of two studies: one dealing with
item development, reliability, and treatment effects on a small sample of 64 patients, the
other dealing with the relationship between BMI, age, and gender on quality of life in 181
patients (20).

The IWQOL in Clinical Trials


IWQOL and SF-36 data from four randomized clinical trials for sibutramine versus
placebo in mildly to moderately obese patients were analyzed in order to determine the
effects of moderate weight loss on health-related quality of life(18). After approximately
6-months of treatment, statistically significant relationships were observed between
weight change and IWQOL scores for the following scales: Health, Social/Interpersonal,
Mobility, Self-Esteem, Activities of Daily Living, and total score of the IWQOL. For the
SF-36, statistically significant relationships were observed for Physical Function, General
Health Perception, Pain, Vitality, and Emotional Role. Weight reduction of between 5
and 10 percent was associated with an effect size of .29 IWQOL total score points.
IWQOL scales showing the greatest sensitivity to change were Health, Mobility, and total
score. See Bibliography for other studies using the IWQOL.

Development of the Short-Form: IWQOL-Lite


Because the IWQOL contained a large number of items (74 items), researchers designing
clinical trials for obesity expressed concern about the potential for response burden to
subjects. As a result, a shorter version was developed, the IWQOL-Lite. The objectives in
developing a short-form were as follows: 1) to assess obesity-specific quality of life in a
brief version that is convenient to use, and 2) to improve upon the psychometric
properties of the IWQOL. Having achieved these objectives, we no longer recommend

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use of the IWQOL long form. If you have used the long form in your data collection,
you may still score it using IWQOL-Lite scoring criteria. See the section on scoring
the IWQOL-Lite.

Item Selection Process(13)

We analyzed baseline IWQOL data from 1,987 subjects who had taken the IWQOL in a
variety of settings an open label study of phentermine-fenfluramine, an intensive day-
treatment program, an outpatient weight loss treatment program, gastric bypass surgery,
and community volunteers. The sample was randomly divided into two groups: a
Development Sample (N = 996) and a Cross-Validation Sample (N=991). The
Development Sample and the Cross-Validation Sample were not statistically different
from each other in terms of BMI, age, gender, or race (p>.25). The Development Sample
provided data upon which decisions about item selection and scale construction were
based. Selection of items and construction of scales in the Development Sample was
accomplished by compiling data on each of the 74 original IWQOL items. Data included
frequency distributions, inter-item correlations, alpha coefficients for scales and total
score, item-to-scale correlations for scales and total score, baseline correlations with
collateral measures, exploratory factor analysis, and 1-year change correlations between
items and collateral measures. Items were selected if they adequately distributed across
item responses (never true to always true), maximized alpha coefficients, maximized
item-to-scale correlations, and correlated significantly with relevant collateral measures,
both cross-sectionally and longitudinally. Initially, we deleted items from the original 74
if they (1) correlated poorly with the scale score, (2) correlated poorly with the total
score, or (3) correlated poorly with BMI. Changes in items at one-year follow-up were
then correlated with changes in BMI at one-year follow-up. Additional items were
deleted if they did not correlate well with changes in BMI. Exploratory factor analyses
were then performed on the reduced set of items. Factor loadings were examined, and
additional items were deleted if they did not load adequately on the derived factors. This
process was repeated iteratively until an acceptable and interpretable factor structure was
obtained. Therefore, assignment of items to scales was based both on exploratory factor
analysis and on the original scale composition. All decisions about item selection were
finalized prior to analyzing any data in the Cross-Validation Sample.

Methods Used in the Psychometric Evaluation of the IWQOL-Lite (13)


Psychometric evaluation was based entirely on the Cross-Validation Sample. Using the
Cross-Validation Sample, a two-way analysis of variance (ANOVA) was performed for
each of the newly developed scales and total score distributed across 5 BMI
classifications (< 25, 25-29.9, 30-34.9, 35-39.9, 40+) by gender. An alpha of .01 was
used to control for multiple comparisons. Post hoc tests for comparisons between BMI
groups were performed using Tukeys honestly significant difference method (hsd) based
on an alpha of .01.

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A series of confirmatory factor analyses was performed on the Cross-Validation Sample
to evaluate the hypothesized scale structure using EQS software.

The sensitivity of the IWQOL-Lite was evaluated on the Cross-Validation Sample using
two different methods. First, effect sizes were calculated between adjacent BMI groups
(< 25 vs. 25-29.9, 25.9-29.9 vs. 30-34.9, 30-34.9 vs. 35-39.9, etc.) and between extreme
BMI groups (<25 vs. 40+). Effect sizes were calculated as the difference between group
means (after adjusting for age and gender) divided by the standard deviation for the entire
sample. For example, the effect size comparing <25 with 40+ would be calculated as the
adjusted mean for <25 minus the adjusted mean for 40+. That quantity is then divided by
the standard deviation for the entire group. Next, effect sizes were calculated in the one
year longitudinal sample (N = 160) for 3 groups: (1) those subjects losing less than 10%
of baseline BMI, (2) those subjects losing 10-20% of their baseline BMI, and (3) those
subjects losing more than 20% of their baseline BMI. Effect sizes were calculated as the
difference between IWQOL-Lite scores at baseline and 1 year (after adjusting for age and
gender) divided by the standard deviation at baseline (32). Effect sizes were calculated
instead of Guyatts responsiveness statistic because there were not sufficient cases with
stable weight over the one-year period (97% lost at least 10 pounds and 89% lost at least
20 pounds, leaving only five subjects who lost less than ten pounds.)

Characteristics of the IWQOL-Lite


31 items
Items begin with the phrase, Because of my weight
5 domains
o physical function (11 items)
o self-esteem (7items)
o sexual life (4 items)
o public distress (5 items)
o work (4 items)
Total score
Each item has 5 response options (1= never true, 2=rarely true, 3=sometimes
true, 4=usually true, and 5=always true.)

Administration of the IWQOL-Lite


Administration of the IWQOL-Lite is easy and respondents seldom have difficulty
understanding the instructions. Due to the sensitive nature of some of the items,
respondents may prefer to leave a few items blank. Generally, this does not affect the
scoring (see scoring algorithm below). It is acceptable for people to omit items, unless it
is careless omission of items. It is recommended that administering staff say something
like, "I need to check to see that you didn't accidentally omit any items. Is this okay with
you? Did you omit any items intentionally?" If they say that they omitted items
intentionally, then perhaps staff does not check this person's form for omitted items, OR
perhaps instead the staff asks the subject to identify in which section(s) intentionally
omitted items occurred. Then the research staff can check to see that there were not any
accidentally missed items in the other sections, asking them, "is it okay if I look for
accidentally missed items in the other sections?"

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Meaningful Change in IWQOL-Lite Scores
Meaningful changes in IWQOL-Lite total score are determined using the algorithm
described by Crosby and colleagues (21, 22). Based on this algorithm, patients IWQOL-
Lite total scores are considered to have shown meaningful improvement from baseline to
one year if they increased between 7 and 12 points, depending upon baseline severity in
comparison to the normative mean. Normative means for the IWQOL-Lite have been
derived from a sample of 534 non-obese individuals who were not enrolled in any weight
loss treatment program [238 women and 296 men with BMIs between 18.5 and 29.9]
(21).

Available Languages for the IWQOL-Lite

Afrikaans for South Africa, Arabic for UAE (United Arabic Emirates), Arabic for Israel,
Bengali for India, Bulgarian for Bulgaria, Catalan for Spain, Chinese for Hong Kong,
Chinese for Taiwan, Cebuano for Philippines, Chinese for Hong Kong, Chinese for
Taiwan, Czech for Czech Republic, Danish for Denmark, Dutch for Netherlands, Dutch
for Belgium, English for Australia, English for Canada, English for India, English for
Malaysia, English for New Zealand, English for Philippines, English for Singapore,
English for South Africa, English for the UK (including Ireland), English for the US,
Estonian for Estonia, Finnish for Finland, French for France, French for Belgium, French
for Canada, French for Switzerland, German for Germany, German for Austria, German
for Switzerland, Greek for Greece, Gujarati for India, Harmonized Latin American and
U.S. Spanish, Hebrew for Israel, Hindi for India, Hungarian for Hungary, Italian for Italy,
Italian for Switzerland, Japanese for Japan, Kannada for India, Korean for Korea, Latvian
for Latvia, Lithuanian for Lithuania, Malay for Malaysia, Malay for Singapore,
Malayalam for India, Mandarin for Malaysia, Mandarin for Singapore, Marathi for India,
Norwegian for Norway, Polish for Poland, Portuguese for Portugal, Portuguese for
Brazil, Romanian for Romania, Russian for Russia, Russian for Israel, Russian for
Estonia, Russian for Latvia, Russian for Ukraine, Slovakian for Slovakia, Spanish for
Spain, Spanish for Argentina, Spanish for Chile, Spanish for Costa Rica, Spanish for
Mexico, Spanish for Peru, Spanish for Puerto Rico, Spanish for the USA, Swedish for
Sweden, Swedish for Finland, Tagalog for Philippines, Tamil for India, Tamil for
Malaysia, Telugu for India, Thai for Thailand, Turkish for Turkey, Ukrainian for
Ukraine, Urdu for India, Xhosa for South Africa, and Zulu for South Africa.

Six-Month Changes in IWQOL-Lite Scores for Weight Loss Participants (n = 4511)


Data from 10 non-surgical weight loss studies were pooled to examine six-month changes
in IWQOL-Lite scores by weight loss/gain category (weight gain, 0-4.9% loss, 5-9.9%
loss, 10-14.9% loss, and 15+% loss). In Figures 1- 6 mean IWQOL-Lite change scores by
gender are displayed. In Tables 11-13 means and standard deviations are displayed for
each weight loss/gain category for men, women, and the total sample.

Ceiling and Floor Effects of the IWQOL-Lite (Based on a sample size of 12,231
(which includes 550 nonobese, 1344 overweight, 3371 with a BMI of 30-34.9, 3109 with
a BMI of 35-39.9, and 3857 with a BMI of 40+)

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Ceiling Effects
2% of all individuals scored at the ceiling (a score of 100, i.e. no impairment) on the
IWQOL-Lite

For adults with obesity (BMI 30 and above), .5% scored at the ceiling
For adults with a BMI between 30-34.9, .9% scored at the ceiling
For adults with a BMI between 35-39.9, .5% scored at the ceiling
For adults with a BMI 40 and above, .1% scored at the ceiling
For adults with overweight/obesity (BMI 25 and above), 1 % scored at the ceiling

Floor Effects
.1% of all individuals scored at the floor (a score of 0, i.e. the most severe impairment) on
the IWQOL-Lite

For adults with obesity (BMI 30 and above), .1% scored at the floor
For adults with a BMI between 30-34.9, .0% scored at the floor
For adults with a BMI between 35-39.9, .0% scored at the floor
For adults with a BMI 40 and above, .3% scored at the floor
For adults with overweight/obesity (BMI 25 and above), .1% scored at the floor

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Below are tables describing the psychometric properties of the IWQOL-Lite in
different samples. Tables 2-9 are based on data from over 11,000 subjects.

