Health-related quality of life in overweight German children and adolescents: do treatment-seeking youth have lower quality of life levels? Comparison of a clinical sample with the general population using a multilevel model approach

BMC Public Health

Petra Kolip¹  Katrin Winkel²  Anke Schaefer²  Thomas Reinehr²  Emily Finne¹ 

[1] School of Public Health, Bielefeld University, Universitätsstraße 25, Bielefeld, D-33615, Germany;Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Youth Hospital, University of Witten/Herdecke, Dr.-F.-Steiner-Str. 5, Datteln, D-45711, Germany

关键词: Treatment-seeking status;    Children and adolescents;    Body image;    Weight perception;    Obesity;    Overweight;    Health-related quality of life;   

Others  :  1162121
DOI  :  10.1186/1471-2458-13-561

 received in 2012-11-08, accepted in 2013-06-04,  发布年份 2013

【 摘 要 】

Background

Health-related quality of life (HRQoL) is reduced in obese children and adolescents, especially in clinical samples. However, little is known regarding the HRQoL of moderately overweight youth. Moreover, several studies have indicated perceived overweight as a critical factor associated with lower HRQoL. Our main objective was to compare HRQoL between treatment-seeking overweight youth and the general adolescent population, whilst separating the effects of treatment-seeking status and perceived weight from those of objective weight status.

Methods

We compared the HRQoL of a clinical sample of overweight youth (N=137 patients, mean age±s.e.=11.24±0.15 years) with that of a representative population sample (N=6354, mean age=12.75±0.03 years). The population sample was subdivided into groups based on measured and perceived weight status. We used hierarchical linear models to compare HRQoL subscale scores (self- and parent-reported) between patients and population groups, adjusted for sociodemographic characteristics and taking into account clustering of the population sample.

Results

The parent-reported HRQoL of the treatment sample was significantly lower than that of other overweight youth perceived as ‘too fat’ on two subscales: ‘self-esteem’ and ‘friends’ (effect sizes: d=0.31 and 0.34, respectively). On other subscales, patients scored lower than adolescents perceived as having a ‘proper weight’ by their parents. The patterns for self-reported HRQoL in adolescents were different: patients reported higher self-esteem than other overweight youth feeling ‘too fat’ (d=-0.39). Female patients also reported higher physical well-being (d=-0.48), whereas males scored lowest among all compared groups (d=0.42-0.95). Patients did not differ from other overweight youth who felt ‘too fat’ with respect to other HRQoL dimensions. In general, lower HRQoL was primarily associated with a perceived, rather than actual, overweight status.

Conclusions

The treatment-seeking status of overweight youth was notably associated with low social well-being, which may therefore be the main motive for seeking treatment. Other HRQoL domains were not consistently reduced in treatment-seekers. Our results further indicate that perceived overweight rather than actual overweight impacts HRQoL in youth with a modest excess weight. These results have implications for interventions in overweight youth and in individuals who are dissatisfied with their weight.

Trial registration

‘Obeldicks light’ is registered at clinicaltrials.gov (NCT00422916).

