The effect of gender and age on the association between weight status and health-related quality of life in Australian adolescents

Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach

Background

Promoting active, balanced lifestyles among children may be an important approach to optimising their health-related quality of life (HRQoL). However, the relationships between children's movement behaviours and HRQoL remain unclear.

Methods

We examined the associations between movement behaviours (sleep, inactivity, light and moderate-to-vigorous intensity physical activity) assessed using accelerometers at ages 8 and 10 years and self-reported HRQoL scores (overall, and physical and emotional well-being, self-esteem, relationship with family and friends, and school functioning domains) at age 10 years among 370 children in a local birth cohort using compositional isotemporal substitution techniques.

Findings

Cross-sectionally, light and moderate-to-vigorous intensity physical activities were associated with better self-esteem (β = 15.94 [2.71, 29.18]) and relationship with friends (β = 10.28 [3.81, 16.74]) scores respectively. Prospectively, inactivity was associated with lower overall HRQoL (β = -10.00 [-19.13, -0.87]), relationship with friends (β = -16.41 [-31.60, -1.23]) and school functioning (β = -15.30 [-29.16, -1.44]) scores, while sleep showed a positive trend with overall HRQoL (β = 10.76 [-1.09, 22.61]) and school functioning (β = 17.12 [-0.87, 35.10]) scores. Children's movement behaviours were not associated with their physical and emotional well-being, or relationship with family scores. The isotemporal substitution analyses suggest that increasing time spent in physical activity and/or sleep at the expense of inactivity may benefit children's HRQoL.

Interpretation

Our findings suggest that sleep and physical activity may be associated with better HRQoL, with the inverse for inactivity. However, the relationship between children's movement behaviours and HRQoL is complex and warrants further research.

Funding

Singapore National Research Foundation, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research.

Association of health predictors with quality of life in children and adolescents

OBJECTIVES

To evaluate the association of health-related quality of life (HRQOL) with physical activity, food consumption, sleep duration and screen time in children and adolescents.

METHODS

Cross-sectional study with 268 students aged 10-17 years from a public school in Brazil. The outcome variable was HRQOL score, evaluated by the Pediatric Quality of Life Inventory™ (PedsQL™). Exposure variables were habitual physical activity, food consumption, sleep duration, and screen time. A general linear model was used to estimate age-adjusted means and 95 % confidence interval (95 % CI) of HRQOL scores, and a multivariable analysis of variance to identify factors associated with lower/higher HRQOL scores. The study was approved by the Human Research Ethics Committee of the Pontifical Catholic University of Campinas.

RESULTS

Overall HRQOL score was 70.3 (95 % CI: 68.0-72.6). Multivariable analyses showed lower HRQOL scores for those adolescents who: 1-were physically inactive (67.3; p=0.014); 2-sleep less than 6 h per night (66.8; p=0.003); 3-eat fruits and vegetables less than five days/week (68.9; p=0.027); and 4-eat fast food twice/week or more (68.6; p=0.036) when compared to their opposite groups. Screen time was not statistically significantly associated with total HRQOL.

CONCLUSIONS

The joint association found in our study suggests that at least three habits must change to improve the HRQOL of children and adolescents (physical activity, food consumption, and sleep duration). Therefore, interventions in schools to promote a healthy lifestyle to achieve a better HRQOL should include a multidisciplinary team to properly guide children and adolescents about these habits simultaneously.

Quality of life of low-income adults

BACKGROUND

Quality of life is currently one of the basic conceptual categories in many research disciplines. The authors of the present study are convinced that measurement of quality of life in reference to people living on the poverty line deserves special attention.

OBJECTIVE

The aim of the study was to identify relationships between the quality of life and sociodemographic variables in low-income Wrocław residents.

METHODS

The research was conducted in Wrocław (Poland) and involved 1215 respondents aged 18-64 years, whose monthly gross income per capita in the household did not exceed 1043 PLN. The respondents' quality of life was assessed with the World Health Organization Quality of Life Questionnaire with additional questions on the respondents' social and demographic status.

RESULTS

The Wrocław residents most often assessed their quality of life as average or below average. They rated their health-related quality of life in the social domain as the highest, and in the physical domain as the lowest. Age, household size, stable source of income, savings, and indebtedness were significantly correlated with the quality of life of Wrocław residents under study. Among the respondents, statistically significant relationships between perceived health condition assessment and age, professional status, stable source of income, and debt were also identified.

CONCLUSIONS

The results of the study indicate that public health programs and other activities related to quality of life management should be directed to individuals and social groups particularly threatened by low quality of life, i.e., people living on the income poverty line.

Weight status and meeting the physical activity, sleep, and screen-time guidelines among Texas children: results from a population based, cross-sectional analysis

BACKGROUND

Evidence suggests that the interactive effects of physical activity, screen-time and sleep are stronger than independent effects of these behaviors on pediatric obesity. However, this hypothesis has not been fully examined among samples of young school-aged children. The aim of this study is to determine the association of weight status with meeting the physical activity, screen-time, and sleep guidelines, independently and concurrently, among 2nd grade children.

METHODS

The Texas School Physical Activity and Nutrition Project collected parent-reported physical activity, screen-time, and sleep, and measured body height and weight on a statewide representative weighted sample (n = 320,005) of children. Weighted multivariable logistic regressions were used to assess associations of weight status (classified using age- and sex-specific body weight [kg]/height [m]², based on International Obesity Task Force cutoffs) with meeting the physical activity, screen-time, and sleep guidelines, while controlling for relevant covariates (age, sex, race/ethnicity, comorbidities etc.).

