Associação entre obesidade grave e qualidade de vida em indivíduos adultos

Abstract

Introduction: Severe obesity is a complex chronic condition associated with adverse physical and mental health outcomes, reduced life expectancy, and increased premature mortality. Its impacts affect multiple dimensions of quality of life (QoL). Despite the rising prevalence of obesity in Brazil and worldwide, there is still a lack of investigations assessing the QoL of people with severe obesity outside the context of bariatric surgery, especially based on representative population samples. Objective: To analyze the association between severe obesity and QoL in adults, considering its different domains, through two complementary studies: (1) a systematic literature review and (2) a cross-sectional study using data from the 2019 Brazilian National Health Survey (PNS). Methods: The first study was a systematic review conducted according to PRISMA guidelines, with searches in PubMed, Scopus, Web of Science, Embase, and SciELO, with no language, country or year restrictions. Studies investigating the association between severe obesity and QoL in adults not undergoing bariatric surgery were included. The results were synthesized narratively and complemented by a random-effects meta-analysis. The second study was a cross-sectional analysis using data from 17,908 adults (≥18 years) with obesity from the 2019 PNS, of whom 1,071 had severe obesity. Multidimensional QoL indicators were developed based on available survey variables, organized into two main components: physical health (functional capacity, comorbidities, and self-rated health) and psychological health (vitality, emotional aspects, social support, and perceived discrimination). Associations were estimated using ordinal regression models adjusted for sociodemographic and behavioral covariates. Results: The systematic review included 22 studies, of which 19 were cross-sectional and 3 were cohort studies. The most commonly used QoL assessment tool was the SF-36. The findings confirmed a proportional reduction in QoL as BMI increased. Among individuals with severe obesity, the most affected domains were functional capacity, role limitations due to physical health, bodily pain, and general health perception. In the psychological component, vitality was the most affected domain. The study using PNS data confirmed these findings among the Brazilian adult population. Individuals with severe obesity showed poorer physical QoL scores associated with comorbidities, severe functional limitations, and negative self-rated health. In the psychological dimension, emotional symptoms, low vitality, and perceived discrimination were strongly associated with worse QoL indicators. Conclusion: The findings demonstrate that severe obesity compromises multiple dimensions of QoL, with more pronounced impacts among adults. These results reinforce the need for expanded care strategies that go beyond weight control, incorporating mental health care, stigma reduction, daily functionality, pain management, and prevention and control of comorbidities. Including QoL indicators in national surveys and conducting longitudinal studies are essential to guide more effective, integrated, and humanized public policies.