Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

Evaluation of Health-Related Quality of Life in Adolescents With Obesity: A Randomized Qualitative Study Among Healthcare Professionals

Adolescent obesity constitutes a disorder with physical and psychosocial implications. Childhood and adolescent obesity rates are constantly increasing worldwide. Since adolescent obesity is a chronic disease, which is part of noncommunicative degenerative diseases, its holistic approach decisively includes the assessment of its impact on quality of life. The use of the tools Pediatric Quality of Life Inventory 4.0 (PedsQL4.0) and The Impact of Weight on Quality of Life for Kids (IWQOL-Kids), the familiarity of health professionals with them, their applicability, and relevance in clinical practice, are a cornerstone in the promotion of health services in adolescent obesity. The present randomized qualitative study aimed to highlight the attitudes and preferences of pediatricians on the assessment of health-related quality of life (HRQoL), among obese adolescents. The sample consists of 120 pediatricians, randomly selected from the totality of municipality-registered pediatricians (Municipality of Thessaloniki, Greece) who were interviewed in a semi-structured way, regarding their attitudes in the assessment of health-related quality of life, as measured by the PedsQL4.0 and IWQOL-Kids tools. The interviews revealed that most participants gained insight into the HRQoL assessment process during the present study interview with the researchers. Only eight (n=8/120) participants were familiar with the explored tools, PedsQL4.0 and IWQOL-KIDS. The remaining sample (n=112/120) was unfamiliar with both the two questionnaires and their content as well. Among the referred barriers to the usage of the tools, lack of time was stated as the pivotal factor hindering the implementation of the tools in clinical practice. There was no consensus on the preferred questionnaire among the participating healthcare professionals. All participants stated that the use of one or both questionnaires would have added significant value to the support and care of adolescents with obesity. Tools assessing HRQoL present low familiarity among pediatricians in real-world data. Focus on the engagement of the healthcare providers in the evaluation of obesity-related quality of life is unequivocal, in order to improve health care status in adolescents with obesity.

Preferences on how to measure and discuss health related quality of life within integrated care for children with obesity

BACKGROUND

Childhood obesity can affect physical as well as psychosocial wellbeing. Therefore, childhood obesity care aims to improve all dimensions of health related quality of life (HRQoL). HRQoL can be measured with the generic questionnaire PedsQL4.0 and the weight-specific IWQOL-Kids. In the Netherlands, HRQoL assessment is conducted by the coordinating professional (CP). The aim of this qualitative study was to examine how and when to implement the measurement and discussion of HRQoL using the PedsQL4.0 and IWQOL-Kids within the integrated care for children with obesity in the Netherlands. Semi-structured interviews were conducted with fourteen CPs, in which the following was discussed: a) familiarity and attributions with regard to the assessment of HRQoL; b) wishes and needs with regard to the usage of the questionnaires; c) its practical incorporation.

RESULTS

Interviews revealed that most CPs gained insight into the HRQoL by talking with families. One CP used the PedsQL4.0, the remaining CPs were unfamiliar with the two questionnaires. Even though some barriers, for instance a lack of time, might hinder the implementation of the PedsQL4.0 and IWQOL-Kids, all participants think the usage of either one or both questionnaires would have additional value to the support and care for children with obesity. There was no consensus about the questionnaire of preference.

CONCLUSIONS

When the right preconditions are met, HRQoL questionnaires have the potential to support CPs in improving the care for children with obesity, tailored to each individual child.

Quality of life of children and adolescents with clinical obesity, perspectives of children and parents

BACKGROUND/OBJECTIVES

Childhood obesity can have important psychological impacts. The objective of this study was to evaluate the Health Related Quality of Life (HRQoL) of children and adolescents with overweight and obesity. The participants were referred to an outpatient hospital-based obesity treatment. Additionally, we investigated the differences between parent- and self-reported HRQoL.

SUBJECTS/METHODS

Children and adolescents aged 3-18 years with overweight or obesity, referred by their general practitioner or youth health care physician to the pediatric outpatient clinic of Hospital Gelderse Vallei (Ede, the Netherlands) for multidisciplinary obesity treatment, were enrolled in this cross-sectional study (n = 119).

INTERVENTIONS/METHODS

Parent-proxy reported HRQoL was assessed using the Child Health Questionnaire Parental Form 50 (CHQ-PF50, n = 119) and the Infant Toddler Quality of Life Questionnaire 97 (ITQOL-97). Adolescents completed CHQ Child Form 87 (CHQ-CF87, n = 45) and Impact of Weight on Quality of Life-Kids (IWQOL-Kids, n = 38) to assess self-reported HRQoL.

RESULTS

The mean age of the children was 9.6 years (SD 4.3). Both parent-proxy reports and child self-reports showed lower HRQoL in children with a higher degree of obesity, especially in the physical domains of HRQoL (p < 0.05). Child self-reported scores were significantly lower than parent-proxy scores on the subscales 'bodily pain/discomfort' and 'general health perceptions', and significantly higher on 'behavior' and 'family cohesion' (p < 0.05).

