The effect of weight status, lifestyle, and body image perception on health-related quality of life in children: a quantile approach

The role of lifestyle in the impact of constant phthalate exposure on overweight and obesity: A longitudinal cohort study in China

BACKGROUND AND OBJECTIVES

To explore the relationship between constant exposure to phthalates (PAEs) and overweight/obesity and the role of lifestyle in children.

METHODS

This study conducted five repeated follow-up visits with 829 children and analysed data from 740 children. Logistic regression models were used to evaluate the association between constant PAE exposure, lifestyle and overweight/obesity.

RESULTS

The study found that constant high levels of PAEs exposure may increase the risk of obesity in girls, and the risk is higher in girls with an unhealthy lifestyle. In the unhealthy lifestyle group of girls, compared with the constant low (CL) exposure group of PAEs, the odds ratios (ORs) for overweight/obesity and obesity in the constant high (CH) exposure group were 2.99 (1.11, 8.05) and 11.58 (1.38, 96.87), respectively. In addition, an interaction effect between constant exposure to PAEs and lifestyle was observed on obesity in girls.

CONCLUSION

These results suggest the importance of reducing constant exposure to high levels of PAEs to reduce the risk of obesity, especially in individuals with unhealthy lifestyles. The government should strengthen the formulation of regulations and standards for PAEs while guiding parents to use fewer plastic products.

Assessment of Multiple Dimensions of Psychological Well-Being in Swiss Youth Born with a Unilateral Cleft Lip and Palate

ObjectiveThis study examines the psychological well-being of Swiss youths born with a unilateral cleft lip and palate (UCLP), in a multi-dimensional and clinical perspective.DesignRetrospective cross-sectional study.SettingSelf-report questionnaires completed by youths born with UCLP, followed at a specialized cleft clinic in Switzerland, and by peers without UCLP, recruited in schools of the Vaud county, Switzerland.ParticipantsYouths aged 7.5 to 16, born with UCLP (clinical group, n = 41, 29.2% female) or without UCLP (control group, n = 56, 49.0% female).Outcome measuresAdverse life events (ALE; Adverse Life Events), behavioral and emotional symptoms (Strengths and Difficulties Questionnaire and Post-Traumatic Checklist Scale), bodily self-esteem (Body Esteem Scale), quality of life (Kidscreen-27), emotion regulation (Cognitive Emotion Regulation Questionnaire), social support (Sarason's Social Support Questionnaire).ResultsMost outcomes showed no significant group-difference. Compared to matched peers, youths with UCLP reported lower psychological quality of life and social support satisfaction, along with positive factors of fewer ALE and lower non-adaptive emotion regulation. In youths with UCLP, higher scores for ALE were associated with higher total scores for behavioral and emotional symptoms. Higher scores for bodily self-esteem were associated with higher scores for satisfaction of social support and adaptive emotion regulation.ConclusionsYouths with UCLP show globally similar psychological well-being as matched peers. We observed some vulnerabilities but also protective factors, which support the need for psychological perspective within multidisciplinary care. The relationships between dimensions suggest specific targets that may have an impact in context of intervention.

Effects of different surgical approaches on health-related quality of life in pediatric and adolescent patients with papillary thyroid carcinoma

OBJECTIVE

We aimed to compare the health-related quality of life (HRQOL) in pediatric and adolescent patients with papillary thyroid carcinoma who underwent bilateral or unilateral thyroidectomy.

METHODS

This prospective observational study recruited children and adolescents diagnosed with papillary thyroid carcinoma at low risk of recurrence. Participants were categorized into bilateral or unilateral thyroidectomy groups. They were asked to complete one questionnaire regarding basic information and three others regarding quality of life. HRQOL data from patients who underwent different procedures at various time points were compared.

RESULTS

Thirty patients underwent unilateral thyroidectomy and 54 bilateral thyroidectomy (median age = 14.27 years). HRQOL of the unilateral thyroidectomy group was higher than the bilateral group.

CONCLUSION

For children and adolescents with papillary thyroid carcinoma at low risk of recurrence, bilateral thyroidectomy is associated with a lower HRQOL than unilateral thyroidectomy. Surgeons should consider tumor impact and HRQOL when selecting the most appropriate surgical method.