Table 1. Test-retest reliability of the IWQOL-Lite


Community Psychiatric
Sample1 Sample2
Test-Retest ICC Test-Retest ICC
IWQOL-Lite Scale (n = 112 ) (n = 65 )
Physical Function .877 .862

Self-Esteem .870 .864

Sexual Life .849 .764

Public Distress .814 .938

Work .857 .840

Total Score .937 .935


1 Kolotkin R L, Crosby R D. Psychometric evaluation of the Impact Of Weight On Quality Of Life-Lite Questionnaire (IWQOL-Lite) in a
community sample. Quality of Life Research 2002; 11: 157-171.
2 Kolotkin R L, Crosby R D, Corey-Lisle P K, Li H, Swanson J M. Performance of a weight-related measure of quality of life in a psychiatric
sample. Quality of Life Research 2006; 15:587-596.

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Table 2. Demographic and Weight Characteristics of Samples
General Severely Weight Outpatient Residential Bariatric Psychiatric Obese Obese Obese
Community Obese Loss Weight Weight Surgery With With with
Community Clinical Loss Loss Type 2 BED Hyper-
Trials Program Program Diabetes lipidemia
(n = 711 ) (n = 317) (n = 1635)
(n = 5519) (n = 2250) (n = 209 ) (n = 692 ) (n = 95 )
(n = 736) (n = 850)
Female 401 (56.4) 241 (76.0) 3971 (72.0) 1827 439 (59.6) 1345 (82.3) 112 (53.6) 330 (47.7) 72 (75.8) 505 (59.4)
(n, %) (81.2)
Age 37.6 (12.4) 48.8 (10.9) 47.0 (11.4) 45.4 (11.3) 49.3 (13.6) 42.3 (10.7) 43.1 55.2 (9.3) 45.0 47.2
(mean, (10.7) (12.6) (10.6)
SD)
Caucasian 442 (62.2) 308 (97.2) 4398 (79.7) 1318 674 (91.6) 1242 146 (69.9) 550 (79.5) 94 (98.9) 773 (90.9)
(n, %) (81.7%)1 (90.2)2
BMI 27.4 (6.8) 43.2 (6.3) 36.8 (6.0) 36.5 (6.7) 39.3 (10.0) 47.5 (8.4) 33.8 (8.6) 34.5 (3.8) 42.0 34.3 (4.6)
(mean, (10.3)
SD)
BMI
Group (n
%)
18-24.9 286 (40.2) 0 (0) 4 (0.1) 0 (0) 0 (0) 0 (0) 33 (15.8) 4 (0.6) 0 (0) 0 (0)
25-29.9 248 (34.9) 0 (0) 402 (7.3) 272 (12.1) 99 (13.5) 0 (0) 38 (18.2) 96 (13.9) 8 (8.4) 152 (17.9)
30-34.9 104 (14.6) 7 (2.2) 2009 (36.4) 804 (35.7) 190 (25.8) 21 (1.3) 61 (29.2) 257 (37.1) 13 (13.7) 355 (41.8)
35-39.9 45 (6.3%) 93 (29.3) 1824 (33.0) 634 (28.2) 159 (21.6) 216 (13.2) 35 (16.7) 297 (42.9) 19 (20.0) 266 (31.3)
40+ 28 (3.9) 217 (68.5) 1280 (23.2) 539 (24.0) 288 (39.1) 1398 (85.5) 42 (20.1) 38 (5.5) 55 (57.9) 77 (9.1)
1 2
of 1613 reporting ethnicity of 1377 reporting ethnicity

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Table 3. IWQOL-Lite Correlations with BMI for Different Samples
IWQOL- General Severely Weight Outpatient Residential Bariatric Psychiatric Obese Obese Obese
Lite Scale Community Obese Loss Weight Weight Surgery With With with
Community Clinical Loss Loss Type 2 BED Hyperlipidemia
Trials Program Program Diabetes
(n = 711 ) (n = 317) (n = 1635)
(n = (n = 2250) (n = 209 ) (n = 692 ) (n = 95 ) (n = 850)
5519) (n = 736)
Physical -.605*** -.440*** -.402*** -.422*** -.570*** -.252*** -.617*** -.313*** -.498*** -.339***
Function

Self- -.315*** -.127* -.190*** -.179*** -293*** .048 -.540*** -.278*** -.164 -.191***
Esteem

Sexual -.242*** -.116* -.130*** -.166*** -.204*** -.034 -.390*** -.153*** -.133 -.150***
Life

Public -.460*** -.506*** -.571*** -.548*** -.699*** -.382*** -.593*** -.351*** -.643*** -.519***
Distress

Work -.413*** -.240*** -.220*** -.304*** -.266*** -.195*** -.563*** -.211*** -.251* -.225***

Total -.534*** -.376*** -.389*** -.409*** -.569*** -.215*** -.649*** -.337*** -.469*** -.349***
Score

* p < .05 ** p < .01 *** p < .001

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Table 4.Means and Standard Deviations of IWQOL-Lite Scores for Different Samples
IWQOL- General Severely Weight Outpatient Residential Bariatric Psychiatric Obese Obese Obese
Lite Scale Community Obese Loss Weight Weight Surgery With With with
Community Clinical Loss Loss Type 2 BED Hyperlipidemia
Trials Program Program Diabetes
(n = 711 ) (n = 317) (n = (n = 1635)
5519) (n = 2250) (n = 209 ) (n = 692 ) (n = 95 ) (n = 850)
(n = 736)
Physical 90.0 (14.9) 48.4 (21.2) 68.9 65.1 (22.2) 57.3 (26.4) 31.7 62.6 72.1 (20.1) 49.7 73.2 (19.0)
Function (20.6) (21.7) (27.5) (28.2)

Self- 87.5 (19.4) 45.9 (25.9) 59.1 56.1 (27.7) 57.7 (27.2) 30.4 57.2 72.0 (24.7) 39.3 63.6 (26.0)
Esteem (26.4) (25.3) (31.4) (25.9)

Sexual 95.1 (13.0) 65.9 (29.9) 75.1 70.9 (28.0) 65.8 (28.2) 45.8 66.7 80.5 (23.6) 59.1 79.1 (24.5)
Life (26.0) (31.8) (34.6) (30.4)

Public 96.5 (10.9) 62.0 (24.7) 83.5 78.9 (23.6) 71.8 (26.7) 40.8 75.5 89.1 (16.1) 59.2 88.8 (15.7)
Distress (20.2) (25.4) (27.4) (28.4)

Work 95.4 (11.5) 68.1 (23.7) 84.0 79.7 (21.9) 72.0 (23.5) 49.7 72.2 85.6 (18.0) 60.8 85.4 (17.3)
(18.4) (27.5) (28.9) (28.9)
Total 91.8 (12.0) 54.6 (19.5) 71.8 67.9 (19.6) 62.6 (20.7) 36.9 65.3 77.6 (16.8) 51.5 75.9 (16.3)
Score (17.8) (19.0) (25.2) (21.9)

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Table 5. Means and Standard Deviations of IWQOL-Lite Scores by BMI and Gender
for Total Sample (n = 11,640)
BMI
IWQOL scale Sex 18.0-24.9 2529.9 3034.9 3539.9 40+
94.8 (7.3) 82.0 (15.0) 71.8 (19.1) 61.9 (22.0) 43.9 (24.6)
Females n = 241 n = 758 n = 2338 n = 2212 n = 2924
Physical 93.8 (11.0) 88.8 (11.0) 78.1 (17.4) 67.6 (20.6) 46.2 (25.7)
Males
Function n = 97 n = 441 n = 945 n = 810 n = 870
94.5 (8.5) 84.4 (14.1) 73.6 (18.8) 63.4 (21.8) 44.5 (24.9)
Total
n = 338 n = 1199 n = 3283 n = 3022 n = 3794
85.5 (20.1) 65.0 (26.0) 55.4 (26.4) 49.3 (26.7) 40.1 (27.2)
Females
n = 241 n = 758 n = 2338 n = 2213 n = 2924
95.0 (12.6) 87.9 (16.1) 77.4 (20.7) 68.3 (24.0) 53.1 (27.4)
Self-Esteem Males
n = 97) n = 440 n = 944 n = 809 n = 870
88.2 (18.8) 73.4 (25.4) 61.8 (26.8) 54.4 (27.3) 43.1 (27.8)
Total
n = 338 n = 1198 n = 3282 n = 3022 n = 3794
94.5 (14.4) 78.6 (24.8) 71.3 (27.3) 67.3 (28.6) 57.6 (32.6)
Females
n = 237 n = 735 n = 2250 n = 2134 n = 2750
97.7 (10.9) 94.3 (13.0) 86.3 (19.3) 80.5 (22.9) 66.1 (29.6)
Sexual Life Males
n = 97 n = 439 n = 939 n = 807 n = 849
95.4 (13.5) 84.5 (22.5) 75.7 (26.1) 70.9 (27.8) 59.6 (32.1)
Total
n = 334 n = 1174 n = 3189 n = 2941 n = 3599
97.8 (8.1) 94.9 (10.2) 89.3 (15.0) 78.2 (21.2) 51.9 (27.9)
Females
n = 241 n = 758 n = 2338 n = 2211 n = 2925
97.3 (10.9) 97.3 (6.8) 93.2 (11.1) 84.5 (17.5) 55.7 (27.4)
Public Distress Males
n = 97 n = 441 n = 944 n = 810 n = 870
97.7 (9.0) 95.8 (9.2) 90.4 (14.1) 79.9 (20.4) 52.8 (27.8)
Total
n = 338 n = 1199 n = 3282 n = 3021 n = 3795
97.6 (8.3) 89.1 (16.3) 84.2 (18.8) 77.6 (22.4) 63.7 (28.4)
Females
n = 234 n = 747 n = 2322 n = 2182 n = 2877
96.7 (9.9) 93.3 (12.6) 88.5 (15.1) 83.4 (18.5) 67.7 (26.3)
Work Males
n = 94 n = 436 n = 934 n = 798 n = 854
97.4 (8.7) 90.7 (15.2) 85.4 (17.9) 79.1 (21.6) 64.6 (28.0)
Total
n = 328 n = 1183 n = 3256 n = 2980 n = 3731
93.5 (8.8) 80.7 (13.8) 72.5 (16.6) 64.4 (19.1) 48.5 (22.3)
Females
n = 241 n = 758 n = 2339 n = 2213 n = 2925
95.5 (10.0) 91.3 (9.1) 82.8 (13.4) 74.2 (16.4) 54.6 (22.1)
IWQOL-Lite Total Males
n = 97 n = 441 n = 945 n = 810 n = 870
94.0 (9.2) 84.6 (13.3) 75.4 (16.5) 67.0 (18.9) 49.9 (22.4)
Total
n = 338 n = 1199 n = 3284 n = 3023 n = 3795