CONCLUSIONS

Childhood obesity has a negative effect on HRQoL, especially on the physical aspects. The discordance between parent and child reports underscores the importance of using a combination of parent-proxy and child self-reports to assess HRQoL.

Poverty and other correlates of obesity and underweight among 7-year-olds from Croatia and Montenegro

OBJECTIVES

This study aimed at investigating poverty and other correlates of childhood underweight and obesity in two urban regions with lower (Podgorica, Montenegro) and higher economic development (Osijek, Croatia).

STUDY DESIGN

Comparative study.

METHODS

A comparative study was conducted on 693 children (52% boys), aged 7 years old (224 from Podgorica and 469 from Osijek). Parents completed the study-specific questionnaire on relevant factors for children's nutritional status. We measured children's height and weight and calculated their body mass index (BMI). International Obesity Task Force cut-off values of BMI were used to assess children's nutritional status. Subjective social position was assessed by the Mac Arthur scale.

RESULTS

There were more underweight children in Osijek compared with Podgorica, both among boys (5.5% vs. 1.6%) and girls (6.9% vs. 1.0%). Obesity was more frequent in Podgorica than Osijek, both among boys (11.3% vs. 5.9%) and girls (10.0% vs. 4.3%). However, poverty in two cities diminished observed differences in children's nutritional status. The odds for child underweight decreased by 12.2%, while the odds for obesity increased by 3.6% per each paternal BMI unit. The frequency of child obesity was lowered per each step higher on the Mac Arthur scale and with breastfeeding by 23.2% and 68.0%, respectively.

CONCLUSIONS

We show that a higher economic development is related to less obese children but more underweight children. However, poverty seems to impact nutritionally all children equally, regardless of the regional economic development. Paternal and not maternal BMI is relevant for both extremes in children's nutritional status. Breastfeeding and higher social position independently protect from child obesity.

Impaired quality of life in treatment-seeking obese children of Dutch, Moroccan, Turkish and Surinamese descent

Objective

To determine the health-related quality of life (HRQOL) of overweight and obese multi-ethnic children compared with normal-weight children; and to investigate differences in HRQOL between self- and parent-proxy reports and ethnic groups.

Design

Prospective cross-sectional study.

Setting

Out-patient clinic where children and their parents filled out a validated HRQOL questionnaire (KIDSCREEN-52) and height, weight, waist circumference and fat percentage were measured.

Subjects

Overweight and obese children, aged 8–18 years (mean BMIZ-score 3·2 (sd0·6)), from the obesity out-patient clinic.

Results

Three hundred and eight self- and 213 parent-proxy reported questionnaires were completed. Global HRQOL and the Physical Wellbeing, Moods & Emotions and Self-Perception subscales were markedly reduced in our multi-ethnic obese cohort, relative to the Dutch reference values. Parent proxies reported significantly lower on the global HRQOL and the Physical Wellbeing, Moods & Emotions and Bullying subscales. In Caucasian children, multivariate analyses showed that BMI was associated with the quality-of-life subscales Moods & Emotions, Self-Perception and Bullying.

Conclusions

HRQOL was markedly reduced in our multi-ethnic overweight and obese out-patient clinic cohort, with significantly lower parent-proxy scores compared with self-reported scores. We believe intervention programmes aiming to improve HRQOL should be directed to both parents and children, while ethnic-specific programmes to enhance HRQOL seem of less importance.

Consumption of sweetened beverages among school-going children in a densely populated township in Lilongwe, Malawi

BACKGROUND

The growing global childhood obesity pandemic has not spared low-income countries like Malawi, where 8% of children below the age of five years are overweight. Globally, regular consumption of sweetened beverages is implicated among the factors that fuel childhood obesity. Despite the growing problem, there are no local studies on any aspect of sweetened beverage consumption among children in Malawi that could help in guiding interventions and public health nutrition policies.

AIM

We aimed to assess sweetened beverage consumption among school-going children in Chilinde, a densely populated township in Lilongwe, the capital city of Malawi.

METHODS

A total of 60 school-going children whose caregivers gave verbal consent were included, and a structured questionnaire was administered to the caregiver (or other knowledgeable and responsible member of the household) of each eligible child.

RESULTS

Our results showed that 50 of the 60 children sampled were consuming a wide-range of sweetened beverages on a regular basis on any day of the week, mostly during meal times (n = 23), before going to school (n = 22), and after school (n = 19). One-third of the children were reportedly consuming up to 300 mL of several sweetened beverages per day.

CONCLUSION

Like in many countries around the world, consumption of sweetened beverages appears to be common among young school-going children in this urban setting in Malawi. As the country builds public health responses to the growing problem of non-communicable diseases, early preventive interventions among children should be given priority.

Determinants of health-related quality of life in school-aged children: a general population study in the Netherlands

Background

Health related quality of life is the functional effect of a medical condition and/or its therapy upon a patient, and as such is particularly suitable for describing the general health of children. The objective of this study was to identify and confirm potential determinants of health-related quality of life in children aged 4-11 years in the general population in the Netherlands. Understanding such determinants may provide insights into more targeted public health policy.