How do determinants of health relate to children's quality of life? A cross-sectional study in Izmir, Turkey

AIM

This study aims to determine health-related quality of life (QoL) and the related factors from the perspective of social determinants of health among children.

BACKGROUND

Childhood is the most intense period of life, and environmental factors surrounding children, as well as individual lifestyle factors, are related to the child's physical and mental well-being. To our knowledge, there is a lack of studies evaluating the relationship between determinants of health and the QoL of healthy children in general.

METHODS

This cross-sectional study was executed in the Bayrakli district of Izmir city. Stratified clustered sampling was used including 24 schools and 3367 7th-grade children, and 1284 students were targeted (50% prevalence, 95% CI, %5 margins of error, 2.25 design effect, and 20% replacement). The response rate was 84.9% (n = 1090). The Turkish KID-KINDL Health-Related Quality of Life Questionnaire for Children was used to assess QoL. Independent variables were examined in four layers using Dahlgren's Determinants of Health Model: basic characteristics, lifestyle factors, family characteristics, and life conditions.

RESULTS

The mean QoL score was 71.3 ± 12.6. Our study explained 31.7% of the variance in QoL. Higher QoL scores were associated with better health status, perceived academic achievement, normal/thin body perception, physical activity (PA), and adequate sleep duration. Living with both parents and having fewer siblings positively influenced QoL. Moreover, the presence of structural problems in the household and poorer health perceptions were associated with lower QoL scores (P < 0.05) This study highlighted the multifaceted nature of QoL in Turkish children, revealing the importance of various determinants of health. The results show that in order to improve the general well-being of this population, interventions and policies are required that concentrate on elements including health status, academic accomplishment, body perception, physical activity, family structure, and living situations.

Association of Socioeconomic Factors and Physical Activity with Health-Related Quality of Life in Italian Middle School Children: An Exploratory Cross-Sectional Study

Health-related quality of life (HRQoL) provides a broad assessment of an individual's well-being and can serve as a good prognosticator of life's outcomes later for children and adolescents. Understanding the factors associated with HRQoL is crucial for promoting better health and life satisfaction. This study investigated the cross-sectional association of socioeconomic status, cardio fitness, and physical activity levels with HRQoL in 224 Italian early adolescents attending secondary school in the Emilia-Romagna region located in Northern Italy. In a multivariate path regression model, younger students and females reported a higher quality of life (β = -0.139, p = 0.015, 95% CI: -0.254--0.023 and β = 0.142, p = 0.019, 95% CI: 0.011-0.273, respectively). Having both parents employed and having a higher familiar educational status were also associated with a higher quality of life (β = 0.142, p = 0.013, 95% CI 0.027-0.257 and β = 0.133, p = 0.017, 95% CI 0.022-0.244, respectively). Greater engagement in routine physical activity levels from moderate to vigorous intensity was positively associated with quality of life (β = 0.429, p < 0.001, 95% CI: 0.304-0.554). Endurance (speed) was positively associated with quality of life (β = 0.221, p = 0.001, 95% CI: 0.087-0.355), and students with longer times on the shuttle run reported less quality of life (β = -0.207, p = 0.002, 95% CI: -0.337--0.077). These relations remained intact even when controlling for socioeconomic factors. The current findings reinforce the importance of promoting regular physical activity among younger children and also addressing socioeconomic status disparities to improve children's well-being. Future studies may want to consider expanding the array of measures used to assess physical activity and include additional measures assessing nutrition, cultural factors, and family functioning, all of which can influence a child's willingness to engage in physical activity and their well-being. The emphasis on fitness and physical activity and their contribution to a child's well-being should be the prime focus for stakeholders who work in the education, public health, and health policy sectors.

The mediating effect of food choice upon associations between adolescent health-related quality of life and physical activity, social media use and abstinence from alcohol

BACKGROUND

Understanding how health-related quality of life (HRQoL) is related to lifestyle factors during adolescence is crucial to effective health promotion. The aim of this analysis was to identify associations between HRQoL and lifestyle and to determine the degree to which they are mediated by food choices in adolescents.