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Table 6. Means and Standard Deviations of IWQOL-Lite Scores by Age and Gender
for Obese Sample (BMI > 30) (n = 10,096)
Age Group
IWQOL 18.0-24.9 2534.9 3544.9 4554.9 55-64.9 65+
Sex
scale
65.9 (24.8) 60.3 (24.9) 59.1 (25.1) 56.4 (24.8) 55.1 (26.0) 56.2 (24.4)
Females
n = 303 n = 1245 n = 2068 n = 2322 n = 1232 n = 301
Physical 73.6 (21.3) 69.2 (23.0) 63.9 (25.4) 62.4 (26.2) 62.5 (25.1) 69.1 (23.5)
Males
Function n = 50 n = 294 n = 615 n = 852 n = 630 n = 181
67.0 (24.5) 62.0 (24.8) 60.2 (25.2) 58.0 (25.3) 57.6 (25.9) 61.1 (24.8)
Total
n = 353 n = 1539 n = 2683 n = 3174 n = 1862 n = 482
44.6 (27.4) 40.1 (27.1) 44.6 (27.3) 49.7 (26.6) 54.0 (27.8) 60.4 (25.4)
Females
n = 302 n = 1245 n = 2070 n = 2321 n = 1233 n = 301
Self- 57.5 (26.8) 60.3 (28.1) 61.6 (26.2) 65.9 (26.1) 71.7 (24.2) 80.6 (20.2)
Males
Esteem n = 49 n = 293 n = 615 n = 852 n = 630 n = 181
46.4 (27.6) 44.0 (28.4) 48.5 (28.0) 54.0 (27.4) 60.0 (27.9) 70.0 (25.5)
Total
n = 351 n = 1538 n = 2685 n = 3173 n = 1863 n = 482
73.3 (27.6) 64.0 (30.3) 64.3 (29.5) 64.6 (30.5) 64.1 (31.9) 67.9 (31.0)
Females
n = 291 n = 1212 n = 2022 n = 2230 n = 1123 n = 253
Sexual 84.3 (24.9) 80.8 (24.8) 79.7 (25.7) 77.2 (25.3) 75.1 (26.2) 77.7 (25.4)
Males
Life n = 47 n = 294 n = 609 n = 843 n = 621 n = 178
74.8 (27.4) 67.3 (30.1) 67.9 (29.4) 68.1 (29.7) 68.0 (30.5) 72.0 (29.2)
Total
n = 338 n = 1506 n = 2631 n = 3073 n = 1744 n = 431
68.6 (28.6) 64.8 (29.3) 69.3 (28.2) 73.1 (26.7) 76.7 (26.3) 81.1 (22.1)
Females
n = 303 n = 1245 n = 2069 n = 2321 n = 1232 n = 301
Public 77.0 (24.6) 73.8 (26.8) 74.0 (27.9) 77.2 (25.9) 82.2 (22.2) 89.3 (17.1)
Males
Distress n = 50 n = 293 n = 615 n = 852 n = 630 n = 181
69.8 (28.2) 66.5 (29.0) 70.3 (28.2) 74.2 (26.5) 78.5 (25.1) 84.2 (20.7)
Total
n = 353 n = 1538 n = 2684 n = 3173 n = 1862 n = 482
77.4 (26.4) 72.9 (26.4) 73.5 (26.0) 75.1 (24.9) 74.6 (25.4) 74.3 (22.2)
Females
n = 300 n = 1230 n = 2050 n = 2294 n = 1212 n = 292
81.4 (19.5) 79.1 (22.9) 78.2 (24.9) 79.2 (22.8) 81.7 (19.5) 85.5 (17.4)
Work Males
n = 50 n = 292 n = 606 n = 844 n = 616 n = 175
77.9 (25.5) 74.1 (25.9) 74.6 (25.8) 76.2 (24.4) 77.0 (23.9) 78.5 (21.2)
Total
n = 350 n = 1522 n = 2656 n = 3138 n = 1828 n = 467
63.9 (21.9) 58.5 (22.4) 60.0 (22.4) 61.0 (21.9) 61.9 (22.8) 64.7 (19.9)
Females
n = 303 n = 1245 n = 2070 n = 2323 n = 1233 n = 300
IWQOL- 73.0 (16.4) 70.7 (21.4) 68.8 (22.3) 69.6 (21.8) 71.8 (20.4) 78.2 (17.1)
Males
Lite Total n = 50 n = 294 n = 615 n = 852 n = 630 n = 181
65.2 (21.4) 60.8 (22.7) 62.0 (22.6) 63.3 (22.2) 65.3 (22.5) 70.0 (20.0)
Total
n = 353 n = 1539 n = 2685 n = 3175 n = 1863 n = 481

13
Table 7. Cut-offs for none, mild, moderate, severe baseline IWQOL-Lite total
score*

IWQOL-Lite None Mild Moderate Severe


Total Score = > 87.1. 79.5-87.0 71.9-79.4 <71.9
*Based on Crosby, R. D., Kolotkin, R. L., & Williams, G. R. (2004). An integrated method
to determine meaningful changes in health-related quality of life. J Clin Epidemiol,
57(11), 1153-1160. (Normative sample = 534 normal/overweight individuals not enrolled
in a weight loss program)

14
Table 8. Item to Scale Correlations Total Sample (n = 11,640)
Physical Self- Sexual Public

Function Esteem Life Distress Work Total

Physical Function

Picking up objects -.808 -.480 -.477 -.577 -.554 -.721

Tying shoes -.811 -.472 -.470 -.577 -.540 -.715

Getting up from chairs -.845 -.497 -.501 -.646 -.596 -.762

Using stairs -.834 -.518 -.495 -.632 -.585 -.759

Dressing -.750 -.451 -.491 -.569 -.587 -.695

Mobility -.816 -.487 -.504 -.635 -.635 -.752

Crossing legs -.742 -.523 -.460 -.633 -.518 -.714

Feel short of breath -.747 -.500 -.465 -.558 -.544 -.696

Painful stiff joints -.634 -.377 -.371 -.435 -.439 -.558

Swollen ankles/legs -.627 -.398 -.403 -.494 -.477 -.589

Worried about health -.568 -.506 -.390 -.486 -.456 -.596

Self-Esteem

Self-conscious .-.495 -.794 -.475 -.482 -.427 -.650

Self-esteem not what it -.516 -.844 -.518 -.502 -.491 -.692

could be

Unsure of self -.530 -.855 -.545 -.546 -.555 -.724

Do not like myself -.477 -.805 -.547 -.482 -.506 -.669

Afraid of rejection -.500 -.799 -.533 -.600 -.558 -.708

Avoid looking in mirrors -.509 -.754 -.529 -.518 -.475 -.671

Embarrassed in public -.573 -.767 -.592 -.639 -.617 -.761

15
Sexual Life

Do not enjoy sexual -.508 -.598 -.856 -.480 -.530 -.669

activity

Little sexual desire -.499 -.548 -.855 -.434 -.505 -.637

Difficulty with sexual -.603 -.558 -.810 -.547 -.579 -.713

performance

Avoid sexual encounters -.498 -.571 -.862 -.475 -.530 -.653

Public Distress

Experience ridicule -.508 -.547 -.439 -.669 -.579 -.645

Fitting in public seats -.683 -.548 -.466 -.854 -.587 -.740

Fitting through aisles -.687 -.569 -.486 -.872 -.601 -.757

Worry about finding chairs -.668 -.512 -.461 -.847 -.600 -.722

Experience discrimination -.551 -.562 -.454 -.731 -.628 -.684

Work

Trouble accomplishing -.630 -.504 -.521 -.584 -.772 -.694

things

Less productive -.624 -.526 -.504 -.542 -.712 -.680

Do not receive recognition -.482 -.423 -.442 -.561 -.685 -.585

Afraid to go on interviews -.545 -.577 -.512 -.636 -.674 -.678

Bold cells represent correlations corrected for influence of that item

16
Table 9. Internal Consistency of IWQOL-Lite Scores for Different Samples
IWQOL- General Severely Weight Outpatient Residential Bariatric Psychiatric Obese Obese Obese Total
Lite Community Obese Loss Weight Weight Surgery With With with
Scale Community Clinical Loss Loss Type 2 BED Hyper-
Trials Program Program Diabetes lipidemia
(n = 711 ) (n = 317) (n = (n =
5519) (n = 2250) 1635) (n = 209 ) (n = 692 ) (n = 95
(n = 736) ) (n = 850) (n =
11,640)
Physical .920 .908 .908 .906 .935 .908 .939 .910 .945 .893 .940
Function

