Ariane de Gennaro, Illustrations Editor

Yale School of Medicine Researchers have developed a new weight loss metric geared towards veterans in collaboration with the Department of Veterans Affairs.

 Developed as an alternative to the Body Mass Index, the metric has been termed the “Weight and Eating Quality of Life Scale.” The WE-QOL scale aims to assess the interface of weight and health in a nuanced way. It incorporates multiple factors in assessment, including self-care and daily activities, emotional and social distress, physical conditions and appearance-related concerns.

“I don’t want to understate, you know how much of an advance this is,” said Christopher Ruser, associate professor of general medicine at the YSM and chief of primary care at West Haven VA’s Multidisciplinary Weight Management Program. “Even if this doesn’t end up being the final scale, it’s a way to ask that question, how our patients experience the healthcare setting when it comes to weight.”

Currently, many medical professionals rely on Body Mass Index measurements to determine weight-related impacts on daily life. The BMI metric, however, is a limited representation of how weight influences quality of life, researchers said. 

“BMI doesn’t necessarily track directly with obesity-related illnesses,” said Robin Masheb, professor of psychiatry and director of the Veterans Initiative for Eating and Weight. “And what we’ve been finding is that weighing patients in the healthcare setting leads to weight stigma, which instead of motivating people to lose weight has done the opposite of that.”

The WE-QOL scale seeks to address some of these shortcomings. While BMI focuses solely on the physical aspect of health, WE-QOL is a more comprehensive measure that considers the broader impact of weight on a person’s well-being.

“We sought to develop a health metric for veterans more nuanced than the BMI that can capture the effect of weight and eating on veterans’ quality of life,”  said Eugenia Buta, a research scientist in biostatistics who contributed to the initiative.

Understanding how weight impacts specific areas of a patient’s life helps care providers develop more effective treatments and interventions for weight-related problems, while also helping individuals make positive lifestyle changes. This can lead to the development of more evidence-based approaches to targeting specific weight-related issues and improving individual wellbeing overall.

The metric consists of eight items that assess how weight impacts various aspects of daily life. The domains include physical activity, self-care, daily responsibilities, public distress, physical discomfort, emotional distress and shame or guilt. The items in these domains are classified on a five-point scale, where patients rate how much they believe their weight impacts a certain domain on a scale of zero, meaning that weight has no impact, to four, indicating that weight’s impact on that domain could not be worse.

Developing and testing the WE-QOL scale involved a mixed-methods approach. First, researchers conducted a literature review and identified existing measures of weight-related quality of life. Then, the researchers sought to assess the WE-QOL’s psychometric properties. To this end, researchers used results from the WE-QOL and compared it to relevant results from BMI, binge eating, eating pathology and physical activity questionnaires. The results between the WE-QOL scale and the individual questionnaires showed strong similarities, indicating that the WE-QOL scale properly assessed these factors. 

Afterwards, the study was administered to a convenience sample of 213 veterans attempting to lose weight. However, Ruser emphasized that the scale still needs to be tested on a broader scale, which is a goal that Masheb’s future research seeks to address.

Ruser called on other physicians to prepare for how the metric may change patient care. 

“Be ready for the conversation that it’s going to open up,” Ruser said. “Lead, educate yourself and be ready to deal with what comes out of that conversation in a very positive way.”

The Veterans Health Administration is the largest healthcare system in the USA.