RESULTS

A greater proportion of healthy weight children (9.9%) met the physical activity, screen-time, and sleep guidelines concurrently compared to children who are thin (3.3%), or children with overweight (5.7%), obese (3.5%), and morbid obesity (1.0%). Children who were thin (adjusted odds ratio [aOR]:0.40, 95% confidence interval [CI]: 0.10, 1.50), overweight (aOR = 0.75, CI: 0.33, 1.70), obese (aOR = 0.53, CI: 0.15, 1.81), and morbidly obese (aOR = 0.10, CI: 0.02, 0.28) had lower odds of concurrently meeting the guidelines compared to children with healthy weight.

CONCLUSIONS

Among this representative sample of Texas children, weight status was associated with meeting physical activity, screen-time, and sleep guidelines. Future studies should aim to evaluate causal relations between these behaviors and weight status.

Socio-economic correlates of quality of life in single and married urban individuals: a Polish case study

Background

One of key current social trends is the increasing number of single people. It has multiple implications as single individuals often live and behave differently than those living in relationships. Marital status and socioeconomic status may also be significant quality of life factors for single persons. The aim of this study is to identify relationships between quality of life and selected indicators of socioeconomic status in single and married respondents from the Wrocław metropolitan area in Poland.

Methods

4460 respondents took part in the study (1828 single, 2632 married). The study was cross-sectional based on a diagnostic survey. Data was gathered on respondents’ sex, age, education, marital status, occupational status and financial situation as well as their quality of life and perceived health condition. Frequencies (f) and relative frequencies (rf) of categories of dependent and independent variables were determined. The chi-squared test (χ²) and odds ratio (OR) statistics were applied. The level of statistical significance was set at α = .05.

Results

A stochastic dependence (p ≤ .05) between marital status and perceived health condition and quality of life in the social domain was found among the respondents. Male sex, higher education, being an entrepreneur, college student or white-collar worker, and good financial status were associated with the highest assessments of quality of life and perceived health condition. The directions of quality of life modifications determined by socioeconomic status were similar in single and married urban respondents; however, the strength of these modifications was greater in the latter.

Conclusions

It is recommended to target respondents with public health programs aimed at lifestyle improvement, tailored to the needs of single and married individuals. Public policies directed at improving education and material situation of respondents are also worth considering, as they may be essential for modeling their quality of life. In addition, research on quality of life should be continued, which is particularly relevant in a pandemic situation.

Health-related quality of life, Mediterranean diet, physical activity and socioeconomic factors of Greek adolescents during COVID-19: A cross sectional study

BACKGROUND: Health related quality of life of the adolescents during quarantine and social isolation potentially decreases, with significant alteration on physical activities and nutrition behaviour. OBJECTIVE: The present study investigates the relationship between Greek adolescents’ health related quality of life and socioeconomic factors, lifestyle and dietary characteristics, along with their adherence to the Mediterranean Diet immediately after the lockdown period in Greece. METHODS: A total sample of 459 students aged 12–16 years old were recruited from secondary schools in the area of Athens. The KIDSCREEN-27 questionnaire for children and adolescents, the KIDMED test, the Godin and Shephard Leisure Time Physical Activity Questionnaire and the Family Affluence Scale III, were used for the statistical analysis. T-tests, Kruskal Wallis, Chi-square, Anova tests and multiple regression analyses were employed. RESULTS: Econometric analysis reveals that adolescents’ health related quality of life is higher among boys, adolescents who live with both parents, tend to sleep more during night and do not spend many hours on screen viewing. Also, adolescents with higher family affluence level, being physically active and with a high adherence to the Mediterranean Diet have higher health related quality of life. CONCLUSIONS: Adolescents’ adherence to the Mediterranean Diet, physical activity, socioeconomic characteristics and life style behaviors are highly correlated with perceived health related quality of life during COVID-19 period.

Health Economic Aspects of Childhood Excess Weight: A Structured Review

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.

Maternal Emotional States in Relation to Offspring Weight and Health-Related Quality of Life: Tehran Lipid and Glucose Study

BACKGROUND

Maternal characteristics have been known to be associated with parenting practices, which could eventually influence their child's weight and health-related quality of life (HRQoL).

OBJECTIVES

This study aimed to assess the direct and indirect associations of maternal emotional states (depression, anxiety, and stress) with body mass index (BMI) and HRQoL in their children.

METHODS

This study was conducted within the framework of the Tehran lipid and glucose study (TLGS). Participants were the children (n = 231) enrolled in TLGS during 2014 - 2016, who had complete data on maternal emotional states. The body weight and height of children were measured using the standard protocol, and BMI Z-score was determined using Anthroplus. Also, HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQLTM4.0) and the depression, anxiety, and stress scale (DASS-21), respectively. Structural equations modeling (SEM) was used to assess the direct and indirect relations of maternal emotional states with children's BMI Z-score and HRQoL.