METHODS

The Wellbeing in Schools (NI) survey (N = 1609; 13-14 years) assessed HRQoL using the Kidscreen52. Food choice was assessed by Food Frequency Questionnaire (FFQ) and physical activity was assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A). Social media and alcohol abstinence were self-reported.

RESULTS

Path analysis indicated that fruit and vegetable intake was associated with higher HRQoL on dimensions of moods and emotions, parent relations and home life, financial resources, and social support and peers. Bread and diary intake was related to higher physical wellbeing. Protein was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, financial resources, and lower social support and peers. Junk food was related to lower moods and emotions. Males had higher psychological wellbeing, moods and emotions, parental relations and home life. Females had higher self-perception, autonomy, and social support and peers. Greater physical activity explained higher HRQoL on all dimensions. Less social media was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment. Alcohol abstinence was associated with higher physical wellbeing, psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment dimensions.

CONCLUSION

Intervention to promote HRQoL in adolescents should consider food choices whilst encouraging physical activity, discouraging social media and deterring alcohol, and targeting boys and girls separately.

Physical Activity and Body Image Perception in Adolescents: A Systematic Review

Adolescence represents a vulnerable phase of life for psychological health. The practice of physical activity (PA) appears to have a positive influence on adolescents, increasing self-esteem and producing a more positive body image. A systematic review of published articles over the past 10 years until June 2022 was conducted according to the PRISMA statement employing the electronic databases MEDLINE and Web of Science (639 records) to summarize the literature on the relationship between body image dissatisfaction (BID) and assessed by figural scales and practice of structured and unstructured PA in adolescents (10-18 years), taking into account BMI and/or weight status. All articles were independently reviewed using inclusion/exclusion criteria, retrieved data, and assessed quality with the adapted Newcastle-Ottawa Scale for observational studies. The main finding of interest that emerged from most of the 28 included studies is the negative association between BID and PA during adolescence: as PA increases, BID decreases. However, this updated systematic review also identified some flaws in the existing literature, highlighting the need for high-quality adolescent research using validated figural scales and objective PA assessments. In conclusion, the reviewed studies showed that PA involvement can be efficacious in protecting from body image perception concerns and enhancing body satisfaction. Future interventions should promote structured and unstructured PA during adolescence to improve self-esteem and body image.

Adverse Influences of Nonstrabismic Amblyopia on Quality of Life of Teenagers in China

The aim of this study was to explore the influences of nonstrabismic amblyopia on quality of life in adolescents. Health-related quality of life (HRQoL) scale, a multidimensional construct that indicates a fundamental health outcome, was used to measure physical and psychosocial functioning of the adolescents. Forty teenagers with nonstrabismic amblyopia and 40 control teenagers without nonstrabismic amblyopia were recruited between April 2019 and July 2021. The anthropometric measures, body image, physical activity outcome, and HRQoL scores including physical health, emotional functioning, social functioning, and school functioning were compared between the two groups. The results revealed that teenagers with nonstrabismic amblyopia had less weekly sedentary time (P < 0.001), weekly total steps (P < 0.001), and worse school functioning (P = 0.0211) than control teenagers. No significant difference was found in anthropometric measures and body image between the two groups (P > 0.05). This study implied the needs for teenagers with nonstrabismic amblyopia to enhance physical activities. Teachers and parents are encouraged to pay more attention to teenagers with nonstrabismic amblyopia to improve their school functioning.