Self- .938 .935 .927 .928 .922 .920 .945 .932 .912 .926 .940
Esteem

Sexual .910 .939 .926 .923 .890 .927 .932 .909 .893 .925 .935
Life

Public .893 .881 .889 .888 .893 .861 .913 .872 .875 .844 .919
Distress

Work .831 .795 .789 .836 .882 .800 .892 .781 .913 .770 .860

Total .953 .949 .951 .952 .953 .941 .973 .953 .955 .945 .967
Score

17
Table 10a. Percentiles Associated with IWQOL-Lite Scores for Obese Female
Sample (BMI > 30) (n = 7,478)

Physical Self- Sexual Public IWQOL


Function Esteem Life Distress Work Total
Percentiles 1 .000 .000 .000 .000 .000 6.452
2 4.545 .000 .000 5.000 6.250 11.290
3 6.818 .000 .000 10.000 12.500 14.516
4 9.091 .000 .000 15.000 18.750 16.935
5 11.364 3.571 .000 15.000 25.000 20.161
6 13.636 3.571 6.250 20.000 25.000 22.581
7 15.909 3.571 6.250 20.000 31.250 24.194
8 15.909 7.143 12.500 25.000 31.250 25.806
9 18.182 7.143 12.500 25.000 31.250 27.419
10 20.455 10.714 18.750 30.000 37.500 28.226
11 22.727 10.714 18.750 30.000 37.500 29.839
12 25.000 10.714 25.000 30.000 43.750 31.452
13 25.000 14.286 25.000 35.000 43.750 33.065
14 27.273 14.286 25.000 35.000 43.750 33.871
15 29.545 14.286 25.000 40.000 43.750 35.484
16 29.545 17.857 31.250 40.000 50.000 36.290
17 31.818 17.857 31.250 40.000 50.000 37.903
18 31.818 17.857 37.500 45.000 50.000 38.710
19 34.091 21.429 37.500 45.000 50.000 39.516
20 34.091 21.429 37.500 45.000 50.000 41.129
21 36.364 21.429 37.500 50.000 56.250 41.935
22 36.364 25.000 43.750 50.000 56.250 42.742
23 38.636 25.000 43.750 50.000 56.250 43.548
24 38.636 25.000 43.750 50.000 56.250 44.355
25 40.909 25.000 43.750 55.000 56.250 45.161
26 40.909 28.571 50.000 55.000 62.500 46.774
27 43.182 28.571 50.000 55.000 62.500 46.823
28 43.182 28.571 50.000 55.000 62.500 48.387
29 43.182 28.571 50.000 60.000 62.500 49.194
30 45.455 32.143 50.000 60.000 62.500 50.000
31 45.455 32.143 50.000 60.000 62.500 50.000
32 47.727 32.143 50.000 60.000 68.750 51.613
33 47.727 32.143 50.000 60.000 68.750 52.419
34 50.000 35.714 56.250 65.000 68.750 53.226
35 50.000 35.714 56.250 65.000 68.750 54.032
36 50.000 35.714 56.250 65.000 68.750 54.839
37 52.273 35.714 56.250 65.000 68.750 54.839
38 52.273 35.714 56.250 70.000 68.750 55.645
39 52.273 39.286 56.250 70.000 75.000 56.452
40 52.273 39.286 62.500 70.000 75.000 57.258
41 54.545 39.286 62.500 70.000 75.000 58.065

18
42 54.545 39.286 62.500 70.000 75.000 58.065
43 54.545 42.857 62.500 70.000 75.000 58.871
44 56.818 42.857 62.500 75.000 75.000 59.677
45 56.818 42.857 62.500 75.000 75.000 60.484
46 56.818 42.857 68.750 75.000 75.000 60.484
47 59.091 46.429 68.750 75.000 75.000 61.290
48 59.091 46.429 68.750 75.000 81.250 62.097
49 59.091 46.429 68.750 75.000 81.250 62.903
50 61.364 46.429 68.750 80.000 81.250 62.903
51 61.364 46.429 68.750 80.000 81.250 63.710
52 61.364 50.000 68.750 80.000 81.250 64.516
53 63.636 50.000 75.000 80.000 81.250 64.516
54 63.636 50.000 75.000 80.000 81.250 65.323
55 63.636 50.000 75.000 85.000 87.500 66.129
56 65.909 53.571 75.000 85.000 87.500 66.935
57 65.909 53.571 75.000 85.000 87.500 67.742
58 65.909 53.571 75.000 85.000 87.500 67.742
59 65.909 53.571 75.000 85.000 87.500 68.548
60 68.182 53.571 75.000 85.000 87.500 69.355
61 68.182 57.143 75.000 90.000 87.500 70.161
62 68.182 57.143 81.250 90.000 87.500 70.161
63 70.455 57.143 81.250 90.000 87.500 70.968
64 70.455 57.143 81.250 90.000 87.500 71.774
65 70.455 60.714 81.250 90.000 93.750 72.581
66 72.727 60.714 81.250 90.000 93.750 72.581
67 72.727 60.714 87.500 90.000 93.750 73.387
68 72.727 64.286 87.500 90.000 93.750 73.387
69 75.000 64.286 87.500 95.000 93.750 74.194
70 75.000 64.286 87.500 95.000 93.750 75.000
71 75.000 64.286 87.500 95.000 93.750 75.806
72 75.000 64.286 87.500 95.000 93.750 75.935
73 77.273 67.857 93.750 95.000 93.750 76.613
74 77.273 67.857 93.750 95.000 100.000 77.419
75 79.545 67.857 93.750 95.000 100.000 78.226
76 79.545 71.429 93.750 95.000 100.000 79.032
77 79.545 71.429 93.750 100.000 100.000 79.839
78 81.818 71.429 100.000 100.000 100.000 79.839
79 81.818 71.429 100.000 100.000 100.000 80.645
80 81.818 75.000 100.000 100.000 100.000 81.452
81 81.818 75.000 100.000 100.000 100.000 82.258
82 84.091 75.000 100.000 100.000 100.000 82.258
83 84.091 78.571 100.000 100.000 100.000 83.065
84 84.091 78.571 100.000 100.000 100.000 83.871
85 86.364 78.571 100.000 100.000 100.000 84.677
86 86.364 82.143 100.000 100.000 100.000 85.484
87 86.364 82.143 100.000 100.000 100.000 86.290
88 88.636 82.143 100.000 100.000 100.000 87.097
89 88.636 85.714 100.000 100.000 100.000 87.903
90 88.636 85.714 100.000 100.000 100.000 88.710
91 90.909 85.714 100.000 100.000 100.000 89.516

19
92 90.909 89.286 100.000 100.000 100.000 90.323
93 90.909 89.286 100.000 100.000 100.000 91.129
94 93.182 92.857 100.000 100.000 100.000 91.935
95 93.182 92.857 100.000 100.000 100.000 92.742
96 95.455 96.429 100.000 100.000 100.000 93.548
97 95.455 96.429 100.000 100.000 100.000 95.161
98 97.727 100.000 100.000 100.000 100.000 95.968
99 100.000 100.000 100.000 100.000 100.000 97.581

20
Table 10b. Percentiles Associated with IWQOL-Lite Scores for Obese Male Sample
(BMI > 30) (n = 2,625)

Physical Self- Sexual Public IWQOL


Function Esteem Life Distress Work Total
Percentiles 1 .000 .000 .000 5.000 6.250 10.484
2 4.545 3.571 6.250 10.000 12.500 17.742
3 6.818 7.143 12.500 15.000 25.000 21.774
4 9.091 14.143 18.750 20.000 31.250 25.000
5 13.636 15.000 25.000 20.000 37.500 28.226
6 15.909 17.857 25.000 25.000 37.500 30.645
7 18.182 21.429 31.250 30.000 43.750 33.871
8 20.455 21.429 31.250 30.000 43.750 35.484
9 25.000 25.000 37.500 35.000 50.000 37.097
10 25.000 25.000 37.500 40.000 50.000 38.710
11 27.273 28.571 43.750 40.000 50.000 40.323
12 29.545 32.143 43.750 40.000 50.000 42.742
13 31.818 32.143 43.750 45.000 56.250 43.855
14 34.091 35.714 50.000 45.000 56.250 45.968
15 34.091 35.714 50.000 50.000 56.250 46.774
16 36.364 39.286 50.000 50.000 56.250 48.387
17 38.636 39.286 56.250 55.000 62.500 50.000
18 40.182 42.857 56.250 55.000 62.500 51.613
19 40.909 42.857 56.250 55.000 62.500 52.419
20 43.182 42.857 56.250 60.000 62.500 53.226
21 43.182 46.429 57.250 60.000 62.500 54.839
22 45.455 46.429 62.500 60.000 62.500 55.645
23 47.727 46.429 62.500 60.000 68.750 56.452
24 47.727 50.000 62.500 65.000 68.750 57.258
25 47.727 50.000 62.500 65.000 68.750 58.871
26 50.000 50.000 62.500 65.000 68.750 59.677
27 50.000 53.571 68.750 65.000 68.750 59.677
28 52.273 53.571 68.750 70.000 68.750 60.484
29 52.273 53.571 68.750 70.000 75.000 61.726
30 54.545 53.571 68.750 70.000 75.000 62.097
31 54.545 57.143 68.750 70.000 75.000 62.903
32 54.545 57.143 75.000 75.000 75.000 63.710
33 56.818 57.143 75.000 75.000 75.000 64.516
34 56.818 60.714 75.000 75.000 75.000 65.323
35 56.818 60.714 75.000 75.000 75.000 66.129
36 59.091 60.714 75.000 75.000 75.000 66.935
37 59.091 60.714 75.000 75.000 75.000 67.742
38 59.091 60.714 75.000 80.000 81.250 68.548
39 61.364 64.286 75.000 80.000 81.250 68.548
40 61.364 64.286 75.000 80.000 81.250 69.355
41 63.636 64.286 81.250 80.000 81.250 70.161
42 63.636 64.286 81.250 80.000 81.250 70.161
43 63.636 64.286 81.250 85.000 81.250 70.968
44 63.636 67.857 81.250 85.000 81.250 71.774

21
45 65.909 67.857 81.250 85.000 81.250 72.581
46 65.909 67.857 81.250 85.000 87.500 73.387
47 65.909 67.857 87.500 85.000 87.500 74.194
48 68.182 67.857 87.500 85.000 87.500 74.194
49 68.182 71.429 87.500 90.000 87.500 75.000
50 70.455 71.429 87.500 90.000 87.500 75.000
51 70.455 71.429 87.500 90.000 87.500 75.806
52 70.455 71.429 87.500 90.000 87.500 76.613
53 72.727 71.429 87.500 90.000 87.500 77.242
54 72.727 75.000 87.500 90.000 87.500 77.419
55 72.727 75.000 87.500 90.000 87.500 78.226
56 75.000 75.000 93.750 90.000 87.500 78.226
57 75.000 75.000 93.750 90.000 87.500 79.032
58 75.000 75.000 93.750 95.000 93.750 79.839
59 75.000 75.000 93.750 95.000 93.750 80.645
60 75.000 78.571 93.750 95.000 93.750 80.645
61 77.273 78.571 93.750 95.000 93.750 81.452
62 77.273 78.571 93.750 95.000 93.750 81.452
63 77.273 78.571 93.750 95.000 93.750 82.258
64 78.727 78.571 93.750 95.000 93.750 83.065
65 79.545 82.143 100.000 95.000 93.750 83.065
66 79.545 82.143 100.000 95.000 93.750 83.871
67 79.545 82.143 100.000 95.000 93.750 83.871
68 81.818 82.143 100.000 95.000 93.750 84.677
69 81.818 85.714 100.000 96.250 100.000 85.484
70 81.818 85.714 100.000 100.000 100.000 85.484
71 81.818 85.714 100.000 100.000 100.000 86.290
72 84.091 85.714 100.000 100.000 100.000 86.290
73 84.091 85.714 100.000 100.000 100.000 87.097
74 84.091 85.714 100.000 100.000 100.000 87.097
75 84.091 89.286 100.000 100.000 100.000 87.097
76 86.364 89.286 100.000 100.000 100.000 87.903
77 86.364 89.286 100.000 100.000 100.000 88.710
78 86.364 89.286 100.000 100.000 100.000 88.710
79 86.364 92.714 100.000 100.000 100.000 89.516
80 86.364 92.857 100.000 100.000 100.000 89.516
81 88.636 92.857 100.000 100.000 100.000 90.323
82 88.636 92.857 100.000 100.000 100.000 91.129
83 88.636 92.857 100.000 100.000 100.000 91.129
84 88.636 92.857 100.000 100.000 100.000 91.935
85 90.909 96.429 100.000 100.000 100.000 91.935
86 90.909 96.429 100.000 100.000 100.000 92.742
87 90.909 96.429 100.000 100.000 100.000 92.742
88 90.909 96.429 100.000 100.000 100.000 93.548
89 93.182 96.429 100.000 100.000 100.000 94.355
90 93.182 100.000 100.000 100.000 100.000 94.355
91 93.182 100.000 100.000 100.000 100.000 95.161
92 95.455 100.000 100.000 100.000 100.000 95.161
93 95.455 100.000 100.000 100.000 100.000 95.968
94 95.455 100.000 100.000 100.000 100.000 95.968