RESULTS

Mean age, BMI Z-score, and HRQoL total score in children were 13.8 ± 3.1 years, 0.74 ± 1.5, and 84.7 ± 11.3, respectively. In the mothers, median DASS-21 scores (interquartile ranges) in the three scales of depression, anxiety, and stress were 4 (0 - 10), 6 (2 - 12), and 14 (8 - 20), respectively. Maternal level of education was significantly associated with the DASS-21 score (β = -0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 score was significantly associated with BMI Z-score only in girls (β = 0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were the child's age (β = -0.21, 95% CI: -0.40, -0.01) and maternal education (β = -0.24, 95%CI: -0.44, -0.02) and emotional state (β = -0.24, 95% CI: -0.44, -0.03). The child's age (β = -0.33, 95% CI: -0.53, -0.10) and maternal emotional state (β = -0.31, 95% CI: -0.54, -0.08) were significantly associated with HRQoL in girls.

CONCLUSIONS

The maternal emotional state is an important determinant of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and suburban populations, taking into consideration more influential factors.

Evaluating the Quality of Life of 231 Children With Primary Nephrotic Syndrome and Assessing Parental Awareness of the Disease

Objective: This study aims to investigate the quality of life of children with primary nephrotic syndrome (PNS), assess their parents' disease awareness, and provide a basis for the comprehensive management of children with PNS. Methods: A total of 231 children with PNS who were hospitalized in the Department of Pediatric Renal Rheumatology and Immunology in the ShengJing Hospital of the China Medical University from March 2019 to October 2020 were selected as the study subjects. The subjects and their parents were surveyed via a disease education and communication WeChat group and online questionnaire to investigate the children's quality of life, the needs of the parents, and their knowledge related to the disease. Results: In 93.51% of cases, the child's quality of life was affected, with mild to moderate effects being the most frequent (90.47%). The lowest overall quality of life scores were recorded for children who had been diagnosed 1-3 year prior to inclusion in the study, and the scores plateaued thereafter. On the physical functioning scale, the longer the illness, the greater the physical impact, with children typically experiencing pain and fatigue. The children generally scored low on the emotional functioning scale, exhibiting sleep disturbances for up to 5 years and worrying about accidents. The children's average score on the social functioning scale was high, with males achieving significantly higher scores (69.61 ± 25.42) than females (62.30 ± 27.51), and more than one-third of the children experiencing problems getting along with other teenagers and making friends. The primary problems expressed by parents were anxiety (59%), sadness (44%), fear (43%), and depression (40%), and several parents indicated that they struggled with issues of self-blame. Conclusion: PNS impacts the physical and psychological wellbeing of children suffering from the condition, significantly reduces their quality of life, and negatively impacts the psychological wellbeing of their parents. Therefore, children with PNS and their families need integrated management by doctors, nurses, dieticians, psychotherapists, educational institutions, and social stakeholders to improve their quality of life.

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea

OBJECTIVES

To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA.

METHODS

This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale.

RESULTS

A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001).

CONCLUSION

We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.

[Psychological Parameters of Adolescent Patients Prior to Obesity Treatment]

Overweight and obesity in children and adolescents are highly prevalent and persistent. Current weight loss treatments are rarely individualized and show only small to moderate efficacy. Only rarely, psychopathological parameters are considered. The present study evaluated the psychopathology of adolescents with overweight and obesity (N=201, ages 12-17 years) prior to obesity treatment. The data were analyzed for age and sex effects. Self-report questionnaires assessed general symptom burden, eating disorder and general psychopathology, weight-related self-stigmatization, and physical and mental quality of life. Girls showed higher rates of weight-related self-stigmatization and higher disordered eating behavior compared to boys. Older adolescents reported a lower quality of life compared to younger adolescents. In normative comparisons with population-based samples and norms, adolescents with overweight and obesity showed significantly adverse outcomes in all parameters. Thus, this study identified psychopathology as an important factor in adolescents with high weight status that may affect obesity treatment. Future studies should examine psychopathology more differentially and determine therapeutic resources in adolescent overweight and obesity.

Estimating Age- and Sex-Specific Utility Values from the CHU9D Associated with Child and Adolescent BMI z-Score

OBJECTIVE

Our objective was to identify age- and sex-specific utilities for children and adolescents by body mass index (BMI) z-score.

METHODS

We used data from 6822 participants and 12,094 observations from two cohorts and two waves of interviews from the Longitudinal Study of Australian Children. We fit linear models using generalised estimating equations to investigate associations between Child Health Utility 9D and BMI z-score in girls and boys aged 10-17 years. We initially fit models for each sex, fully adjusted for known predictors of health-related quality of life, including socioeconomic position, long-term medical condition and maternal smoking status and also included an interaction between age and BMI z-score to examine age-specific effects. Finally, we derived a minimal model for each sex by eliminating interaction terms with P > 0.01 and predictors with P > 0.05.

RESULTS

Our adjusted results show different utility patterns in girls and boys. In girls, utility decrements for each unit increase in BMI z-score changed with age (P < 0.01 for interaction between age and BMI z-score). At age 10 years, the mean utility decrement for each unit increase in BMI z-score was 0.002 (95% confidence interval [CI] 0.011 decrement to 0.006 increment), but, by age 17 years, this utility decrement was 0.023 (95% CI 0.013 to 0.032). In boys, small non-significant decrements were found in utility for each unit increase in BMI z-score, with no observable change with age.

CONCLUSION

Our analyses demonstrated that age and sex should be considered when attributing utility values and decrements to BMI z-scores.

Examining boys' and girls' health-related quality of life from the first to the third year of upper secondary school: A prospective longitudinal study

AIM

To examine differences in health-related quality of life between boys and girls in the first and third years of upper secondary school.

DESIGN

Prospective longitudinal study.

METHODS

The KIDSCREEN-10 was used to assess health-related quality of life. Differences in health-related quality of life over time were estimated using a linear mixed-effects model for correlated measurements.