Reliability and Validity of the Polish Version of the Esophageal-Atresia-Quality-of-Life Questionnaires to Assess Condition-Specific Quality of Life in Children and Adolescents Born with Esophageal Atresia

Aim: This study reports the reliability and validity of the Polish version of the Esophageal Atresia Quality of Life (EA-QOL) questionnaires, which were originally developed in Sweden and Germany. Methods: A total of 50 families of children (23 aged 2 to 7, and 27 aged 8 to 17) with EA/TEF (esophageal atresia/tracheoesophageal fistula) participated in the study. The development and validation of the Polish version of the EA-QOL involved forward-backward translation of the survey items following the guidelines for cross-cultural translation, cognitive debriefing and evaluation of psychometric properties, including assessment of internal and retest reliability, linguistic validity, content validity, known-group validity and convergent validity. The medical records of patients and standardized questionnaires were used to obtain clinical data. The level of significance was p < 0.05. Results: The Polish versions of the EA-QOL questionnaires demonstrated strong linguistic and content validity, are slightly discriminative for esophageal and respiratory problems, but do not show convergent validity with the PedsQL 4.0 generic core scales. In terms of reliability, the internal consistency of the subscale and total scale of Polish versions as measured by Cronbach’s alpha is good, and retest reliability is excellent. Conclusions: The Polish versions of the EA-QOL questionnaires meet most psychometric criteria that confirm the EA-QOL questionnaires’ reliability and validity. This study enables application of these questionnaires in future research among children with EA in Poland and participation in international multicenter studies focusing on advancing knowledge of condition-specific QOL in this population. Future cross-cultural research using larger sample sizes is still needed to better address the relationship between condition-specific and generic QOL, as well as the discriminative ability of the EA-QOL questionnaires.

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.

Physical Activity Levels, Perceived Body Appearance, and Body Functioning in Relation to Perceived Wellbeing Among Adolescents

This study aimed to investigate self-reported physical activity levels, perceived body appearance, and body functioning in relation to perceived wellbeing among adolescents. A cross-sectional survey was performed in four upper secondary schools in one municipality in southern Sweden. Data were obtained from questionnaires completed by 1,491 adolescents (55.4% females; median age 16; range 15–17 years) during school hours. The participation rate was 71.4%. Logistic regression analyses were carried out with wellbeing as the dependent variable. The independent variables included gender, perceived family financial situation, perceived body appearance, perceived body function, and physical activity level. Perceived positive wellbeing was associated with being satisfied with their body's appearance (OR 3.4; CI 2.6–4.4) and function (OR 3.1; CI 2.2–4.2), being physically active three or more times per week (OR 1.5; CI 1.1–2.0), and a good perceived family financial situation (OR 3.3; CI 1.6–6.7). Gender was not significantly associated with wellbeing. A positive body image, which include both body appearance and body function, and high physical activity levels were significantly associated with wellbeing in adolescents, corroborating the importance of promoting physical activity among younger populations.

What Type of Body Shape Moves Children? An Experimental Exploration of the Impact of Narrative Cartoon Character Body Shape on Children's Narrative Engagement, Wishful Identification, and Exercise Motivation

BACKGROUND

The incorporation of narratives helps to enhance children's engagement in active video games (AVGs), thus increasing moderate-to-vigorous physical activity (MVPA). Specific narrative elements, such as the visual representation of the characters' body shape, have been rarely manipulated to explore their role in modulating children's narrative engagement (NE) and exercise motivation.

OBJECTIVE

To investigate the effects of character body shape manipulation (overweight/obese, average, or athletic slim) on children's narrative immersion (NI), NE, wishful identification (WI), as well as their mediating effect on AVG and PA motivation.

METHODS

Children ages 8-12 years old (N = 87) were randomly assigned to watch a 15-min animated video (designed for an existing AVG) in which the main characters had an overweight/obese, or average∗, or athletic slim body shape (all other elements were identical). Children's NI, NE, WI, and AVG and physical activity (PA) motivation were then assessed.

RESULTS

Controlling for social desirability, the analysis indicated that participants with a BMI of greater than the 75th percentile had a significantly higher NI, NE, WI, and PA motivation when video characters were set to the overweight/obese condition, than they did for video characters set to the average or athletic slim conditions. On the other hand, children of equal or less than the 75th percentile exposed to the average character body condition had a greater NE, WI, and PA motivation than overweight/obese or athletic slim conditions. A mediation analysis with structural equation modeling indicated that NE mediated the effect between character body shape and AVG and PA motivation.