22
95 95.455 100.000 100.000 100.000 100.000 96.774
96 97.727 100.000 100.000 100.000 100.000 97.581
97 97.727 100.000 100.000 100.000 100.000 98.387
98 100.000 100.000 100.000 100.000 100.000 98.387
99 100.000 100.000 100.000 100.000 100.000 100.000

23
Table 11: Conversion of Raw Scores to Transformed (0-100) Scores
Raw Physical Self- Sexual Public Work Total
Score Function Esteem Life Distress Score
4 100 100
5 93.8 100 93.8
6 87.5 95.0 87.5
7 100 81.3 90.0 81.3
8 96.4 75.0 85.0 75.0
9 92.9 68.8 80.0 68.8
10 89.3 62.5 75.0 62.5
11 100 85.7 56.3 70.0 56.3
12 97.7 82.1 50.0 65.0 50.0
13 95.5 78.6 43.8 60.0 43.8
14 93.2 75.0 37.5 55.0 37.5
15 90.9 71.4 31.3 50.0 31.3
16 88.6 67.9 25.0 45.0 25.0
17 86.4 64.3 18.8 40.0 18.8
18 84.1 60.7 12.5 35.0 12.5
19 81.8 57.1 6.3 30.0 6.3
20 79.5 53.6 0 25.0 0
21 77.3 50.0 20.0
22 75.0 46.4 15.0
23 72.7 42.9 10.0
24 70.5 39.3 5.0
25 68.2 35.7 0
26 65.9 32.1
27 63.6 28.6
28 61.4 25.0
29 59.1 21.4
30 56.8 17.9
31 54.5 14.3 100
32 52.3 10.7 99.2
33 50.0 7.1 98.4
34 47.7 3.6 97.6
35 45.5 0 96.8
36 43.2 96.0
37 40.9 95.2
38 38.6 94.4
39 36.4 93.5
40 34.1 92.7
41 31.8 91.9
42 29.5 91.1
43 27.3 90.3
44 25.0 89.5
45 22.7 88.7
46 20.5 87.9
47 18.2 87.1
48 15.9 86.3
49 13.6 85.5

24
50 11.4 84.7
51 9.1 83.9
52 6.8 83.1
53 4.5 82.3
54 2.3 81.5
55 0 80.6
56 79.8
57 79.0
58 78.2
59 77.4
60 76.6
61 75.8
62 75.0
63 74.2
64 73.4
65 72.6
66 71.8
67 71.0
68 70.2
69 69.4
70 68.5
71 67.7
72 66.9
73 66.1
74 65.3
75 64.5
76 63.7
77 62.9
78 62.1
79 61.3
80 60.5
81 59.7
82 58.9
83 58.1
84 57.3
85 56.5
86 55.6
87 54.8
88 54.0
89 53.2
90 52.4
91 51.6
92 50.8
93 50.0
94 49.2
95 48.4
96 47.6
97 46.8
98 46.0

25
99 45.2
100 44.4
101 43.5
102 42.7
103 41.9
104 41.1
105 40.3
106 39.5
107 38.7
108 37.9
109 37.1
110 36.3
111 35.5
112 34.7
113 33.9
114 33.1
115 32.3
116 31.5
117 30.6
118 29.8
119 29.0
120 28.2
121 27.4
122 26.6
123 25.8
124 25.0
125 24.2
126 23.4
127 22.6
128 21.8
129 21.0
130 20.2
131 19.4
132 18.5
133 17.7
134 16.9
135 16.1
136 15.3
137 14.5
138 13.7
139 12.9
140 12.1
141 11.3
142 10.5
143 9.7
144 8.9
145 8.1
146 7.3
147 6.5

26
148 5.6
149 4.8
150 4.0
151 3.2
152 2.4
153 1.6
154 0.8
155 0

27
Table 12: IWQOL-Lite Six-Month Change Scores for Men
Weight Loss Group Physical Self- Sexual Public Work IWQOL-
Function Esteem Life Distress Change Lite Total
Change Change Change Change Change
Weight Mean 2.188 3.966 1.046 1.045 -.894 1.930
Gain N 134 134 132 134 132 134
Std. Deviation 12.018 16.342 17.800 10.744 16.830 9.562
Grouped 2.266 3.560 1.364E- .467 2.128E- 2.377
Median 02 03
Minimum -45.5 -57.2 -100.0 -30.0 -62.5 -25.8
Maximum 34.1 64.3 50.0 35.0 50.0 29.0
Range 79.6 121.5 150.0 65.0 112.5 54.8
0-4.9% Mean 6.192 6.783 3.293 2.591 2.967 4.926
Loss N 467 466 464 467 461 467
Std. Deviation 13.257 13.424 16.067 10.969 13.673 9.622
Grouped 4.545 3.596 2.279E- 2.189 2.389E- 4.039
Median 02 02
Minimum -50.0 -53.5 -100.0 -50.0 -56.3 -43.6
Maximum 61.4 67.9 75.0 50.0 56.3 49.2
Range 111.4 121.4 175.0 100.0 112.5 92.8
5-9.9% Mean 9.969 10.548 4.106 4.251 3.704 7.602
Loss N 374 372 369 374 372 374
Std. Deviation 13.984 15.025 15.246 11.698 11.744 10.063
Grouped 9.084 7.161 2.528E- 2.464 3.242E- 6.474
Median 02 02
Minimum -52.3 -32.2 -75.0 -50.0 -37.5 -35.5
Maximum 77.3 92.9 87.5 50.0 43.8 54.8
Range 129.5 125.1 162.5 100.0 81.3 90.3
10- Mean 16.719 12.259 7.329 5.794 5.828 11.308
14.9% N 170 169 169 170 170 170
Loss Std. Deviation 16.107 15.865 17.171 11.946 15.604 11.679
Grouped 13.645 10.706 3.519E- 3.039 4.697E- 9.487
Median 02 02
Minimum -52.3 -39.3 -56.2 -20.0 -62.5 -35.5
Maximum 79.5 67.9 81.3 65.0 56.3 58.9
Range 131.8 107.2 137.5 85.0 118.8 94.3

28
15% Mean 19.745 16.089 9.126 9.148 5.132 13.905
+ N 88 87 87 88 87 88
Loss Std. Deviation 16.139 18.335 14.065 16.050 13.344 11.805
Grouped Median 18.170 13.067 5.523 5.000 3.611E- 11.669
02
Minimum -11.4 -35.8 -18.8 -35.0 -25.0 -12.1
Maximum 61.4 60.7 62.5 60.0 50.0 49.2
Range 72.8 96.5 81.3 95.0 75.0 61.3
All Mean 9.321 9.029 4.270 3.836 3.326 6.933
Men N 1233 1228 1221 1233 1222 1233
Std. Deviation 14.830 15.294 16.159 11.883 13.860 10.705
Grouped Median 6.858 7.143 2.642E- 2.917 2.843E- 5.657
02 02
Minimum -52.3 -57.2 -100.0 -50.0 -62.5 -43.6
Maximum 79.5 92.9 87.5 65.0 56.3 58.9
Range 131.8 150.1 187.5 115.0 118.8 102.4

29
Table 13: IWQOL-Lite Six-Month Change Scores for Women
Weight Gain Mean 2.576 8.208 4.861 2.113 1.955 3.956
N 389 388 376 388 387 389
Std. Deviation 13.975 17.654 19.114 13.388 15.524 11.434
Grouped Median 2.273 7.120 2.885E-02 2.026 1.849E-02 3.226
Minimum -59.3 -46.4 -81.2 -70.0 -56.3 -39.8
Maximum 56.9 64.3 81.3 50.0 62.5 46.0
Range 116.2 110.7 162.5 120.0 118.8 85.9
0-4.9% Loss Mean 8.501 11.778 5.829 4.004 4.572 7.674
N 1092 1086 1045 1089 1087 1092
Std. Deviation 14.177 17.426 21.138 13.227 15.349 11.359
Grouped Median 6.827 10.714 4.411E-02 3.420 3.447E-02 6.452
Minimum -52.3 -75.0 -100.0 -75.0 -75.0 -69.4
Maximum 68.2 92.9 100.0 55.0 75.0 54.8
Range 120.5 167.9 200.0 130.0 150.0 124.2
5-9.9% Loss Mean 12.261 14.405 8.669 5.343 5.510 10.266
N 912 910 864 912 905 912
Std. Deviation 14.107 18.234 20.197 14.001 14.775 11.635
Grouped Median 9.988 14.257 2.165 1.799 4.108E-02 9.095
Minimum -54.5 -57.1 -75.0 -50.0 -50.0 -50.0
Maximum 75.0 85.7 100.0 90.0 87.5 62.1
Range 129.6 142.8 175.0 140.0 137.5 112.1
10-14.9% Loss Mean 16.435 19.167 11.540 6.897 7.715 13.766
N 535 532 505 535 531 534
Std. Deviation 15.217 19.664 19.667 13.578 15.648 12.453
Grouped Median 15.870 17.857 6.263 5.000 2.238 12.619
Minimum -50.0 -57.1 -56.3 -60.0 -62.5 -53.2
Maximum 68.2 100.0 100.0 90.0 62.5 75.8
Range 118.2 157.1 156.3 150.0 125.0 129.1
15% + Loss Mean 18.997 21.162 13.972 8.814 8.391 15.837
N 350 349 331 350 348 350
Std. Deviation 16.209 21.358 21.400 15.153 15.637 13.531
Grouped Median 15.918 21.407 6.291 4.167 .809 13.716
Minimum -25.0 -50.0 -37.5 -30.0 -37.5 -29.8
Maximum 70.4 89.3 100.0 80.0 75.0 63.7
Range 95.4 139.3 137.5 110.0 112.5 93.6
All Women Mean 11.260 14.293 8.286 5.140 5.442 9.819
N 3278 3265 3121 3274 3258 3277
Std. Deviation 15.284 18.906 20.635 13.854 15.397 12.366
Grouped Median 9.091 12.292 4.395 1.928 3.985E-02 8.871
Minimum -59.3 -75.0 -100.0 -75.0 -75.0 -69.4
Maximum 75.0 100.0 100.0 90.0 87.5 75.8
Range 134.4 175.0 200.0 165.0 162.5 145.2