RESULTS

In the first-year boys (N = 168) and girls (N = 228) reported a mean health-related quality of life score of 76.3 (SD 10.7) and 69.8 (SD 11.5), respectively. In the third year, the mean health-related quality of life score for boys and girls was 73.5 (SD 12.4) and 65.7 (SD 13.3), respectively. Boys had a significant decrease in health-related quality of life mean score of -2.6 and girls a significant decrease of -3.8 (p < .001) over the 3-year period. There was no significant difference between boys' and girls' health-related quality of life changes (p = .39).

Health-related quality of life in adolescents with excess weight

OBJECTIVE

To identify health-related quality of life in adolescents with excess weight and associated factors, such as gender, age, and weight categories.

METHOD

A cross-sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity, and whose parents or guardians authorized their participation. Anthropometric data, pubertal development, and the PedsQL 4.0 questionnaire were collected for the health-related quality of life assessment. Categorical data were described as numbers and percentages. For the description of health-related quality of life subscales, medians and the 25^th and 75^th percentiles were used, as well as the Mann-Whitney test for comparisons between age group, gender, and weight categories.

RESULTS

The median health-related quality of life total score was 78.3 (68.5-87.4). The lowest scale was the "emotional score", 65 (50-80). Higher health-related quality of life was found in boys in most of the scores (p<0.05), except for the "school score" (p=0.09). Regarding the age group, the median of the "physical scores" (p=0.03) and "social score" (p=0.02) were significantly lower in the group younger than 14 years. When separated according to weight categories, it was verified that obese adolescents differed significantly in relation to the "physical score" (p=0.00), "school score" (p=0.04), and "total score" (p=0.02) of the health-related quality of life. However, there was no significant difference between the emotional, social, and psychosocial scores.

CONCLUSIONS

Adolescents with overweight and obesity show losses in the health-related quality of life and also between the different domains, when separated by age, gender, and weight categories.

Weight Status, Physical Fitness, and Health-Related Quality of Life among Chinese Adolescents: A Cross-Sectional Study

PURPOSE

The impact of physical fitness (PF) on adolescents' health-related quality of life (HRQOL) is an important health issue in China. The purpose of this study was to identify whether body mass index (BMI), cardiorespiratory fitness (CRF), and musculoskeletal fitness (MSF) influences HRQOL among Chinese adolescents.

METHOD

The participants were 10,007 students (boys = 5276, 14.14 years ± 1.79; girls = 4829, 14.22 years ± 1.81) who were randomly selected from 30 secondary schools in Shandong, China. BMI, CRF, MSF, and HRQOL were measured and analyzed using ANCOVA and multiple regression.

RESULTS

BMI and physical fitness variables were partially associated with HRQOL in Chinese adolescents. ANCOVA showed a significant difference among BMI categories in terms of physical sense (PS), living convenience, and self-satisfaction (SS) for boys, but this difference was only seen with social activity opportunity (SAO) for girls. Multiple regression found that BMI was significantly associated with SAO. For boys, CRF was associated with the teacher and student relationship and SS, whereas MSF was only associated with PS. For girls, CRF was significantly linked with the parent and children relationship, learning capacity, and attitudes and self-perception (S-P), while MSF was associated with S-P.

CONCLUSION

Enforcing physical activity and enhancing PF will be a crucial pathway in improving adolescents' HRQOL in China.

Associations between physical fitness and adherence to the Mediterranean diet with health-related quality of life in adolescents: results from the LabMed Physical Activity Study

Background

Physical fitness (PF) and adherence to the Mediterranean diet are important indicators of healthy lifestyles. The purpose of this study is to analyze the independent and combined associations between PF and adherence to Mediterranean diet with health-related quality of life (HRQoL) in adolescents.

Methods

This is a cross-sectional analysis with 956 Portuguese adolescents aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire. PF was assessed with the ALPHA health-related fitness battery. The 20-m shuttle run test was used for the estimation of cardiorespiratory fitness; handgrip strength and standing long jump tests were applied for the assessment of muscular fitness and the 4 × 10 m shuttle run test for the assessment of motor fitness (speed and agility). The results of the PF tests (cardiorespiratory fitness, muscular fitness and motor fitness) were transformed into standardized values (Z-scores) by age and sex. Adherence to the Mediterranean diet was assessed with the KIDMED index. Regression analysis and analysis of covariance were performed.

Results

PF (B = 0.228; P < 0.05) and adherence to the Mediterranean diet (B = 0.259; P < 0.05) were positively associated with HRQoL, after controlling for several variables. Participants classified as high PF and high adherence to Mediterranean diet had on average the highest HRQoL score compared with those with low PF and low adherence to Mediterranean diet (F(3, 939) = 4.270; P = 0.005), after adjustments for potential confounders.

Conclusions

The combination of high PF levels and optimal adherence to Mediterranean diet is positively associated with HRQoL.

Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing

OBJECTIVE

To compare motivational interviewing (MI) with conventional care regarding the health-related quality-of-life (HRQoL) of adolescents with overweight/obesity.

METHODS

RCT with parallel design, involving two groups: intervention group (MI group [MIG]) and control group (conventional intervention group [CIG]). The intervention included three 30-minute interviews 3 months apart.

OUTCOME

Change in Pediatric Quality of Life Inventory (PedsQL) scores. A mixed repeated-measures analysis of variance was used to assess group versus time interactions.

