2023 HSR&D/QUERI National Conference

4098 — Development of the brief, Weight and Eating Quality-of-Life (WE-QOL) Scale for standardized use across VHA weight- and eating-related health services

Lead/Presenter: Robin Masheb,  COIN - West Haven
All Authors: Masheb RM ((VA Connecticut Healthcare System; Yale School of Medicine)), Snow JL(VA Connecticut Healthcare System) Antoniadis NE (VA Connecticut Healthcare System; Yale School of Medicine) Fenn LM (VA Connecticut Healthcare System) Raffa SD (VA National Center for Health Promotion and Disease Prevention) Ruser CB (VA Connecticut Healthcare System; Yale School of Medicine)

The Veterans Health Administration (VHA) is the largest healthcare system in the United States and faces the challenge of addressing obesity and eating disorders that each disproportionately affect Veterans and are highly comorbid. While a useful screening tool, the widely-used BMI metric is an inaccurate measure for complex weight-related disorders such as diabetes, and is a poor indicator for eating disorder health status. The aim of the present study is to develop and validate a brief measure of weight and eating quality-of-life (QOL) in an effort to standardized screening, referral and evaluation across the range of VHA weight- and eating-related health services.

An 8-item measure, called the Weight and Eating Quality-of-Life (WE-QOL) Scale, was developed using common and overlapping dimensions from existing measures that separately assess weight-related and eating disorder QOL. 213 US Veterans attending an orientation session for VHA’s weight management program, MOVE!, completed this measure, as well as a widely-used, generic health-related QOL measure (the EuroQoL) and other validated measures of eating behaviors.

The WE-QOL demonstrated greater internal covariance, higher reliability and higher associations to relevant constructs (BMI and eating pathology) than the EuroQoL. The WE-QOL demonstrated impacts on Physical Activity and Physical Discomfort (each at the severe level for more than ¼ of the sample); Daily Responsibilities, Emotional Distress, and Shame and Guilt (each at the moderate or severe level for more than 1/3 of the sample), and; Public Distress (moderate or severe level for approximately ¼ of the sample). Female Veterans reported more severe and significant impacts on eating and weight quality of life compared to male Veterans as did Veterans with binge eating compared to those without (p’s < .01).

The current study supports the psychometrics of the WE-QOL and provides evidence that a brief weight- and eating-specific measure of QOL can provide a nuanced quality-of-life assessment that discriminates important subgroups of patients, such as female Veterans and Veterans with eating disorders, that typically have unique clinical needs. Future research should determine screening cutoffs for this measure, and assess the extent to which the WE-QOL is sensitive to treatment change.

The WE-QOL has potential to provide a standardize metric that could be used as a screening tool and clinical reminder to identify and refer patients who are struggling with their weight and/or eating within VHA. Additionally, the measure could be used to evaluate treatment improvements for the full range of weight- and eating-related health services provided by VHA such as its weight management programs (MOVE!, weight loss medications and bariatric surgery), nutrition services, Whole Health initiative, and mental health/eating disorder care.