30
Table 14: IWQOL-Lite Six-Month Change Scores for Total Sample
Weight Gain Mean 2.477 7.119 3.869 1.839 1.231 3.437
N 523 522 508 522 519 523
Std. Deviation 13.491 17.411 18.838 12.760 15.898 11.011
Grouped Median 2.273 3.582 2.432E-02 1.643 1.451E-02 2.455
Minimum -59.3 -57.2 -100.0 -70.0 -62.5 -39.8
Maximum 56.9 64.3 81.3 50.0 62.5 46.0
Range 116.2 121.5 181.3 120.0 125.0 85.9
0-4.9% Loss Mean 7.810 10.278 5.049 3.580 4.094 6.851

N 1559 1552 1509 1556 1548 1559


Std. Deviation 13.944 16.483 19.747 12.605 14.883 10.937
Grouped Median 6.818 7.163 3.571E-02 2.977 3.088E-02 5.645
Minimum -52.3 -75.0 -100.0 -75.0 -75.0 -69.4
Maximum 68.2 92.9 100.0 55.0 75.0 54.8
Range 120.5 167.9 200.0 130.0 150.0 124.2
5-9.9% Loss Mean 11.595 13.286 7.303 5.025 4.984 9.492
N 1286 1282 1233 1286 1277 1286
Std. Deviation 14.105 17.446 18.962 13.377 13.980 11.262
Grouped Median 9.105 10.714 4.555E-02 1.757 3.826E-02 8.099
Minimum -54.5 -57.1 -75.0 -50.0 -50.0 -50.0
Maximum 77.3 92.9 100.0 90.0 87.5 62.1
Range 131.8 150.0 175.0 140.0 137.5 112.1
10-14.9% Loss Mean 16.504 17.502 10.484 6.631 7.257 13.172
N 705 701 674 705 701 704
Std. Deviation 15.425 19.039 19.146 13.203 15.647 12.308
Grouped Median 13.682 15.490 3.059 4.982 1.443 11.692
Minimum -52.3 -57.1 -56.3 -60.0 -62.5 -53.2
Maximum 79.5 100.0 100.0 90.0 62.5 75.8
Range 131.8 157.1 156.3 150.0 125.0 129.1
15% + Loss Mean 19.147 20.150 12.964 8.881 7.740 15.449
N 438 436 418 438 435 438
Std. Deviation 16.179 20.869 20.176 15.319 15.248 13.212
Grouped Median 15.941 17.857 6.278 4.321 4.887E-02 13.710
Minimum -25.0 -50.0 -37.5 -35.0 -37.5 -29.8
Maximum 70.4 89.3 100.0 80.0 75.0 63.7
Range 95.4 139.3 137.5 115.0 112.5 93.6
All subjects Mean 10.730 12.854 7.157 4.783 4.865 9.030
N 4511 4493 4342 4507 4480 4510
Std. Deviation 15.185 18.142 19.562 13.355 15.021 12.003
Grouped Median 9.091 10.714 4.451E-02 1.789 3.644E-02 8.043
Minimum -59.3 -75.0 -100.0 -75.0 -75.0 -69.4
Maximum 79.5 100.0 100.0 90.0 87.5 75.8
Range 138.8 175.0 200.0 165.0 162.5 145.2

31
Six-Month Changes in IWQOL-Lite Scores for Weight Loss Participants (n = 4511)
Figures 1-6

32
33
34
35
36
37
IWQOL-Lite Scoring
Raw scores for each scale are computed for each of the five scales only if a minimum of
50% of the items for that scale are answered, and for the total score only if 75% of the
answers for all items are completed. (The required number of minimum responses is:
Physical Function=6 of 11; Self-Esteem =4 of 7; Sexual Life=2 of 4; Public Distress=3 of
5; Work=2 of 4; Total=24 of 31.) In computing raw scores, we use a pro-rated system for
handling missing data. To calculate the raw score for any scale or total score, the
procedures are as follows:

1- Determine if the minimum number of items are answered for that scale. The required
number of minimum responses is: Physical Function=6 of 11; Self-Esteem =4 of 7;
Sexual Life=2 of 4; Public Distress=3 of 5; Work=2 of 4; Total=24 of 31.

Example 1: If an individual answered 5 of 11 Physical Function questions, the Physical


Function score would be considered missing and coded as 999.

Example 2: If an individual answered 26 items on the entire scale, a valid score would be
calculated for the IWQOL-Lite total.

2- Take the average of the valid items for that scale. Compute the average for the valid
responses to items for that scale where 1=Never True and 5=Always True. The
average must be a number between 1 and 5. For example, if the respondent answered 3
on every item of the Physical Function scale, the mean would be 3.

Example 3: An individual answered the 11 Physical Function questions as follows (9


indicates missing question): 2, 3, 2, 4, 9, 2, 2, 3, 4, 9, 5. The individual answered 9 of 11
questions, with an average of 3.0 (27/9).

Example 4: An individual answered the 5 Public Distress questions as follows: 3, 1, 3, 4,


3. The individual answered 5 of 5 questions with an average of 2.8 (14/5).

3- Multiply that average by the total number of items for that scale. The total number of
items on IWQOL-Lite scales are as follows: Physical Function=11, Self-Esteem=7,
Sexual Life=4, Public Distress=5, Work=4, Total=31). Round to the nearest whole
integer. For example, if the mean of the Physical Function scale is 3.0, then you would
multiply 3.0 X 11 = 33.

Example 5: From the Physical Function answers in Example 3, multiply the average (3.0)
times the number of total questions in the Physical Function scale (11) and round to the
nearest whole integer: 3 X 11 = 33 (no need to round). This is the Physical Function Raw
Score.

Example 6: From the Public Distress answers in Example 4, multiply the average (2.8)
times the number of total questions in the Public Distress scale (5) and round to the

38
nearest whole integer: 2.8 X 5 = 14 (no need to round). This is the Public Distress Raw
Score.

Round to the nearest whole integer.

For example, here is the code for calculating total score:

***** Compute TOTAL Score.

count misstot = IWPF1 TO IWWRK4 (9,missing,sysmis).

do if (misstot lt 8).

compute IWTOT = rnd((sum(IWPF1 TO IWWRK4 )/(31-misstot))*31).

end if.

if (misstot ge 8) IWTOT = 999.

var lab IWTOT 'Impact Total Score (Brief)'.

mis val IWTOT (999).

Here is the code for calculating the individual scales of the IWQOL-Lite:

***** Compute PHYSICAL FUNCTION Score.

count misspf = IWPF1 TO IWPF11 (9,missing,sysmis).

do if (misspf lt 6).

compute IWPF = rnd((sum(IWPF1 TO IWPF11 )/(11-misstpf))*11).

end if.

if (misspf ge 6) IWPF = 999.

var lab IWPF 'Impact Physical Function (Brief)'.

mis val IWPF (999).

***** Compute SELF-ESTEEM Score.

39
count missse = IWSE1 TO IWSE7 (9,missing,sysmis).

do if (missse lt 4).

compute IWSE = rnd((sum(IWSE1 TO IWSE7 )/(7-misstse))*7).

end if.

if (missse ge 4) IWSE = 999.

var lab IWSE 'Impact Self-Esteem (Brief)'.

mis val IWSE (999).

***** Compute SEXUAL LIFE Score.

count misssl = IWSL1 TO IWSL4 (9,missing,sysmis).

do if (misssl lt 3).

compute IWSL = rnd((sum(IWSL1 TO IWSL4 )/(4-misstsl))*4).

end if.

if (misssl ge 3) IWSL = 999.

var lab IWPF 'Impact Sexual Life (Brief)'.

mis val IWSL (999).

***** Compute PUBLIC DISTRESS Score.

count misspd = IWPD1 TO IWPD5 (9,missing,sysmis).

do if (misspd lt 3).

compute IWPD = rnd((sum(IWPD1 TO IWPD5 )/(5-misstpd))*5).

end if.

if (misspd ge 3) IWPD = 999.

var lab IWPD 'Impact Public Distress (Brief)'.

mis val IWPD (999).

40
***** Compute WORK Score.

count misswk = IWWK1 TO IWWK4 (9,missing,sysmis).

do if (misswk lt 3).

compute IWWK = rnd((sum(IWPF1 TO IWPF4 )/(11-misstwk))*4).

end if.

if (misswk ge 3) IWWK = 999.

var lab IWWK 'Impact Work (Brief)'.

mis val IWWK (999).

We have been converting the IWQOL-Lite raw scores to the more familiar 0 (worst) to
100 (best) scoring using the following formulae:

1. Subtract the raw score (as calculated above) from the maximum score for each scale
(Physical Function=55, Self-Esteem=35, Sexual Life=20, Public Distress=25,
Work=20, Total=155).

2. Divide that difference by the range for each scale (Physical Function=44, Self-
Esteem=28, Sexual Life=16, Public Distress=20, Work=16, Total=124).

3. Multiply that total by 100.

Example 7: From the Physical Function answers in Example 5, subtract the raw score
(33) from the maximum score for Physical Function (55) and divide that result by the
range for Physical Function (44) and multiply the result by 100: (55 - 33)/44 = .50 X 100
= 50.

Example 8: From the Public Distress answers in Example 6, subtract the raw score (14)
from the maximum score for Public Distress (25) and divide that result by the range for
Public Distress (20) and multiply by 100: (25 - 14)/20 = .55 X 100 = 55.

An easy way to check the scoring is to enter a record with all 1's and a second record with
all 5's. The first record should have all transformed scores equal to 100 and the second
record should have all transformed scores equal to 0.