RESULTS

Eighty-three participants finished the protocol (82% girls). MIG participants showed a significant average increase (+4.7) on the Psychosocial (t[41] = -2.388, p = .022, d = .37) and Emotional Subscales (+5.1) (t[41] = 5.733, p < .001, d = .88). CIG participants showed a significant average decrease on the Psychosocial (-6.1) (t[40] = 5.733, p < .001, d = .90), Emotional (-14.1) (t[40] = 7.249, p < .001, d = 1.13) and Social Subscales (-3.8) (t[40] = 3.782, p = .001, d = .59) and on the Total Score (-4.4) (t[40] = 3.535, p = .001, d = .55) CONCLUSION: MI improved HRQoL among overweight adolescents participating in a weight management program.

PRACTICE IMPLICATIONS

MI increases HRQoL and has the potential to benefit weight management programs for adolescents.

Combined effect of different factors on weight status and cardiometabolic risk in Italian adolescents

Background

The observed increase in body weight and cardiometabolic risk (CR) in youth from developed countries contributes to the global burden of chronic diseases in adult age. The aim of this work is to provide a patterning of the associations between different factors and the weight status and CR of the subjects involved in the Italian ministerial ASSO project.

Methods

This study involved 919 students from high schools in Palermo. Weight, height and waist circumference were collected by trained teachers; weight status was estimated by the BMI cut-offs for adolescents and CR through the waist-to-height ratio. Questionnaires were administered through the web-based ASSO-NutFit software. Chi-square test investigated the variables significantly associated with the outcomes, which were then included in a Multiple Correspondence Analysis (MCA), to explore their dimensional relationship to weight status and CR. Poisson regressions were conducted separately for the two outcomes, reporting raw and adjusted prevalence ratios (PRs) and Bootstrap Method was used to determine confidence intervals (CIs), to assessing the degree of effect of the explanatory variables over the outcomes.

Results

Two main dimensions were evidenced, with the overweight/obese group and the group at CR characterized by the following strongly associated factors: male gender, overweight/obese parents, following a slimming regime, caesarean birth, sedentariness, being under/overweight at birth, presence of metabolic risk, going to school by car/scooter, not using supplements.

Conclusions

This study contributed to identifying those adolescents that should be prioritized in interventions aiming at reducing overweight/obesity and CR in this age group.

Electronic supplementary material

The online version of this article (10.1186/s13052-019-0619-9) contains supplementary material, which is available to authorized users.

Prevalence of body dissatisfaction and its effects on health-related quality of life among primary school students in Guangzhou, China

Background

The relationship between body dissatisfaction (BD) and health-related quality of life (HRQoL) has been well documented in adolescents and adults but is less clear in children, particularly in China. The aims of this study were to describe body image perception and dissatisfaction and to examine their effects on HRQoL among primary school students in Guangzhou, China.

Methods

A total of 5734 children aged 8–12 years from 29 schools completed self-report questionnaires, which included the Paediatric Quality of Life Inventory 4.0 for measuring HRQoL and Ma figural stimuli for measuring BD. Based on their level of BD, the children were divided into three groups: no dissatisfaction, mild dissatisfaction and moderate or high dissatisfaction. Based on the children’s perceptions of their own body image, the groups were also categorized into just right, too fat and too thin groups. Height and weight were objectively measured using standardized methods, and a BMI z-score was derived using the age- and sex-specific WHO references from 2007 for children aged 5–19 years. Weight status was classified as underweight, healthy weight, overweight or obese.

Results

A total of 78.10% of children aged 8–12 years in Guangzhou had different levels of BD; boys had slightly higher levels BD than girls (p < 0.01), and obese children demonstrated the highest degree of BD (p < 0.01). However, BD levels did not differ significantly according to age (p = 0.194). Gender differences in body image perceptions were only found in children with a healthy weight (p < 0.01), but age differences in body image perception were present in both children with a healthy weight (p < 0.05) and underweight children (p < 0.05). Of the children with a healthy weight who were dissatisfied with their body image, 65.54% of the boys wanted to be heavier, whereas 52.95% of the girls wanted to be thinner (p < 0.01), and older children were more inclined to perceive themselves as too fat (p < 0.01). After controlling for the influence of confounding factors, significant trends for lower HRQoL scores with increasing BD levels persisted in all domains (p < 0.01).

Conclusions

BD is as common in children as in adolescents and adults and might be independently associated with HRQoL impairment. The present findings suggest that the current epidemic of BD is a threat to the health of primary school children in China, and prevention programmes for this population should be implemented in the future.

Associations between combined overweight and obesity, lifestyle behavioural risk and quality of life among Australian regional school children: baseline findings of the Goulburn Valley health behaviours monitoring study

INTRODUCTION

Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight/obesity, and associated obesogenic risk behaviours with health related quality of life and physical, social, emotional and school sub-domains, among a large cohort of Australian primary school children.

METHODS

The data were derived from the Goulburn Valley Health Behaviours Monitoring study whereby a census-styled school recruitment process and high participatory opt-out (passive) procedure was employed. All primary schools in three Local Government Areas were invited to participate between July-September 2016 with 39/62 (62%) of schools participating and 1606/2034 (79%) students in Grade 2 (aged approx. 7-8 years), Grade 4 (aged approx. 9-10 years) and Grade 6 (aged approx. 11-12 years) participating. Measured height and weight were collected among participating students and older children (Grade 4 and 6) who also completed a self-report behavioural questionnaire, including the paediatric quality of life inventory.

