Many studies have reported that obese children and adolescents have poorer HRQOL not only in the total domain score but also in all domains (physical, emotional, social, and school life) compared with their normal-weight peers 32–35, which is in agreement with the results of the present study, except for public distress. Kolotkin et al.36 found statistically significant differences between the overweight and the obese groups for all domains. Similarly, Schwimmer et al.19 reported that children’s HRQOL was markedly more decreased in obese than overweight children. This was also found in the present study, in which overweight and obese children seemed to have the same HRQOL, except psychological distress and WRSM, but poorer than those of healthy weight children. Kolotkin et al.36 reported a significant difference between the healthy weight and overweight adolescents, especially in the domain of body esteem, with the overweight children reporting lower QOL scores. Moreover, Wille et al.14 found that overweight children showed impairments in their perceived health, social, and emotional well-being, but other dimensions of HRQOL such as physical well-being, psychological well-being, self-esteem, family and school life as well as overall HRQOL were not significantly impaired.
The domain of physical dysfunction describes the subjective perception of how weight affects mobility and comfort in daily life. Obesity has negative effects on functional status including work absenteeism, productivity, bodily pain, and depression 37. Kaukua 38 found that overweight and obesity affected physical functioning more strongly than mental functioning. In contrast, Sato et al.39 reported that the overall QOL scores did not differ significantly among their three studied groups (underweight, normal weight, and overweight). The domain of body esteem assesses the impact of weight on body self-perceptions and appearance.
In contrast to the present results of poorer total HRQOL in children than in adolescents, Wille et al.13 reported that because of the marked decrease in HRQOL in the general population during adolescence, compared with age-specific norms, adolescents had less impairments than children. However, overweight and obese adolescents (especially females) reported the poorest absolute HRQOL scores.
The effect of sex in the present study seemed to be negligible on total and almost all the domains of HRQOL. This is in agreement with the study of Riazi et al.40, whose results were found to be similar for boys and girls, and suggests that the impact of obesity is not necessarily sex specific. In contrast to our results, Kunkel et al.34 reported that the QOL of female adolescents compared with that of males was lower among both the excess weight group and the normal weight group. These results are expected as many studies have shown that female adolescents have greater concern with their body image 41,42. Other authors have found that overweight and obese adolescent females reported lower quality-of-life scores than males 13,34. It is widely accepted that females, in general, report poorer body esteem 43 and poorer emotional functioning 44 compared with males. Modi et al.45 found that males reported higher scores on the emotional domain compared with females. Normal-weight boys reported higher physical functioning scores than their obese peers. Normal-weight girls reported higher physical functioning and average HRQOL scores than obese girls. Normal-weight and overweight boys reported higher average HRQOL scores than girls 46. Another study showed that obese female adolescents were significantly more likely to report lower QOL than those with normal weight in all domains, except the emotional domain. For male adolescents, this difference remained significant only for the total domain score 34. Tsiros et al.47 reported an inverse relationship between BMI and pediatric HRQOL with impairments in physical and social functioning.
In the present study, it was found that mother’s education played no apparent role in HRQOL in each group. In contrast, Williams et al.20 reported that low maternal education was associated with a significant decrease in the pediatric QOL in the higher weight category. HRQOL is rather affected by the father’s occupation/social class than by the mother’s education. Lower socioeconomic status is associated with a reduction in quality-adjusted life years, mediated partly through behavioral risk factors such as obesity, smoking, a sedentary lifestyle, and alcohol 48. In agreement with the results of the present study, Minet Kinge and Morris 49 reported that the negative impact of obesity was greater on HRQOL in individuals from lower socioeconomic groups. Moreover, they found that overweight and obese individuals in lower socioeconomic groups had lower HRQL than those of normal-weight individuals in the same socioeconomic group, and had lower HRQL than those in higher socioeconomic groups of the same weight. The disparities in the risk of overweight and obese status among those with limited economic resources has remained and even increased; indigent adolescent males, for example, are more likely to remain overweight, and indigent adolescent females are more likely to become overweight, than their peers with greater economic resources 50. Factors in the environment may contribute to the relation between lower socioeconomic status and obesity; these factors may include walkability of the neighborhood 51.
This study focused on the evaluation of determinants of poor HRQOL in children. Obesity, overweight, and lower social class predispose to poor HRQOL in children. This problem should be dealt with as early as possible comprehensively: obesity and HRQOL and the underlying sociodemographic determinants. For health providers, total and domain HRQOL can yield a better understanding of life and health aspects that are most affected by overweight and obesity in children. HRQOL can be used by physicians and teachers to assess the effectiveness of obesity management and lifestyle health education.
There are no conflicts of interest.
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