CONCLUSION

Narrative cartoon characters that mirror the target participant's body shape can increase NE, which in turn mediates AVG and PA motivation. Content producers should identify optimal strategies in character body shape design to encourage children of different weight status to participate in PA with engaging stories to maximize health narratives' persuasive potentials.∗The term average in this sense is not in reference to the national average body weight, but rather an average of the body weights represented in conditions A and C.

The Determinants of Health-Related Quality of Life in a Sample of Primary School Children: A Cross-Sectional Analysis

Background: Health-related quality of life (HRQoL) in childhood is a multidimensional construct with many sub dimensions of subjective experience, including physical activity (PA), psychological well-being, social interaction, and school performance, that represents a fundamental health outcome to assess a child’s physical and psycho-social functioning. Our study aims to explore the potential predictors of children’s health-related quality of life, using a convenience sample from the Imola Active Break Study (I-MOVE), considering demographic, anthropometric measures, PA level measured by Actigraph accelerometers, parent-reported/self-reported HRQoL, and body image. Methods: A cross-sectional analysis was conducted among 151 primary school children in Italy. HRQoL was assessed using the Italian version 4.0 of the Paediatric Quality of Life (PedsQL) questionnaire. Results: Children who spent more time partaking in moderate PA were associated with a higher total PedsQL score (p < 0.03). Mother’s body mass index (BMI) was the only variable statistically significant associated with the physical health domain of PedsQL. Parent’s proxy-report perception concerning children’s psychosocial health was statistically relevant. The children’s gender, age, and BMI had no association with any of the HRQoL outcomes. Discussion: Parent proxy-report psychosocial health and mother’s BMI should be considered as predictors of HRQoL for the psychosocial and physical domain. PA should be implemented in order to improve the HRQoL of primary school children.

Body Weight Misperception and Weight Disorders among Chinese Children and Adolescents: A Latent Class Analysis

Body misperception plays an important role in the development of weight and dietary disorders among children and adolescents. A school-based health promotion program (2014-2015) was conducted to promote the school health education and improve the teenagers' physical health among Chinese children and adolescents. Based on this program, we intended to examine weight status and weight misperception among Chinese children and adolescents and to explore the relationship between weight misperception and lifestyle behaviors. A total of 10 708 Chinese children and adolescents in 3rd and 7th grade from Shandong and Qinghai province participated in the program. The participants' dietary and activity patterns were clustered by latent class analysis (LCA). Logistic regression analysis was undertaken to explore the relationship between weight perception and demographic factors or dietary and activity patterns. Given the gender-specific difference of children and adolescents, analyses were separately conducted among boys and girls. The total prevalence of weight misperception was 44.50%. Boys, especially those in higher grade and living in wealthier district, were more likely to misperceive body weight. Girls were more likely to overestimate their weight (26.10%) while boys tended to underestimate the weight (28.32%). Three latent dietary and activity patterns including obesogenic pattern, malnourished pattern and healthy pattern were derived. The participants who had weight misperception were more likely to choose unhealthy dietary and exercise activities. The high prevalence of weight misperception was closely related to the unhealthy weight pattern and unhealthy dietary or exercise patterns. Our research found that most children and adolescents failed to perceive their weight correctly and boys tended to underestimate their weight while girls were subjected to overestimation. So, comprehensive intervention programs should focus on improving self-weight awareness, and appropriate guidance should be made to lead the adolescents to more healthy weight pattern.

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.

Weight Misperception and Health-Related Quality of Life in Appalachian Adolescents in the United States

Introduction There is limited research on the relation between weight misperceptions and health-related quality of life (HRQoL) among U.S. adolescents. Methods Baseline data (n = 1509) collected in 2012 from the Team Up for Healthy Living project were used. Measures included BMI percentiles calculated from measured height and weight; self-perception of weight status; and the 23-item PedsQL™ Inventory. Multiple linear regression was performed after adjustment for covariates to examine associations between weight misperception and HRQoL. Results Compared to accurate weight perception, weight underestimation was associated with higher total HRQoL (β = 2.41), physical health (β = 2.77), and emotional (β = 2.83), social (β = 2.47) and psychosocial functioning (β = 2.38) (all p < 0.05). Weight overestimation was associated with lower social functioning (β = -13.13, p < 0.05). Stratified by gender, associations were observed only in males. Discussion Weight underestimation had greater association with HRQoL than weight overestimation; and varied by gender. Better understanding of these associations will assist in improving the health of adolescents in Southern Appalachia.