RESULTS

Among 809 children aged 9 to 12 years, there were 219 (27.1%) classified as overweight/obese. Male children classified as overweight/obese reported significantly lower health related quality of life in the physical functioning and global functioning scores, compared to normal weight males. Significantly higher quality of life scores were observed among all children who met the physical activity recommendations on five out of the seven previous days. Significantly higher scores were observed among males adhering to the daily screen time recommendations, and among those meeting daily recommendations for fruit consumption. Among male school children, soft drink consumption was associated to lower health related quality of life.

CONCLUSION

Although cross-sectional, these findings highlight children with overweight/obesity and some underlying lifestyle behavioural risk factors, had significantly lower healthy-related quality of life, although this was observed most consistently among male school children. These findings have not previously been identified in young children and highlights the need to consider mental and emotional health in public health efforts to prevent obesity.

TRIAL REGISTRATION

ANZCTR Trial Registry: ACTRN12616000980437 retrospectively registered 26 July 2016.

Is there an association between early weight status and utility-based health-related quality of life in young children?

PURPOSE

Few studies focus on the health-related quality of life (HRQoL) of preschool children with overweight or obesity. This is relevant for evaluation of obesity prevention trials using a quality-adjusted life year (QALY) framework. This study examined the association between weight status in the preschool years and HRQoL at age 5 years, using a preference-based instrument.

METHODS

HRQoL [based on parent proxy version of the Health Utilities Index Mark 3 (HUI3)] and weight status were measured in children born in Australia between 2007 and 2009. Children's health status was scored across eight attributes of the HUI3-vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain, and these were used to calculate a multi-attribute utility score. Ordinary least squares (OLS), Tobit and two-part regressions were used to model the association between weight status and multi-attribute utility.

RESULTS

Of the 368 children for whom weight status and HUI3 data were available, around 40% had overweight/obesity. After adjusting for child's sex, maternal education, marital status and household income, no significant association between weight status in the preschool years and multi-attribute utility scores at 5 years was found.

CONCLUSIONS

Alternative approaches for capturing the effects of weight status in the preschool years on preference-based HRQoL outcomes should be tested. The application of the QALY framework to economic evaluations of obesity-related interventions in young children should also consider longitudinal effects over the life-course. Clinical Trial Registration The Healthy Beginnings Trial was registered with the Australian Clinical Trial Registry (ACTRNO12607000168459).

Utility values for childhood obesity interventions: a systematic review and meta-analysis of the evidence for use in economic evaluation

Rigorous estimates of preference-based utilities are important inputs into economic evaluations of childhood obesity interventions, yet no published review currently exists examining utility by weight status in paediatric populations. A comprehensive systematic literature review and meta-analysis was therefore undertaken, pooling data on preference-based health state utilities by weight status in children using a random-effects model. Tests for heterogeneity were performed, and publication bias was assessed. Of 3,434 potentially relevant studies identified, 11 met our eligibility criteria. Estimates of Cohen's d statistic suggested a small effect of weight status on preference-based utilities. Mean utility values were estimated as 0.85 (95% uncertainty interval [UI] 0.84-0.87), 0.83 (95% UI 0.81-0.85), 0.82 (95% UI 0.79-0.84) and 0.83 (95% UI 0.80-0.86) for healthy weight, overweight, obese and overweight/obese states, respectively. Meta-analysis of studies reporting utility values for both healthy weight and overweight/obese participants found a statistically significant weighted mean difference (0.015, 95% UI 0.003-0.026). A small but statistically significant difference was also estimated between healthy weight and overweight participants (0.011, 95% UI 0.004-0.018). Study findings suggest that paediatric-specific benefits of obesity interventions may not be well reflected by available utility measures, potentially underestimating cost-effectiveness if weight loss in childhood/adolescence improves health or well-being.

Differentials in health-related quality of life of employed and unemployed women with normal vaginal delivery

Background

The combination of child care and domestic work demands on both housewives and the employed (hired) women may impact their health-related quality-of-life. There is paucity of studies to ascertain this. This study investigated the differences in health-related quality of life of employed and unemployed women with normal vaginal delivery and associated socio-demographic variables.

Methods

This longitudinal study was done from March, 2012 to June, 2013. Modified SF-36v2™ health-related quality of life questionnaire was administered to 234 newly delivered women drawn from six selected hospitals in Enugu, Southeast Nigeria at 6, 12 and 18 weeks postpartum. Respondents were reached for data collection through personal contacts initially at the hospitals of delivery, and subsequently by visits to their homes/workplaces or cell-phone calls. Women were asked to indicate how each of 36 items applied to them at each of the three times. Data collection lasted for six calendar months and 17 days (from September 3rd 2012 to 20th March, 2013).

Results

All the women had their best HrQoL at 12 weeks postpartum. Employed women reported lower health-related quality-of-life than the unemployed at the three time-points, the lowest mean score being at 18 weeks postpartum (Mean = 73.9). Multiple comparison of scores of the two groups using Tukey HSD Repeated Mean showed significant variation on the eight subscales of the health-related quality-of-life. Physical functioning (p = 0.045), Physical role limitation (p = 0.000), bodily pain (p = 0.000), social functioning (p = 0.000) and general health (p = 0.000) were unequal guaranteeing type 1 error. Women with higher education and personal income reported higher health-related quality-of-life (p < 0.05). Employed women have more problems with physical health components and are more negatively affected by increasing age except those with higher education and personal income.