【 授权许可】

   
2013 Finne et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Wang Y, Lobstein T: Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006, 1:11-25.
• [2]Wang Y: Child obesity and health. In International encyclopedia of public health. Edited by Heggenhougen K. Oxford: Academic Press; 2008:590-604.
• [3]Jackson-Leach R, Lobstein T: Estimated burden of paediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. Int J Pediatr Obes 2006, 1:26-32.
• [4]Kurth BM, Schaffrath Rosario A: Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland [the prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt 2007, 50:736-743.
• [5]Puhl RM, Latner JD: Stigma, obesity, and the health of the nation's children. Psychol Bull 2007, 133:557-580.
• [6]Latner JD, Stunkard AJ: Getting worse: the stigmatization of obese children. Obesity 2003, 11:452-456.
• [7]Warschburger P: The unhappy obese child. Int J Obes Relat Metab Disord 2005, 29:S127-S129.
• [8]Solans M, Pane S, Estrada M-D, Serra-Sutton V, Berra S, Herdman M, Alonso J, Rajmil L: Health-related quality of life measurement in children and adolescents: a systematic review of generic and disease-specific instruments. Value in Health 2008, 11:742-764.
• [9]Bullinger M: Wohlbefinden von Kindern und Jugendlichen [well-being in children and adolescents – the state of the art in research and conceptual background]. Z Gesundheitspsychol 2009, 17:50-55.
• [10]Tsiros MD, Olds T, Buckley JD, Grimshaw P, Brennan L, Walkley J, Hills AP, Howe PRC, Coates AM: Health-related quality of life in obese children and adolescents. Int J Obes 2009, 33:387-400.
• [11]Swallen KC, Reither EN, Haas SA, Meier AM: Overweight, obesity, and health-related quality of life among adolescents: the national longitudinal study of adolescent health. Pediatrics 2005, 115:340-347.
• [12]Griffiths LJ, Parsons TJ, Hill AJ: Self-esteem and quality of life in obese children and adolescents: a systematic review. Int J Pediatr Obes 2010, 5:282-304.
• [13]Keating CL, Moodie ML, Swinburn BA: The health-related quality of life of overweight and obese adolescents–a study measuring body mass index and adolescent-reported perceptions. Int J Pediatr Obes 2011, 6:434-441.
• [14]Pinhas-Hamiel O, Singer S, Pilpel N, Fradkin A, Modan D, Reichman B: Health-related quality of life among children and adolescents: associations with obesity. Int J Obes (Lond) 2006, 30:267-272.
• [15]Erhart M, Ellert U, Kurth BM, Ravens-Sieberer U: Measuring adolescents' HRQoL via self reports and parent proxy reports: an evaluation of the psychometric properties of both versions of the KINDL-R instrument. Health Qual Life Outcomes 2009, 7:77. BioMed Central Full Text
• [16]Kolotkin RL, Zeller M, Modi AC, Samsa GP, Polanichka Quinlan N, Yanovski JA, Bell SK, Maahs DM, Gonzales de Serna D, Roehrig HR: Assessing weight-related quality of life in adolescents. Obesity 2006, 14:448-457.
• [17]Warschburger P, Fromme C, Petermann F: Gewichtsbezogene Lebensqualität bei Schulkindern: Validität des GW-LQ-KJ [weight-specific quality of life in school-children: validity of the GW-LQ-KJ]. Z Gesundheitspsychol 2004, 12:159-166.
• [18]Riazi A, Shakoor S, Dundas I, Eiser C, McKenzie S: Health-related quality of life in a clinical sample of obese children and adolescents. Health Qual Life Outcomes 2010, 8:134. BioMed Central Full Text
• [19]Kolotkin RL, Crosby RD, Williams GR: Health-related quality of life varies among obese subgroups. Obesity 2002, 10:748-756.
• [20]Wille N, Bullinger M, Holl R, Hoffmeister U, Mann R, Goldapp C, Reinehr T, Westenhofer J, Egmond-Froehlich A, Ravens-Sieberer U: Health-related quality of life in overweight and obese youths: results of a multicenter study. Health Qual Life Outcomes 2010, 8:36. BioMed Central Full Text
• [21]Shoup J, Gattshall M, Dandamudi P, Estabrooks P: Physical activity, quality of life, and weight status in overweight children. Qual Life Res 2008, 17:407-412.
• [22]Kurth BM, Ellert U: Gefühltes oder tatsächliches Übergewicht: Worunter leiden Jugendliche mehr? [perceived or true obesity: which causes more suffering in adolescents?]. Deutsches Ärzteblatt 2008, 105:406-412.
• [23]Mond J, van den Berg P, Boutelle K, Hannan P, Neumark-Sztainer D: Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: findings from the project EAT study. J Adolesc Health 2011, 48:373-378.
• [24]Jansen W, van de Looij-Jansen PM, de Wilde EJ, Brug J: Feeling fat rather than being fat may be associated with psychological well-being in young Dutch adolescents. J Adolesc Health 2008, 42:128-136.
• [25]Pesa JA, Syre TR, Jones E: Psychosocial differences associated with body weight among female adolescents: the importance of body image. J Adolesc Health 2000, 26:330-337.