The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review

BACKGROUND

The association between physical activity, sedentary behavior and health-related quality of life in children and adolescents has been mostly investigated in those young people with chronic disease conditions. No systematic review to date has synthesized the relationship between physical activity, sedentary behavior and health-related quality of life in the general healthy population of children and adolescents. The purpose of this study was to review systematically the existing literature that evaluated the relations between physical activity, sedentary behavior and health-related quality of life in the general population of children and adolescents.

METHODS

We conducted a computer search for English language literature from databases of MEDLINE, EMBASE, PSYCINFO and PubMed-related articles as well as the reference lists of existing literature between 1946 and the second week of January 2017 to retrieve eligible studies. We included the studies that assessed associations between physical activity and/or sedentary behavior and health-related quality of life among the general population of children and adolescents aged between 3-18 years. The study design included cross-sectional, longitudinal and health intervention studies. We excluded the studies that examined associations between physical activity, sedentary behavior and health-related quality of life among children and adolescents with specific chronic diseases, and other studies and reports including reviews, meta-analyses, study protocols, comments, letters, case reports and guidelines. We followed up the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement in the reporting of this review. The risk of bias of the primary studies was assessed by the Newcastle-Ottawa Scale. We synthesized the difference in health-related quality of life scores between different levels of physical activity and sedentary time.

RESULTS

In total, 31 studies met the inclusion criteria and were synthesized in the review. Most of the included studies used a cross-sectional design (n = 21). There were six longitudinal studies and three school-based physical activity intervention studies. One study used both cross-sectional and longitudinal designs. We found that higher levels of physical activity were associated with better health-related quality of life and increased time of sedentary behavior was linked to lower health-related quality of life among children and adolescents. A dose-response relation between physical activity, sedentary behavior and health-related quality of life was observed in several studies suggesting that the higher frequency of physical activity or the less time being sedentary, the better the health-related quality of life.

CONCLUSIONS

The findings in this study suggest that school health programs promoting active lifestyles among children and adolescents may contribute to the improvement of health-related quality of life. Future research is needed to extend studies on longitudinal relationships between physical activity, sedentary behavior and health-related quality of life, and on effects of physical activity interventions on health-related quality of life among children and youth.

How is weight stigma related to children's health-related quality of life? A model comparison approach

PURPOSE

Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with health-related quality of life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of preadolescent children, four competing models (i.e., additive, mediation, moderation, and moderated mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL.

METHODS

A community sample of 600 children aged 8-11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood test, BIC difference, and Wald test were used for model comparisons.

RESULTS

The mediation model outperformed both additive and moderation models and was found to be equally informative (but more parsimonious) as compared to the moderated mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic).

CONCLUSIONS

The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.

Use of time and adolescent health-related quality of life/well-being: a scoping review

Time use could profoundly affect adolescents' health-related quality of life (HRQL). Ideally, overall time use patterns would be considered, because activities within a 24-hour day are inherently correlated (more in one activity means less in another). This review focused on the associations of (i) overall time use patterns and (ii) components of time use patterns with HRQL in adolescents.

CONCLUSION

More physical activity, less screen time and more/adequate sleep, in isolation, are associated with better profile-based HRQL subscales. Greater understanding of adolescents' overall time use patterns and HRQL is, therefore, a priority for policy development.

Association of Perceived Weight Status versus Body Mass Index on Adherence to Weight-modifying plan Among Iranian Children and Adolescents: The CASPIAN-IV Study

OBJECTIVE

To identify risk-groups adhering to weight-changing plans for body dissatisfaction in a National sample of Iranian students.

DESIGN

Cross-sectional.

SETTING

Primary, Middle and high-schools.

PARTICIPANTS

13486 students (mean age, 12.5 y).

MAIN OUTCOME MEASURES

Demographic and anthropometric characteristics were collected via valid instruments. Body image and adherence to weight- changing diets were assessed by using validated questionnaires.