Conclusions

Increased responsibilities combined with increasing age and low socio-economic status reduce women’s health-related quality-of-life post-partum. The traditionally accepted paid 3 months maternity leave should be elongated by extra months to help women balance their daily work with baby care. Gender sensitive employment opportunities in favour of women are necessary to empower more women economically.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0481-0) contains supplementary material, which is available to authorized users.

Association between lifestyle factors and suboptimal health status among Chinese college freshmen: a cross-sectional study

Background

Suboptimal health status (SHS) is the third state between good health and disease. SHS is the clinical or pre-disease status of psychosomatic disease and a major global public health challenge. Although its underlying causes remain unclear, lifestyle is one of the most important factors affecting health status.

Methods

A cross-sectional survey was conducted at Renmin University of China in September of 2015. Data were collected from college freshmen using a questionnaire covering characteristics, lifestyle, nutrition status, and health status. A total of 6025 questionnaires were distributed during the study period, and 5344 completed responses were received.

Results

The prevalence rates for the “healthy,” “SHS,” and “disease” groups of college freshmen were 46.7% (2433), 51.2% (2667), and 2.1% (111), respectively. It is notable that health status was significantly positively correlated with lifestyle (Spearman’s r = 0.4435, p < 0.001). The multivariate Logistic regression results showed that students who were relatively younger and students from rural areas had a higher percentage of SHS. Good sleep quality (aOR = 0.650, 95%CI = 0.612–0.690), abundant physical exercise (aOR = 0.889, 95%CI = 0.845–0.933), and adequate nutrition intake (aOR = 0.868, 95%CI = 0.864–0.908) are negatively associated with SHS. Overuse of electronic devices (aOR = 1.066, 95%CI = 1.013–1.121), smoking (aOR = 1.824, 95%CI = 1.195–2.755), and weight loss (aOR = 1.255, 95%CI = 1.043–1.509) are positively associated with SHS.

Conclusions

Poor lifestyle behaviors are associated with SHS. In particular, the overuse of electronic devices is one of underlying causes of SHS. By altering lifestyle behaviors for the better, the health statuses of these college freshmen can be effectively improved.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-5002-4) contains supplementary material, which is available to authorized users.

Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study

BACKGROUND

Considering the role of different ethnical, cultural and geographical factors in health related quality of life (HRQOL) as well as the perception of different populations regarding various weight disorders, we aimed to evaluate the association between body mass index (BMI) and HRQOL in Iranian children and adolescents.

METHODS

This cross-sectional study was part of the Weight Disorders Survey of the CASPIAN-IV study. During this study, students aged 6-18 years from urban and rural areas of 30 provinces of Iran were selected. HRQOL of the students was evaluated by using the Persian version of the Pediatric Quality of Life inventory (PedsQL™ 4.0™ 4.0) Generic Core Scales. The mean of total HRQOL and its subscales were compared in underweight, normal weight, overweight and obese students.

RESULTS

The mean of total HRQOL, physical functioning and psychological functioning scores in the total population were 83.31, 84.25 and 82.79, respectively. The mean of the total HRQOL score and the psychosocial score were significantly lower in underweight students aged 6-12 years than in other groups (p<0.05). The mean of the total HRQOL score and psychosocial score were significantly lower in obese students aged 13-18 years than in other groups (p<0.05). Overweight and obesity was negatively associated with total HRQOL, psychosocial and school functioning subscales (p<0.05). There was a significant negative association between emotional functioning and obesity (p<0.05).

CONCLUSIONS

The findings or this study support the importance of personal perception and cultural norm roles in HRQOL. Given the association between weight disorders and psychosocial health, it is suggested that social and cultural factors have a more crucial role in the HRQOL of children and adolescents.

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment

PURPOSE

The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity.

METHODS

Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS).

RESULTS

Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001).

CONCLUSIONS

Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS.

TRIAL REGISTRATION

Clinicaltrials.gov, ID-no.: NCT02013843.

Relationship between weight status and health-related quality of life in Chinese primary school children in Guangzhou: a cross-sectional study

BACKGROUND

To investigate the association between weight status and health-related quality of life (HRQOL) among pupils in Guangzhou, China.

METHODS

The study comprised 5781 children aged 8-12 years from 29 schools. Height and weight were objectively measured using standardized methods, and BMI z-score derived using the age and sex specific WHO reference 2007 for 5-19 years. Weight status was classified as underweight (<-2SD), healthy weight (between -2SD and 1SD), overweight/obesity (>1SD). HRQOL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.

RESULTS

After controlling for gender, age, school type, parental education, and family income, HRQOL scores were significantly lower in overweight/obese compared with healthy weight children only in the social functioning domain (β = -1.93, p = 0.001). Compared with healthy weight children, underweight children had significantly lower total (β = -1.47, p = 0.05) and physical summary scores (β = -2.18, p = 0.02). Subgroup analysis for gender indicated that compared to healthy weight, total (β = -1.96, p = 0.02), psychosocial (β = -2.40, p = 0.01), social functioning (β = -3.36, p = 0.001), and school functioning (β = -2.19, p = 0.03) scores were lower in overweight/obese girls, but not boys. On the other hand, being underweight was associated with lower physical functioning (β = -2.27, p = 0.047) in girls, and lower social functioning (β = -3.63, p = 0.01) in boys. The associations were mainly observed in children aged 10 and over, but were not significant in younger children. Children from private schools had generally lower HRQOL compared to those in public schools, but the associations with weight status were similar in both groups.

