At the recent International Conference on Childhood Obesity where Dr. Pretlow presented a workshop, he, of course, also took advantage of the opportunity to hear others speak. He was particularly interested in a presentation by Dr. Tommy Visscher, who referenced a 2003 University of California study that was the origin of the widely-quoted finding that “obese children rate their quality of life with scores as low as those of young cancer patients on chemotherapy.”
Lead author Dr. Jeffrey Schwimmer characterized this result as striking and profound. The subjects were 106 children ages 5 to 18 and their parents, who all filled out questionnaires. Interestingly, the parents rated their children as being even more deeply unhappy than the children themselves did.
A 2005 Australian study with around 1,500 subjects also questioned both the children and their parents. The objective was to see if community population-based samples lined up with clinical samples:
The effects of child overweight and obesity on health-related QOL [quality of life] in this community-based sample were significant but smaller than in a clinical sample using the same measure.
Previously, the only two relevant population-based studies had been less than totally useful because there was no tool for self-reporting by children, so everything came from the parents. Another difficulty in comparing studies is that some concentrate more on the physical aspects and others focus on mental and emotional health and relationships with others. They might take different factors into consideration, or use different methodologies.
There is also the ancient “Which came first, the chicken or the egg?” problem. Is there a “transactional relationship mediated by the presence of co-morbidities or by factors extrinsic to the child, such as parental mental health”? In other words, does the quality of life decline because the child is overweight/obese, or do children become overweight/obese in reaction to lives that are already messed up?
An American study published in 2005 looked at a “nationally representative sample of adolescents” and found a “statistically significant relationship between BMI and general and physical health but not psychosocial outcomes.” However, in the 12-14 year age group the deleterious impact of overweight and obesity was more pronounced in the areas of depression, self-esteem, and functioning in school and other social settings.
A 2010 German study followed children through a year of treatment for overweight/obesity. Even though the majority remained overweight, they seemed to benefit from the intervention in terms of subjective health, emotional well-being, and quality of life both in general and in relation to their weight.
The researchers felt this information could be useful for helping patients deal with chronic obesity, even if the impact on their weight was not impressive. The degree of impairment to quality of life can be influenced, and people can learn better coping skills.
The report on a 2010 meta-study began by noting the following:
Although an increasing number of children and adolescents are becoming obese, the psychological morbidities associated with obesity are not well established. Existing reviews report modest associations between obesity and global self-esteem. However, none have examined how this affects multi-component assessments of self-esteem and quality of life in young people with defined obesity.
The researchers looked mainly at physical competence, appearance, and social functioning. While there are “significant reductions in global self-esteem and quality of life in obese youth,” they found that improvements occurred both in the presence and absence of weight loss.
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Source: “Obese Children Rate Their Life Equal To Cancer,” Forces.org, 04/08/03
Source: “Health-Related Quality of Life of Overweight and Obese Children,” JAMANetwork.com, 01/05/05
Source: “Overweight, Obesity, and Health-Related Quality of Life Among Adolescents: The National Longitudinal Study of Adolescent Health,” AAPPublications.org, Feb 2005
Source: “The impact of overweight and obesity on health-related quality of life in childhood — results from an intervention study,” BioMedCentral.com, 12/23/10
Source: “Self-esteem and quality of life in obese children and adolescents: a systematic review,” NIH.gov, August 2010
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