Obeziteli Bireylerde Yaşam Kalitesinin Özerklik İlkesi Açısından Değerlendirilmesi: Türkiye’den Bir Örnek

Yıl 2025, Cilt: 15 Sayı: 1, 252 - 263, 31.01.2025

Şenol Yıldız , Nurdan Kırımlıoğlu

https://doi.org/10.31020/mutftd.1549835

Öz

Giriş: Bu çalışmada obezitenin özerklik (Ö), ÖSİ (Özerkliğe Saygı İlkesi) ve YK (Yaşam Kalitesi) üzerindeki etkisi, başka bir ifade ile obez hastalar ile obez olmayan bireylerin özerklik, ÖSİ ve YK bakımından farklılaşıp farklılaşmadığının araştırılması amaçlanmıştır.
Gereç ve Yöntem: Veriler Türkiye’nin bir ili olan Eskişehir’de kamu kurum ve kuruluşlarındaki Beslenme ve Diyet polikliniklerinden toplanmıştır. Çalışmaya 354’ü vaka, 354’ü kontrol grubundan olmak üzere 708 gönüllü katılmıştır. Katılımcılara sosyodemografik özelliklerin, özerklik ve ÖSİ’ne ilişkin soruların yer aldığı anket formu ve Obezlere Özgü Yaşam Kalitesi Ölçeği (OÖYKÖ) uygulanmıştır. Verilerin değerlendirilmesinde tanımlayıcı analizler yapılmış, Kruskal Wallis H, Mann Whitney U, ki-kare bağımsızlık testi kullanılmıştır.
Bulgular: Obezite ile OÖYKÖ skoru arasında istatistiksel olarak kontrol grubu lehine anlamlı farklılık bulunmuştur (p<0.001). OÖYKÖ skoru açısından görüş ve düşüncelerini rahatlıkla açıklayabildiğini ve açıklayamadığını ifade eden obez hastalar arasında açıklayabilenler lehine istatistiksel olarak anlamlı farklılık bulunmuştur (p<0.001).
Sonuç: Obez olmayan bireylerin daha iyi yaşam kalitesine sahip olduğu; obezitenin, hastaların özerk olmalarını, kendilerini özgür ve bağımsız hissetmelerini etkilemediği; özerk seçim yapmalarını, eylem özerkliklerini ve düşünce özerkliklerini olumsuz etkilediği; birey özerkliklerini, istek özerkliklerini ve ÖSİ’ni benimsemelerini olumlu etkilediği sonucuna varılmıştır.

Anahtar Kelimeler

Özerklik, Obezlere özgü yaşam kalitesi, Obezite, Özerkliğe saygı, Türkiye.

Evaluation of Quality of Life in Obese Individuals in Terms of the Principle of Autonomy: An Example from Türkiye

Öz

Aim: In this study, it was aimed to investigate the effect of obesity on autonomy, principle of respect for autonomy (PRA) and quality of life (QOL), in other words, whether obese patients and non-obese individuals differ in terms of autonomy, PRA and QOL.
Materyal Methods: The data were collected from Nutrition and Diet polyclinics in public institutions and organizations in Eskisehir /Türkiye. 708 volunteers participated in the study, of which 354 were from the case group and 354 from the control group. A survey including questions about sociodemographic characteristics, autonomy and PRA, as well as Obesity and Weight Loss Quality of Life Scale (OWLQOL) were administered to the participants. In the evaluation of the data, descriptive analyzes were made, Kruskal Wallis H, Mann Whitney U, chi-square independence tests were used.
Results: A statistically significant difference was found between obesity and OWLQOL score in favor of the control group (p<0.001). In terms of OWLQOL score, a statistically significant difference was found between the obese patients who stated that they could easily explain their opinions and thoughts or could not, in favor of those who could (p<0.001).
Conclusion: It was found that; non-obese individuals have better quality of life; obesity does not affect patients' autonomy, feeling free and independent; negatively affects their autonomous choice, autonomy of action and autonomy of thought; positively affects their individual autonomy, autonomy of desire and adoption of PRA.