For example: Physical Function: ((55-33)/44)) = 50

compute iwpft = ((55-iwpf)/44)*100.

41
compute iwset = ((35-iwse)/28)*100.

compute iwsext = ((20-iwsex)/16)*100.

compute iwpdt = ((25-iwpd)/20)*100.

compute iwwrkt = ((20-iwwrk)/16)*100.

compute iwtott = ((155-iwtot)/124)*100.

42
How to Convert IWQOL Long form item responses to IWQOL-Lite Scoring
* THIS PROGRAM CONVERTS IWQOL FILES FROM OLD VERSION TO LITE VERSION AND
SCORES LITE VERSION.
RENAME VAR ( mob8,mob6,mob4,mob7,mob2,mob1,mob5,hlth4,hlth10,hlth8,hlth1,
se4,se2,se1,se8,si11,se7,si2,
sex6,sex2,sex4,sex5,
si5,adl7,adl3,adl2,si3,
wrk1,wrk3,wrk4,wrk5
= IWPF1 TO IWPF11
IWSE1 TO IWSE7
IWSEX1 TO IWSEX4
IWPD1 TO IWPD5
IWWRK1 TO IWWRK4).
SAVE OUTFILE='C:\DATA\Kolotkin\Norms\temp.sav'
/COMPRESSED/KEEP = ID SITE
IWPF1 IWPF2 IWPF3 IWPF4 IWPF5 IWPF6 IWPF7 IWPF8 IWPF9 IWPF10 IWPF11
IWSE1 IWSE2 IWSE3 IWSE4 IWSE5 IWSE6 IWSE7
IWSEX1 IWSEX2 IWSEX3 IWSEX4
IWPD1 IWPD2 IWPD3 IWPD4 IWPD5
IWWRK1 IWWRK2 IWWRK3 IWWRK4.
VAR LAB IWPF1 'Trouble picking up objects'/
IWPF2 'Trouble tying shoes'/
IWPF3 'Difficulty getting up from chairs'/
IWPF4 'Trouble using stairs'/
IWPF5 'Difficulty dressing'/
IWPF6 'Trouble with mobility'/
IWPF7 'Trouble crossing legs'/
IWPF8 'Feel short of breath'/
IWPF9 'Painful stiff joints'/
IWPF10 'Ankles & legs swollen'/
IWPF11 'Worried about health'/
IWSE1 'Self-conscious'/
IWSE2 'Self-esteem not what it could be'/
IWSE3 'Feel unsure of self'/
IWSE4 'Do not like myself'/
IWSE5 'Afraid of being rejected'/
IWSE6 'Avoid looking in mirrors'/
IWSE7 'Embarassed in public places'/
IWSEX1 'Do not enjoy sexual activity'/
IWSEX2 'Have little sexual desire'/
IWSEX3 'Difficulty with sexual performance'/
IWSEX4 'Avoid sexual encounters'/
IWPD1 'Experience ridicule & teasing'/
IWPD2 'Worry about fitting in public seats'/
IWPD3 'Worry about fitting through aisles'/
IWPD4 'Worry about finding chairs'/
IWPD5 'Experience discrimination'/
IWWRK1 'Trouble getting things accomplished'/
IWWRK2 'Less productive than I could be'/
IWWRK3 'Do not receive appropriate recognition'/
IWWRK4 'Afraid to go on job interviews'.
VAL LAB IWPF1 TO IWWRK4 5 'Always True' 4 'Usually True' 3 'Sometimes True' 2
'Rarely True' 1 'Never True'.
FORMAT IWPF1 TO IWWRK4 (F1.0).
MIS VAL IWPF1 TO IWWRK4 (9).

43
EXEC.
********************************************** NEW SCORING FOR BRIEF
IWQOL************************.
***** Compute PHYSICAL Score.
count missphys = IWPF1 TO IWPF11 (9,missing,sysmis).
do if (missphys lt 6).
compute IWPF = rnd((sum(IWPF1 TO IWPF11 )/(11-missphys))*11).
end if.
if (missphys ge 6) IWPF = 999.
var lab IWPF 'Physical Function Score (Brief)'.
mis val IWPF (999).
recode IWPF (sysmis=999).
freq missphys IWPF.
***** Compute SELF-ESTEEM Score.
count misssi = IWSE1 TO IWSE7 (9,missing,sysmis).
do if (misssi lt 4).
compute IWSE = rnd((sum(IWSE1 TO IWSE7 )/(7-misssi))*7).
end if.
if (misssi ge 4) IWSE = 999.
var lab IWSE 'Impact Self-Esteem (Brief)'.
mis val IWSE (999).
recode IWSE (sysmis=999).
freq misssi IWSE.
***** Compute SEXUAL LIFE Score.
count misssex = IWSEX1 TO IWSEX4 (9,missing,sysmis).
do if (misssex lt 3).
compute IWSEX = rnd((sum(IWSEX1 TO IWSEX4 )/(4-misssex))*4).
end if.
if (misssex ge 3) IWSEX = 999.
var lab IWSEX 'Impact Sexual Life Score (Brief)'.
mis val IWSEX (999).
recode IWSEX (sysmis=999).
freq misssex IWSEX.
***** Compute PUBLIC DISTRESS Score.
count misspub = IWPD1 TO IWPD5 (9,missing,sysmis).
do if (misspub lt 3).
compute IWPD = rnd((sum(IWPD1 TO IWPD5)/(5-misspub))*5).
end if.
if (misspub ge 3) IWPD = 999.
var lab IWPD 'Impact Public Distress Score (Brief)'.
mis val IWPD (999).
recode IWPD (sysmis=999).
freq misspub IWPD.
***** Compute WORK Score.
count misswrk = IWWRK1 TO IWWRK4 (9,missing,sysmis).
do if (misswrk lt 3).
compute IWWRK = rnd((sum(IWWRK1 TO IWWRK4 )/(4-misswrk))*4).
end if.
if (misswrk ge 3) IWWRK = 999.
var lab IWWRK 'Impact Work Score (Brief)'.
mis val IWWRK (999).
recode IWWRK (sysmis=999).
freq misswrk IWWRK.
***** Compute TOTAL Score.
count misstot = IWPF1 TO IWWRK4 (9,missing,sysmis).
do if (misstot lt 8).
compute IWTOT = rnd((sum(IWPF1 TO IWWRK4 )/(31-misstot))*31).

44
end if.
if (misstot ge 8) IWTOT = 999.
var lab IWTOT 'Impact Total Score (Brief)'.
mis val IWTOT (999).
recode IWTOT (sysmis=999).
freq misstot IWTOT.
FORMAT iwpf iwse iwsex iwpd iwwrk iwtot (F3.0).
**************** CONVERT SCORES TO T-SCORE FORMAT *******************.
compute iwpft = ((55-iwpf)/44)*100.
compute iwset = ((35-iwse)/28)*100.
compute iwsext = ((20-iwsex)/16)*100.
compute iwpdt = ((25-iwpd)/20)*100.
compute iwwrkt = ((20-iwwrk)/16)*100.
compute iwtott = ((155-iwtot)/124)*100.
exec.
var lab iwpft 'IWQOL Physical Function T-Score'/
iwset 'IWQOL Self-Esteem T-Score'/
iwsext 'IWQOL Sexual Life T-Score'/
iwpdt 'IWQOL Public Distress T-Score'/
iwwrkt 'IWQOL Work T-Score'/
iwtott 'IWQOL Total T-Score'.
format iwpft to iwtott (f5.1).
recode iwpft to iwtott (sysmis=999).
mis val iwpft to iwtott (999).

45
References
1 WHO. Constitution of the World Health Organization. July 22, 1946; WHO:
Geneva.
2 Ware JE. Standards for validating health measures: definition and content. J
Chron Dis 1987;40: 473-80.
3 Testa MA, Simonson DC. Assessment of quality of life outcomes. N. Engl. J.
Med. 1996;334:833-40.
4 Fontaine KR, Bartlett SJ. Estimating health-related quality of life in obese
individuals. Dis Manage Health Outcomes 1998;3:61-70.
5 World Health Organization. World Health Report-Life in the 21st century: A
vision for all, WHO: Geneva. 1998.
6 Fontaine KR, Barofsky I. Obesity and health-related quality of life. Obesity
Reviews 2001;2:173-82.
7 Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obesity Reviews
2001;2:219-29.
8 Kushner RF, Foster G. Obesity and quality of life. Nutrition 2000;16:947-52.
9 Sullivan M, Karlsson J, Sjostrom L, Taft C. Why quality of life measures should
be used in the treatment of patients with obesity. 2001. In: International Textbook of
Obesity. Bjorntorp P, ed.; John Wiley & Sons: New York: 485-510.
10 Brown WJ, Dobson AJ, Mishra G. What is a healthy weight for middle aged
women? Int. J. Obes. 1998;22:520-8.
11 Doll HA, Petersen SEK, Stewart-Brown SL. Obesity and physical and emotional
well-being: Associations between body mass index, chronic illness, and the physical and
mental components of the SF-36 questionnaire. Obes. Res. 2000;8:160-70.
12 Fine JT, Colditz GA, Coakley EH, et al. A prospective study of weight change
and health-related quality of life in women. JAMA 1999;282:2136-42.
13 Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief
measure to assess quality of life in obesity. Obes. Res. 2001;9:102-11.
14 Fontaine KR, Cheskin LJ, Barofsky I. Health-related quality of life in obese
persons seeking treatment. J. Fam. Pract. 1996;43:265-70.
15 LePen C, Levy E, Loos F, Banzet M, Basdevant A. 'Specific' scale compared with
'generic' scale: a double measurement of the quality of life in a French community sample
of obese subjects. J Epidemiol Commun Hlth 1998;52:445-50.
16 Rippe JM, Price JM, Hess SA, et al. Improved psychological well being, quality
of life, and health practices in moderately overweight women participating in a 12-week
structured weight loss program. Obes. Res. 1998;6:208-18.
17 Kolotkin RL, Crosby RD, Williams GR, Hartley GG, Nicol S. The relationship
between health-related quality of life and weight loss. Obes. Res. 2001;9:564-71.
18 Samsa GP, Kolotkin RL, Williams GR, Nguyen MR, Mendel C. Effect of
moderate weight loss on health-related quality of life: an analysis of combined data from
4 randomized trials of sibutramine vs. placebo. Am J Managed Care 2001;7:875-83.
19 Wadden TA, Phelan S. Assessment of quality of life in obese individuals. Obes.
Res. 2002;10 Suppl 1:50S-7S.
20 Kolotkin RL, Head S, Hamilton MA, Tse CTJ. Assessing impact of weight on
quality of life. Obes. Res. 1995;3:49-56.