CONCLUSIONS

The relationship between overweight/obesity and HRQOL in children in China is not as prominent as that seen in children in western or high-income countries. However, there appears to be gender and age differences, with more of an impact of overweight on HRQOL in girls and older children compared with boys and younger children. Underweight is also associated with lower HRQOL. Future intervention to prevent both obesity and undernutrition may have a positive impact on the HRQOL in children in China.

Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs.

Obesity and emotional well-being in adolescents: Roles of body dissatisfaction, loss of control eating, and self-rated health

OBJECTIVE

Weak or inconsistent association between obesity and impairment in emotional well-being in population-based samples has led to efforts to identify mediating variables. This study examined the relative importance of body dissatisfaction (BD), loss of control (LOC) eating, and self-rated health (SRH) in mediating the association between obesity and impairment in emotional well-being in a school-based sample of adolescents (boys, n = 437; girls, n = 950).

METHODS

Moderated mediation analysis was employed to assess the relative importance of the putative mediating variables and moderation of mediation effects by sex following the methods suggested by Hayes and coworkers.

RESULTS

BD and SRH, but not LOC eating, were found to mediate the association between obesity and impairment in emotional well-being. Stronger mediation effects were observed for BD than for SRH. None of these results was moderated by sex.

CONCLUSIONS

The findings suggest that it may be important to target BD in obesity prevention and treatment programs in order to reduce the adverse impact of excess body weight on young people's emotional well-being.

Health-Related Quality of Life Among Jordanian Adolescents

Adolescence is an unpredictable stage of life with varied and rapid changes. In Jordan, health-related quality of life (HRQoL) has been examined among diabetic and obese children and adolescents. The purpose of this study was to assess the HRQoL of Jordanian healthy adolescents. Three hundred fifty-four male and female adolescents whose ages ranged from 12 to 19 participated in the study. A descriptive comparative design was employed to investigate adolescents' HRQoL. The results revealed statistically significant differences in physical well-being, psychosocial well-being, and autonomy in favor of male adolescents. In addition, statistically significant differences were observed in favor of nonsmoker adolescents in psychosocial well-being, self-perception, parent relations and home life, financial resources, social relations and peers and school environment. In conclusion, the creation of a school health nurse role in Jordanian schools is crucial for helping adolescents improve their health.

Adolescents' health-related quality of life (HRQoL) changes over time: a three year longitudinal study

BACKGROUND

Adolescence is a significant developmental stage marked by physical, psychological and social changes. While adolescents are generally perceived to be healthy, this stage of development is also associated with an emergence of risk factors that may have long-term consequences for their wellbeing. The aim of this study was to assess health related quality of life (HRQoL), and possible gender and age differences, in a sample of secondary school-aged adolescents over a three-year time period.

METHODS

Australian adolescents (n = 403, aged 12-15 at baseline) across six New South Wales high schools completed the KIDSCREEN-27 Questionnaire at three time points. The KIDSCREEN-27 measures five HRQoL domains (physical wellbeing, psychological wellbeing, autonomy and parents relations, social support and peers, and school environment). Mixed-between-within-subjects ANOVA analyses were employed to examine HRQoL over time and across age and gender.

RESULTS

HRQoL rates were comparable to the European-based KIDSCREEN norms with the exception of psychological wellbeing, which was considerably lower in this study's sample. Over time, for the total sample, there were significant changes on only one of the five dimensions (social support and peers). However, gender differences were found to be significant across three dimensions (physical wellbeing, psychological wellbeing, and autonomy and parents relations), with females reporting lower scores than males (i.e. lower HRQoL). Females' scores also declined over the three time points across two of the five HRQoL dimensions (social support and peers, and school environment), indicating reductions in HRQoL over time. Age differences were found across all but one dimension (autonomy and parents relations).

CONCLUSIONS

Although statistically significant, the changes in HRQoL may not be clinically significant, as the effect sizes were small and therefore those changes would not be readily noticeable. Those changes, however, suggest that, while HRQoL is predominantly stable over time, fluctuations and declines, such as those found for females, may be early indicators of physical and psychological vulnerabilities. If such vulnerabilities are detected timely; they may be addressed with preventative measures or appropriate interventions.

Health-related quality of life in a sample of Australian adolescents: gender and age comparison

PURPOSE

The primary purpose of this study was to profile the health-related quality of life (HRQoL) in a sample of secondary school-aged children in Australia. The secondary purpose was to contribute to the international literature on the HRQoL of adolescents using the KIDSCREEN instrument.

METHODS

The KIDSCREEN-27 Questionnaire was completed by 1111 adolescents aged between 11 and 17 from six Australian secondary schools. MANCOVA analysis was employed to examine age and gender differences.

RESULTS

Over 70 % of participants reported high levels of HRQoL across all five dimensions. Age patterns were identified with younger adolescents reporting greater HRQoL than older adolescents. Similarly, gender differences were noted with male adolescents reporting higher scores than female adolescents on three out of five dimensions of HRQoL.

CONCLUSIONS

This is the first study to measure HRQoL in Australian adolescents using the KIDSCREEN instrument. Consistent with previous research, gender and age differences were found across most dimensions of HRQoL. These results highlight the importance of comprehensively measuring the HRQoL in adolescents to capture developmental shifts and to inform preventative and supportive programs as needed.

Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents

Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries.

CONCLUSIONS

Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally.

WHAT IS KNOWN

• Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.