Anahtar Kelimeler

Autonomy, Obese-specific quality of life, Obesity, Respect for autonomy, Türkiye

Kaynakça

• 1. Yildiz S, Kirimlioglu N. Surgical solution for medical outcomes caused by a social problem: “Bariatric Surgery” and ethical issues. In: Evereklioglu C, editor. Theory and Research in Health Sciences. Ankara: Gece Library; 2020;365-84. ISBN: 978-625-7243-74-2.
• 2. Holm JC, et al. The ethics of childhood obesity treatment—from the childhood obesity task force (cotf) of the European Association for the Study of Obesity (easo). Obes Facts 2014;7(4):274–81. https://doi.org/10.1159/000365773.
• 3. Haynes E, Hughes R, Reidlinger DP. Obesity prevention advocacy in Australia: an analysis of policy impact on autonomy. Aust N Z J Public Health 2017;41(3):299-305. https://doi.org/10.1111/1753-6405.12660.
• 4. Enzo A, Okita T, Asai A. What deserves our respect? Reexamination of respect for autonomy in the context of the management of chronic conditions. Med Health Care Philos 2019;22(1):85–94. https://doi.org/10.1007/s11019-018-9844-z.
• 5. Lutz AG. Patients’ autonomy as a negotiated order: an ethnographic perspective on the clinical management of childhood obesity. Sociol Health Illn 2019;41(4):772-88. https://doi.org/10.1111/1467-9566.12863.
• 6. House C. The power of autonomy in recovery. [2019 June 06]. Available from: http://cielohouse.com/power-autonomy-recovery
• 7. Salvador-Carulla L, et al. Use of the terms "Wellbeing" and "Quality of Life" in health sciences: A conceptual framework. Eur J Psychiat 2014;28(1):50-65. https://dx.doi.org/10.4321/S0213-61632014000100005.
• 8. Boylu AA, Paçacıoğlu B. Quality of life and indicators. Journal of Academic Research and Studies 2016;8(15):137-50.
• 9. Giuli C, et al. Correlates of perceived health-related quality of life in obese, overweight and normal-weight older adults: an observational study. BMC Public Health 2014;14:35.
• 10. Schermer M. The different faces of autonomy. Patient autonomy in ethical theory and hospital practice. New York:Springer- Science+Business Media B.V. 2002. ISBN: 978-1-4020-0984-6, ISBN: 978-90-481-6161-4, ISBN: 978-94-015-9972-6.
• 11. Patrick DL, Bushnell DM, Rothman M. Performance of two self-report measures for evaluating obesity and weight loss. Obes Res 2004;12(1):48-57. https://doi.org/10.1038/oby.2004.8.
• 12. Çıray Gündüzoğlu N, Fadıloğlu Ç, Yılmaz C. The examination of validity and reliability for obese individuals Specific Quality of Life Scale. Anatolian Journal of Psychiatry 2014;15(1):63-8. https://doi.org/10.5455/apd.39822.
• 13. Gandjour A. Resource allocation in health care and the role of personal autonomy. Gesundheitswesen 2015;77(3):e44-50. https://doi.org/10.1055/s-0034-1384542. 14. Devisch I. Progress in medicine: autonomy, ‘oughtonomy’ and nudging. J Eval Clin Pract 2011; 17(5):857-61. https://doi.org/10.1111/j.1365-2753.2011.01716.x.
• 15. Devisch I. Are there really two cultures in the health debate? Toward a new understanding of autonomy. APORIA 2018;3(1): 42-44. https://doi.org/10.18192/aporia.v3i1.3405. 16. Roberts JL, Fowler LR. How assuming autonomy may undermine wellness programs. Health Matrix: The Journal of Law-Medicine 2017;27(1):101-24.
• 17. Lee AA, et al. Diabetes self-management and glycemic control: the role of autonomy support from informal health supporters. Health Psychol 2019;38(2):122-32. https://doi.org/10.1037/hea0000710.
• 18. Pollak KI, et al. Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med 2011;24(6):665-72. https://doi.org/10.3122/jabfm.2011.06.110025.
• 19. Reach G. Patient autonomy in chronic care: solving a paradox. Patient Prefer Adherence 2013;12(8):15-24. https://doi.org/10.2147/PPA.S55022.
• 20. Cheng S-Y, et al. Cancer patient autonomy and quality of dying—a prospective nationwide survey in Taiwan. Psychooncology 2016;25(2):179–86. https://doi.org/10.1002/pon.3901.
• 21. Naik AD, et al. Patient autonomy for the management of chronic conditions: a two-component re-conceptualization. Am J Bioet 2009;9(2):23-30. https://doi.org/10.1080/15265160802654111.
• 22. Bieskova M. Autonomy in the AAL—between law and ethics (thesis). MDP in Law and Information Society, Faculty of Law, University of Turku. 2018.
• 23. Boldt J. The interdependence of care and autonomy. In: F. Krause, J. Boldt, editors. Care in healthcare reflections on theory and practice. Palgrave: Macmillan; 2018:65-86. ISBN: 978-3-319-61290-4, ISBN: 978-3-319-61291-1.
• 24. da Fonseca P, et al. The role of states in controlling the obesity epidemic and a personal autonomy to decide. Open Journal of Endocrine and Metabolic Diseases 2017;7:35-43. http://dx.doi.org/10.4236/ojemd.2017.71004. 25. Devisch I, et al. Patient’s Perception of Autonomy Support and Shared Decision Making in Physical Therapy. Open Journal of Preventive Medicine 2015;5:387-99. http://dx.doi.org/10.4236/ojpm.2015.59043.
• 26. Silva MN, et al. A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description. BMC Public Health 2008;8:234. https://doi.org/10.1186/1471-2458-8-234.
• 27. Rodríguez-Prat A, Escribano X. A philosophical view on the experience of dignity and autonomy through the phenomenology of illness. J Med Philos 2019;44(3):279–98. https://doi.org/10.1093/jmp/jhz001.
• 28. Devisch I. Oughtonomy in Healthcare. A deconstructive reading of Kantian autonomy. Med Health Care and Philos 2010;13(4): 303–12. https://doi.org/10.1007/s11019-010-9258-z.
• 29. Çıray Gündüzoğlu N. The examination of validity and reliability for a quality of life scale special for obese persons (thesis). Ege University Health Sciences Institute, Istanbul, 2008.
• 30. Merry MS. Paternalism, obesity, and tolerable levels of risk. Democracy and Education 2012; 20:1, Article 3.
• 31. Devisch I. Nudging and obesity: How to get rid of paternalism? J Nurs Educ Pract 2012;2(2):89-97. https://doi.org/10.5430/jnep.v2n2p89.
• 32. Stoljar N. Informed consent and relational conceptions of autonomy. J Med Philos 2011;36(4):375–84. https://doi.org/10.1093/jmp/jhr029.
• 33. Baranzke H. Autonomy and human dignity in current Western ethics: ethical transformations, cultural diversities, and biomedical challenges. The BETIM Journal of Medical Humanities 2020;1(1).
• 34. Azevedo SM, Vartanian LR. Ethical issues for public health approaches to obesity. Cur Obes Rep 2015;4(3):324-9. https://doi.org/10.1007/s13679-015-0166-7.