46
21 Crosby RD, Kolotkin RL, Williams GR. An integrated method to determine
meaningful changes in health-related quality of life. J. Clin. Epidemiol. 2004;57:1153-60.
22 Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in
health-related quality of life. J. Clin. Epidemiol. 2003;56:395-407.

47
Publications for IWQOL-Lite (and its predecessor IWQOL)

Bibliographic references of the original questionnaire

Kolotkin RL, Head S, Hamilton MA, Tse CTJ. Assessing impact of weight on quality of
life. Obesity Research. 1995;3:49-56.

Kolotkin RL, Head S, Brookhart A. Construct validity of the Impact of Weight on


Quality of Life questionnaire. Obesity Research. 1997;5:434-441.

Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief measure
to assess quality of life in obesity. Obesity Research. 2001;9:102-111.

Kolotkin RL, Crosby RD. Psychometric evaluation of the Impact Of Weight On Quality
Of Life-Lite Questionnaire (IWQOL-Lite) in a community sample. Quality of Life
Research. 2002;11:157-171.

Other IWQOL and IWQOL-Lite publications

Di Francesco V, Sacco T, Zamboni M, et al. Weight Loss and Quality of Life


Improvement in Obese Subjects Treated with Sibutramine: A Double-Blind Randomized
Multicenter Study. Annals of Nutrition and Metabolism. 2007; 51:75-81.

Stucki A, Borchers M, Stucki G, Cieza A, Amann E, Ruof J. Content comparison of


health status measures for obesity based on the international classification of functioning,
disability and health. International Journal of Obesity (London) 2006; 30: 1791-1799.

Duval K, Marceau P, Perusse L, Lacasse Y. An overview of obesity-specific quality of


life questionnaires. Obesity Reviews 2006; 7: 347-360.

Tuthill A, Slawik H, O'Rahilly S, Finer N. Psychiatric co-morbidities in patients


attending specialist obesity services in the UK. QJM - Monthly Journal of the Association
of Physicians 2006; 99: 317-325.

Kolotkin R, Crosby R, Corey-Lisle P, Li H, Swanson J. Performance of a weight-related


measure of quality of life in a psychiatric sample. Quality of Life Research 2006; 15:
587-596.

Kolotkin R L, Binks M, Crosby R D, Ostbye T, Gress R E, Adams T D. Obesity and


sexual quality of life. Obesity (Silver Spring) 2006; 14: 472-479.

Rieger E, Wilfley DE, Stein RI, Marino V, Crow SJ. A comparison of quality of life in
obese individuals with and without binge eating disorder. International Journal of Eating
Disorders. 2005;37:234-240.

48
Engel, S.G., Kolotkin, R.L, Teixeira P,J., Sardinha L.B., Vieira P.N., Palmeira A.L.,
Crosby R.D. Psychometric and Cross-National Evaluation of a Portuguese Version of the
Impact of Weight on Quality of Life-Lite (IWQOL-Lite) Questionnaire. European Eating
Disorders Review. 2005;13:133-143.

Adami G.F., Ramberti G., Weiss A., Carlini F., Murelli F., Scopinaro N. Quality of life in
obese subjects following biliopancreatic diversion. Behavioral Medicine. 2005;31:53-60.

Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM, Sardinha
LB, Lohman TG: Pretreatment predictors of attrition and successful weight management
in women. International Journal of Obesity. 2004;28:1124-33.

Teixeira PJ, Palmeira AL, Branco TL, Martins SS, Minderico CS, Barata JT, Silva AM,
Sardinha LB: Who will lose weight? A reexamination of predictors of weight loss in
women. International Journal of Behavioral Nutrition and Physical Activity. 2004;1:12.

Kolotkin, R.L., Westman, E.C., stbye, T., Crosby, R.D., Binks, M., Eisenson, H.E.
Weight-related Quality of Life in Obese Persons With and Without Binge Eating
Disorder. Obesity Research. 2004;12:999-1005.

White, M.A., O'Neil, P. M, Kolotkin, R.L, Byrne, T.K. Gender, Race, and Obesity-
Related Quality of Life at Extreme Levels of Obesity. Obesity Research. 2004;12:949-
955.

Crosby RD, Kolotkin RL, Williams GR. An integrated method to determine meaningful
changes in health-related quality of life. Journal of Clinical Epidemiology. 2004;57:1153-
60.

Boan J, Kolotkin RL, Westman EC, McMahon RL, Grant JP. Binge Eating, Quality of
Life and Physical Activity Improve After Roux-en-Y Gastric Bypass (RYGB) for Morbid
Obesity. Obesity Surgery. 2004;14:341-348.

Brazier JE, Kolotkin RL, Crosby RD, Williams GR. Estimating a Preference-Based
Single Index for the Impact of Weight on Quality of Life-Lite Instrument (IWQOL-Lite)
from the SF-6D. Value in Health. 2004;7:490-498.

Korolija, D.; Sauerland, S.; Wood-Dauphinee, S.; Abbou, C. C.; Eypasch, E.; Caballero,
M. G.; Lumsden, M. A.; Millat, B.; Monson, J. R.; Nilsson, G.; Pointner, R.; Schwenk,
W.; Shamiyeh, A.; Szold, A.; Targarona, E.; Ure, B.; Neugebauer, E. Evaluation of
quality of life after laparoscopic surgery: evidence-based guidelines of the European
Association for Endoscopic Surgery. Surgical Endoscopy 2004; 18: 879-897.

Engel SG, Crosby RD, Kolotkin RL, Hartley GG, Williams GR, Wonderlich SA,
Mitchell JE. The Impact of Weight Loss and Regain on Obesity-Specific Quality of Life:
Mirror Image or Differential Effect. Obesity Research. 2003;11:1207-1213.

49
Gadde KM, Franciscy DM, Wagner HR, Krishnan RR. Zonisamide for weight loss in
obese adults. Journal of the American Medical Association. 2003;289:1820-1825.

Ballantyne GH. Measuring outcomes following bariatric surgery: weight loss parameters,
improvement in co-morbid conditions, change in quality of life and patient satisfaction.
Obesity Surgery. 2003;13:954-64.

de Zwaan M, Mitchell JE, Howell LM, Monson N, Swan-Kremeier L, Crosby RD, Seim
HC. Characteristics of morbidly obese patients before gastric bypass surgery.
Comprehensive Psychiatry. 2003;44:428-34.

Kolotkin RL, Crosby RD, Williams GR. Assessing weight-related quality of life in obese
persons with type 2 diabetes. Diabetes Research and Clinical Practice. 2003;61:125-32.

Kolotkin RL, Crosby RD, Pendleton R et al. Health-related quality of life in patients
seeking gastric bypass surgery vs. non-treatment-seeking controls. Obesity Surgery.
2003;13:371-7.

Heshka, S., Anderson, J. W., Atkinson, R. L., Greenway, F. L., Hill, J.O., Phinney, S.D.,
Kolotkin, R. L., Miller-Kovach, K., and Pi-Sunyer, F.X. Weight loss with self-help
compared with a structured commercial program. Journal of the American Medical
Association. 2003;289:1792-1798.

de Zwaan M, Mitchell JE, Howell LM, Monson N, Swan-Kremeier L, Roerig JL,


Kolotkin RL, Crosby RD. Two measures of health-related quality of life in morbid
obesity. Obesity Research. 2002;10:1143-51.

Dymek MP, Le Grange D, Neven K, Alverdy J. Quality of life after gastric bypass
surgery: a cross-sectional study. Obesity Research. 2002;10:1135-42.

Scholz GH, Flehmig G, Kahl Y, Gutknecht D, Schmidt U, Tolkmitt S, Kohler-Braunig K,


Gabriel C, Dommel S, Krist H, Scholz M. [Proper Weight Loss with Intelligence
(MIRA). 2 programs for weight reduction in general practice trial]. MMW Fortschr Med.
2002;144:28-32. In German.

Kolotkin RL, Crosby RD, Williams GR. Health-related quality of life varies among obese
subgroups. Obesity Research. 2002;10:748-756.

Fontaine KR. Health-related quality of life among obese subgroups: Editorial. Obesity
Research. 2002;10:854-855.

Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Martin CJ, Metcalfe LL, Finkenthal
NR, Blew RM, Sardinha LB, Lohman TG: Weight loss readiness in middle-aged women:
psychosocial predictors of success for behavioral weight reduction. Journal of Behavioral
Medicine. 2002;25: 499-523.

50
Wadden TA, Phelan S. Assessment of quality of life in obese individuals. Obesity
Research. 2002;10 Suppl 1:50S-7S.

Kolotkin RL, Crosby RD, Williams GR et al. The relationship between health-related
quality of life and weight loss. Obesity Research. 2001;9:564-571.

Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obesity Reviews.
2001;2:219-229.

Samsa GP, Kolotkin RL, Williams GR et al. Effect of moderate weight loss on health-
related quality of life: an analysis of combined data from 4 randomized trials of
sibutramine vs. placebo. American Journal of Managed Care. 2001;7:875-883.

Fujioka K, Seaton TB, Rowe E, et.al. Weight loss with sibutramine improves glycemic
control and other metabolic parameters in obese patients with type 2 diabetes mellitus.
Diabetes Obesity and Metabolism. 2000;2:175-184.

51
Acknowlegements:
We acknowledge the generous sharing of data from the following organizations:

Abbott Laboratories, Abbott Park, IL


Abbott Laboratories Canada, Saint Laurent, Quebec, Canada
Bristol-Myers Squibb, Wallingford, CT
Cornell Medical Center, New York, NY
Duke University Diet and Fitness Center, Durham, NC
Geisinger Medical Center, Danville, PA
Glaxo Smith Kline, Research Triangle Park, NC
Hahnemann University, Philadelphia, PA
Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland
Hennepin County Medical Center, Minneapolis, MN
Kaisankoti Rehabilitation Center, Finland
Kaiser Permanente, Denver, CO
Knoll Pharmaceutical Company, Mount Olive, NJ
Lackland Air Force Base, San Antonio, TX
Neuropsychiatric Research Institute, Fargo, ND
Pennington Biomedical Research Center, Baton Rouge, LA
Residents of Durham, NC
Roche Products, Hertfordshire, UK
Sanofi-Aventis, Paris, France
University of Chicago, Chicago, IL
University of Colorado Health Sciences Center, Denver, CO
University of Nevada, Las Vegas, NV
University of Pittsburgh Medical Center, Pittsburgh, PA
University of Tennessee College of Medicine, Memphis, TN
University of Utah School of Medicine, Salt Lake City, UT
Weight Watchers International, Woodbury, NY

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