• [26]Robert Koch-Institut: Public Use file KiGGS, the The German Health Survey for Children and Adolescents 2003–2006. Berlin: Robert Koch-Institut; 2008.
• [27]Reinehr T, Schaefer A, Winkel K, Finne E, Toschke AM, Kolip P: An effective lifestyle intervention in overweight children: findings from a randomized controlled trial on "Obeldicks light". Clin Nutr 2010, 29:331-336.
• [28]Reinehr T, Schaefer A, Winkel K, Finne E, Kolip P: Development and evaluation of the lifestyle intervention “obeldicks light” for overweight children and adolescents. J Public Health 2011, 19:377-384.
• [29]Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, Menner K, Müller G, Müller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Ziegler A, Hebebrand J: Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben [percentiles of body mass index in children and adolescents evaluated from different regional German studies]. Monatsschr Kinderheilkd 2001, 149:807-818.
• [30]Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, Kahl H, Knopf H, Lange M, Mensink G, Neuhauser H, Rosario A, Scheidt-Nave C, Schenk L, Schlack R, Stolzenberg H, Thamm M, Thierfelder W, Wolf U: The challenge of comprehensively mapping children's health in a nation-wide health survey: design of the German KiGGS-study. BMC Public Health 2008, 8:196. BioMed Central Full Text
• [31]Winkler J, Stolzenberg H: Der Sozialschichtindex im Bundes-Gesundheitssurvey [social status scaling in the German National Health Interview and Examination Survey]. Gesundheitswesen 1999, 61:S178-S183.
• [32]Lange M, Kamtsiuris P, Lange C, Schaffrath Rosario A, Stolzenberg H, Lampert T: Messung soziodemographischer Merkmale im Kinder- und Jugendgesundheitssurvey (KiGGS) und ihre Bedeutung am Beispiel der Einschätzung des allgemeinen Gesundheitszustands [sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) – operationalisation and public health significance, taking as an example the assessment of general state of health]. Bundesgesundheitsblatt 2007, 50:578-589.
• [33]Schenk L, Ellert U, Neuhauser H: Kinder und Jugendliche mit Migrationshintergrund in Deutschland [children and adolescents in Germany with a migration background. Methodical aspects in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt 2007, 50:590-599.
• [34]Friedlander SL, Larkin EK, Rosen CL, Palermo TM, Redline S: Decreased quality of life associated with obesity in school-aged children. Arch Pediatr Adolesc Med 2003, 157:1206-1211.
• [35]Ravens-Sieberer U, Bullinger M: Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results. Qual Life Res 1998, 7:399-407.
• [36]Ravens-Sieberer U, Bullinger M: Questionnaire for measuring health-related quality of life in children and adolescents - revised version. 2000. http://kindl.org/english/language-versions/english/ webcite
• [37]Ravens-Sieberer U, Redegeld M, Bullinger M: Quality of life after in-patient rehabilitation in children with obesity. Int J Obes 2001, 25:S63-S65.
• [38]Ravens-Sieberer U, Erhart M, Wille N, Bullinger M, the BELLA study group: Health-related quality of life in children and adolescents in Germany: results of the BELLA study. Eur Child Adolesc Psychiatry 2008, 17:148-156.
• [39]Hughes AR, Farewell K, Harris D, Reilly JJ: Quality of life in a clinical sample of obese children. Int J Obes 2006, 31:39-44.
• [40]Wille N, Erhart M, Petersen C, Ravens-Sieberer U: The impact of overweight and obesity on health-related quality of life in childhood - results from an intervention study. BMC Public Health 2008, 8:421. BioMed Central Full Text
• [41]Schwimmer JB, Burwinkle TM, Varni JW: Health-related quality of life of severely obese children and adolescents. JAMA 2003, 289:1813-1819.
• [42]Knöpfli BH, Radtke T, Lehmann M, Schätzle B, Eisenblätter J, Gachnang A, Wiederkehr P, Hammer J, Brooks-Wildhaber J: Effects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boys. J Adolesc Health 2008, 42:119-127.
• [43]Yackobovitch-Gavan M, Nagelberg N, Phillip M, Ashkenazi-Hoffnung L, Hershkovitz E, Shalitin S: The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children. Nutr Res 2009, 29:397-404.
• [44]Upton P, Lawford J, Eiser C: Parent–child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res 2008, 17:895-913.
• [45]Fallon EM, Tanofsky-Kraff M, Norman A-C, McDuffie JR, Taylor ED, Cohen ML, Young-Hyman D, Keil M, Kolotkin RL, Yanovski JA: Health-related quality of life in overweight and nonoverweight black and white adolescents. J Pediatr 2005, 147:443-450.
• [46]Stern M, Mazzeo SE, Gerke CK, Porter JS, Bean MK, Laver JH: Gender, ethnicity, psychosocial factors, and quality of life among severely overweight, treatment-seeking adolescents. J Pediatr Psychol 2007, 32:90-94.