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The SQOT Initiative determined a core set of patient-reported outcome measures for clinicians to measure quality of life while treating patients with obesity.
In the last several decades, there has been a growing interest in measuring QOL—encompassing aspects such as body image, self-esteem, and social, mental, and physical health—in patients with obesity as they undergo weight loss treatment. Consequently, patient-reported outcome measures (PROMs) have emerged as valuable tools for assessing QOL impacts from the patient’s perspective.
“Despite the growing interest in using PROMs in clinical obesity care, several major concerns exist. These include measuring patient-reported outcomes [PROs] that might not be relevant for people living with obesity, the wide variation in PROMs currently available in obesity treatment, and the use of PROMs with insufficient validation evidence,” wrote the lead author Philip J. Dijkhorst, MD, and colleagues in a paper in Obesity Surgery. “To address these matters and effectively implement PROMs in clinical practice, it is essential to develop a core set of PROs and PROMs with high-quality validation evidence.”
To overcome these challenges, the Standardizing Quality of Life in Obesity Treatment (SQOT) Initiative developed a core set of PROs and PROMs through multidisciplinary international consensus meetings. This core set was designed to ensure high-quality validation and relevance in clinical practice.
The SQOT III meeting took place in May 2022 in the Netherlands and involved 27 attendees representing 12 countries and five continents. The participants included clinicians such as surgeons, endocrinologists, dietitians, and psychologists; researchers experienced in obesity treatment; and people living with obesity.
Through structured group discussions, Delphi exercises, and anonymous voting, the meeting achieved consensus on which PROs and PROMs should be included in the core set.
Identifying Important Outcomes
Nearly all participants voted in favor of including self-esteem as a core PRO. The group selected the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) as the most appropriate PROM for measuring self-esteem.
Most participants also voted to include assessments of physical function, physical symptoms, psychological function, social function, eating behavior, and body image. The attendees determined that BODY-Q subscales were suitable for measuring these outcomes.
More than three-quarters of the group identified excess skin as an important factor, selecting the Quality of Life for Obesity Surgery (QOLOS) as the most appropriate measurement.
Of note, most attendees believed stigma was an important outcome but could not identify a suitable corresponding PROM, highlighting an area for future development.
“Reasons included the absence of questions on general experiences of stigma, the inability to use the questionnaires longitudinally, and the absence of validation evidence in people undergoing obesity treatment,” Dr. Dijkhorst and colleagues reported.
Using PROMs in Clinical Practice
The authors cited several challenges to using PROMs in clinical settings and provided tools to ease clinical implementation.
Patients explained that the lack of feedback on their PROM scores often discouraged them from completing the questionnaires. To address this challenge, the authors recommended using digital platforms to automatically dispatch PROMs before appointments and display results on dashboards for the patient and clinician to view.
“PROMs should only be implemented in clinical practice if the scores are shared with the patients,” Dr. Dijkhorst and colleagues said.
In addition, clinicians require appropriate training in administering and interpreting PROMs. Understanding the minimal clinically important change (MCID) associated with each PROM could help clinicians interpret scores; however, MCIDs for the BODY-Q and QOLOS are still being determined.
The group created a user manual for clinicians to follow to facilitate the implementation of the core set in clinical practice (Table).
“The PROMs that were selected represent outcomes that matter most to patients and should be a minimum when measuring quality of life in clinical practice,” Dr. Dijkhorst and colleagues wrote. “During future meetings, we shall continue to improve the current core set of PROMs, including the development of a PROM for stigma, further validation, and additional translations of the QOLOS (excess skin) questionnaire.”
The consensus group also developed a core set of PROMs suitable for research purposes, which they published separately.