Methods

As part of a population based cross sectional study, the Child Health Questionnaire (CHQ) Parental Form 28 was used to measure health-related quality of life in school-aged children in a general population sample. Parents of 10,651 children aged 4-11 years were interviewed from January 2001 to December 2009.

Results

Multivariate and regression analyses demonstrated a declined CHQ Physical Summary score for children who had >1 conditions, disorders or acute health complaints and who were greater consumers of healthcare; children with a non-western immigrant background; and children whose parents did not work. Lower CHQ Psychosocial Summary score was reported for children who had >1 conditions, disorders or acute health complaints, boys, children of single parents and obese children.

Conclusion

The best predictors of health-related quality of life are variables that describe use of health care and the number of disorders and health complaints. Nonetheless, a number of demographic, socio-economic and family/environmental determinants contribute to a child’s health-related quality of life as well.

Body mass index and health-related quality of life among young Swiss men

BACKGROUND

Studies about the association between body mass index (BMI) and health-related quality of life (HRQOL) are often limited, because they 1) did not include a broad range of health-risk behaviors as covariates; 2) relied on clinical samples, which might lead to biased results; and 3) did not incorporate underweight individuals. Hence, this study aims to examine associations between BMI (from being underweight through obesity) and HRQOL in a population-based sample, while considering multiple health-risk behaviors (low physical activity, risky alcohol consumption, daily cigarette smoking, frequent cannabis use) as well as socio-demographic characteristics.

METHODS

A total of 5 387 young Swiss men (mean age = 19.99; standard deviation = 1.24) of a cross-sectional population-based study were included. BMI was calculated (kg/m²) based on self-reported height and weight and divided into 'underweight' (<18.5), 'normal weight' (18.5-24.9), 'overweight' (25.0-29.9) and 'obese' (≥30.0). Mental and physical HRQOL was assessed via the SF-12v2. Self-reported information on physical activity, substance use (alcohol, cigarettes, and cannabis) and socio-demographic characteristics also was collected. Logistic regression analyses were conducted to study the associations between BMI categories and below average mental or physical HRQOL. Substance use variables and socio-demographic variables were used as covariates.

RESULTS

Altogether, 76.3% were normal weight, whereas 3.3% were underweight, 16.5% overweight and 3.9% obese. Being overweight or obese was associated with reduced physical HRQOL (adjusted OR [95% CI] = 1.58 [1.18-2.13] and 2.45 [1.57-3.83], respectively), whereas being underweight predicted reduced mental HRQOL (adjusted OR [95% CI] = 1.49 [1.08-2.05]). Surprisingly, obesity decreased the likelihood of experiencing below average mental HRQOL (adjusted OR [95% CI] = 0.66 [0.46-0.94]). Besides BMI, expressed as a categorical variable, all health-risk behaviors and socio-demographic variables were associated with reduced physical and/or mental HRQOL.

CONCLUSIONS

Deviations from normal weight are, even after controlling for important health-risk behaviors and socio-demographic characteristics, associated with compromised physical or mental HRQOL among young men. Hence, preventive programs should aim to preserve or re-establish normal weight. The self-appraised positive mental well-being of obese men noted here, which possibly reflects a response shift, might complicate such efforts.

Quality of life in overweight and obese young Chinese children: a mixed-method study

BACKGROUND

Obesity among young children in Hong Kong has become a public health problem. This study explored associations between Chinese parent reported children's quality of life (QoL), socio-demographics and young children's weight status from 27 preschool settings.

METHODS

A mixed-method approach, including quantitative and qualitative tools, was employed for this cross-sectional study. Quantitative data were collected from 336 Chinese parents of children aged 2-7 years. Paediatric Quality of Life Inventory 4.0 (PedsQL, v 4.0) and a questionnaire about parents' socio-demographics were used. In-depth interviews with mothers, teachers and children from a larger sample were the basis of 10 case studies. Quantitative data were analysed using chi-square analysis, one-way ANOVA and logistic regression. Qualitative data were analysed according to a multi-level framework that established linkages with quantitative data.

RESULTS

The children's Body Mass Index (BMI) ranged from 11.3 to 28.0 kg/m(2) and was classified into four weight groups. ANOVAs showed that the normal-weight children had significantly higher PedsQL scores in Physical Functioning than obese children (mean difference = 14.19, p < .0083) and significantly higher scores in School Functioning than overweight children (mean difference = 10.15, p < .0083). Results of logistic regression showed that relative to normal-weight children, obese children had a 2-5 times higher odds of showing problems in Physical, Social Functioning and School Performance. Overweight children had 2 times higher odds of problems in Social Functioning, and underweight children had a 2 times higher odds of problems in Physical Functioning. Children's age (χ(2) = 21.71, df = 3, p < 0.01), and housing (χ(2) = 33.00, df = 9, p < 0.01) were associated with their weight. The case studies further act as a supplement to the quantitative data that children showed emotional problems across different abnormal weight statues; and the association between children's weight status and well-being might be affected by multiple childcare arrangements and familial immigration status.

CONCLUSIONS

This study is one of only a few studies that have examined parents', teachers' and young children's own perceptions of the children's quality of life across different weight statuses. The results are discussed in terms of their implications for intervention.