RESULTS

46.5% students were satisfied with their weight and12.5% declared that they had attempts for weight control, this was significantly higher among adolescent girls (13.8%, P=0.0005). Participants who perceived themselves as overweight and obese, were more likely (OR= 5.32) to follow weight-reduction diets than their peers with normal-weight perception. Actual overweight-BMI and obese-BMI individuals had greater odds for being on a diet (1.3 and 1.47, respectively) compared to their normal-BMI counterparts.

CONCLUSION

Promoting strategies to improve body image concerns and prevent adverse outcomes of chronic dieting among adolescents are necessary.

The relationship between distorted body image and lifestyle among Japanese adolescents: a population-based study

Background

Distorted body image plays a significant role in the development of obesity, eating problems, and eating disorders. The aim of this study was to investigate the relationship between distorted body image and lifestyle among Japanese adolescent boys and girls.

Methods

Subjects were 1731 seventh graders (age 12–13 years) from the Ina-town’s junior high schools, Japan, from 2005–2009. The height and weight of each subject were measured. Childhood underweight, overweight, and obesity were defined using the body mass index cutoff points proposed by the International Obesity Task Force. Information regarding the self-perceived weight status and lifestyles (exercise, snacking after dinner, breakfast, wakeup time, bedtime) of each subject was collected using a self-administered questionnaire. Self-perceived weight status was categorized into three groups (thin, normal, or heavy), and compared with the subjects’ actual weight status. Body image perception was categorized into the following three groups: an underestimated own weight status group (underestimated group), a correct own weight status group (correct group) and an overestimated own weight status group (overestimated group).

Results

The proportion of boys in the underestimated group was higher than that of girls, while the opposite was true for the overestimated group (P < 0.001). There were no statistically significant differences in lifestyle between the underestimated group and the correct group regardless of sex. In contrast, there were statistically significant differences between the overestimated group and the correct group in the lifestyle factors of exercise among boys and snacking after dinner among girls. The adjusted odds ratio (OR) in boys who exercised daily significantly decreased (OR: 0.35, 95 % CI: 0.16–0.77), while a significantly increased OR was observed in girls who snacked after dinner (OR: 1.53, 95 % CI: 1.07–2.19).

Conclusion

Adolescent boys tended to underestimate their body weight, whereas adolescent girls were likely to overestimate their body weight. Furthermore, lifestyle factors associated with distorted body image differed by sex, with exercise affecting body image perception among boys and snacking after dinner affecting body image perception among girls. Thus, lifestyle may lead to distorted body image among adolescents.

The impact of overweight and obesity on health-related quality of life and blood pressure control in hypertensive patients

OBJECTIVE

Hypertension and obesity deteriorate patient health-related quality-of-life (HRQoL). This study assessed the impact of overweight and obesity on HRQoL and blood pressure (BP) control in hypertensive participants, according to sex.

METHODS

HRQoL was assessed using the 12-item Short Form Health Survey in 11,498 white patients treated for hypertension for at least 12 months. Nutritional status was diagnosed according to WHO criteria.

RESULTS

Overweight and obesity were associated with worse BP control, regardless of sex. In women, overweight and especially obesity were inversely associated with all analyzed HRQoL dimensions. Among men, obesity decreased all HRQoL dimensions, and overweight influenced only physical functioning, role physical, bodily pain, vitality, general health, and Physical Component Score (PCS) but not Mental Component Score (MCS). Overweight in men did not influence social functioning, or emotional and mental health. The BMI values associated with optimal PCS and MCS scores were higher for men than for women. Age-adjusted multivariate regression analysis revealed that PCS score was associated with obesity, higher education level, comorbidities, and antihypertensive therapy duration, whereas MCS score was associated with female sex. Polydrug BP control diminished PCS and MCS.

CONCLUSION

Overweight and obesity deteriorate BP control, regardless of age and polytherapy. BMI values associated with optimal HRQoL are higher for men than women treated for hypertension. Obesity more strongly diminishes the physical versus mental HRQoL component, regardless of sex. Overweight worsens HRQoL physical components in both sexes and mental component-only in women.