impact of body mass index health-related quality of life on the health-related quality of life in...
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Impact of body mass indexon the health-related quality of life
in urban disadvantaged children: does body image perception mediate the
relationship
Ms. Ciara Wynne, School of Nursing & Midwifery, TCD.
Professor Catherine Comiskey, School of Nursing & Midwifery, TCD.
Dr. Sinéad McGilloway, Department of Psychology, NUIM.
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The Worldwide Obesity Epidemic
Increasing percentage number of overweight children around the world [1, 2]
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Measuring body fatness in children: Body Mass Index (BMI) z scores using WHO or CDC references [3, 4]
Obesity: a state of excess body fat [5] > 30kg/m² or 97th percentile or +2 standard deviations [3]
Overweight: > 25kg/m² or 85th percentile or +1 standard deviation [3]
Weight Status
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Complications of Childhood Obesity
[6]
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Psychosocial Complications of Obesity
overweight/ obesity
emotional problems
body dissatisfaction
eating disorder symptoms
low self esteem
depression/ anxiety
concern about weight and
shape
weight based stigmatisation/
teasing
HRQoL resiliency
QoL
Wellness factors:
[7]
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Health-related Quality of Life (HRQoL)
physical
psychological
social
other
wellbeingdimensions
wellbeingdimensions
health-related QoL
globalQoL
HRQoL: a health outcome that reflects a subjective, multidimensional and comprehensive model of the quality of one’s life in reaction to one’s health [8]
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Biological function Symptoms Functional
statusHealth status
HRQoL
Health-related Quality of Life (HRQoL)
[9]
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Health-related Quality of Life (HRQoL)
[10]
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Health-related Quality of Life (HRQoL)
[10]
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Psychosocial Complications of Obesity
overweight/ obesity
emotional problems
body dissatisfaction
eating disorder symptoms
low self esteem
depression/ anxiety
concern about weight and
shape
weight based stigmatisation/
teasing
HRQoL resiliency
QoL
Mediating variables [11] :
[12, 13]
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overweight/ obesity
emotional problems
body dissatisfaction
eating disorder symptoms
low self esteem
depression/ anxiety
concern about weight and
shape
weight based stigmatisation/
teasing
HRQoL resiliency
QoL
The Obesity to HRQoL relationship mediated by Body Image Concerns
[14]
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Weight status
emotional problems
body dissatisfaction
eating disorder symptoms
low self esteem
depression/ anxiety
Body image perception
weight based stigmatisation/
teasing
HRQoL resiliency
QoL
The Weight Status to HRQoL relationship mediated by Body Image Perception
[15]
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Body Image Perception
Body image perception: a person’s attitudes and feelings towards their own body [16]
Body image concerns: a person’s perceived concern for their body weight & shape (children as young as 6 are found to have concerns) [17]
No concerns:
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Body Image Perception
Body image perception: a person’s attitudes and feelings towards their own body [16]
Body image concerns: a person’s perceived concern for their body weight & shape (children as young as 6 are found to have concerns) [17]
No concerns:
Negative body image: comprises both body dissatisfaction and body misperception [18] (an inaccurate perception of the body’s natural size & shape)
Positive body image: usually an accurate perception of the body’s natural size & shape
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Weight status
emotional problems
body dissatisfaction
eating disorder symptoms
low self esteem
depression/ anxiety
Body image perception
weight based stigmatisation/
teasing
HRQoL resiliency
QoL
The Weight Status to HRQoL relationship mediated by Body Image Perception
[19]
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This current study
Cross section design
Consecutive sampling of children in urban disadvantaged schools
TCD ethics committee approved study
255 children (50.2% boys)
Height and weight measured [3]
Body image perception question extracted [20]
Kidscreen 27 measures HRQoL [21]
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Mediation Analysis
HRQoL
Body image perception
BMI
Pearson’s r correlations
Regressions
Parametric sobel test approach [22]
Non-parametric bootstrapping approach [11]
Indirect effect of axb should be significant
Bootstrapped confidence interval for axb should not contain zero
Partial mediation exists when c remains significant
Full mediation exists when c is no longer significant
a b
c
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Mediation Results
Total HRQoL
Body image perception
BMI
Body image perception
BMI Autonomy & parent relations
Body image perception
BMI Physical wellbeing
-.393
**
4.654**
(-1.618**).213
(full mediation)
-.393
**
-.393
**
4.201**
4.528**
(-1.456*).197
(full mediation)
(-1.591*).179
(full mediation)
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Mediation Results
HRQoL
Body image perception
BMI
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Limitations of this study
Sampling
Conceptualization of HRQoL
Measurement of HRQoL and body image perceptions
Distribution of HRQoL scores
Study design
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Implications for Research and Practice
Prevention, early intervention and treatment of obesity
Stop the focus and discourse on weight and shape
Focus on health, wellness, and resilience in the whole child population
Encourage weight-neutral thoughts, feelings, attitudes and behaviours [23, 24, 25]
Research
HRQoL as a tool for planning appropriate interventions and protocols that consider the whole health and wellness of the child
HRQoL as an outcome measure to quantify the impact of overweightness on overall health and wellness
Need for a theory of HRQoL in children
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References
1) Government office for science (2005). Prevalence of overweight around the world statistics from the World Health Organisation. http://news.bbc.co.uk/2/hi/health/7151813.stm
2) Growing Up in Ireland (2011). Overweight and Obesity Among 9-Year-Olds. Minister for Children and Youth Affairs.
3) World Health Organisation (2012). WHO AnthroPlus for Personal Computers Manual. http://www.who.int/growthref/tools/who_anthroplus_manual.pdf
4) Centre for Disease Control and Prevention (2012). Epi Info Version 7 User Guide. http://ftp.cdc.gov/pub/software/epi_info/7/Epi_Info_7_User_Guide-V1.0_cleared.pdf
5) Himes, J., & Dietz, W. (1994).Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. Am J Clin Nutr. 1994;59(2):307-316.
6) Wabitsch, M. (2000). Overweight and obesity in European children: definition and diagnostic procedures, risk factors and consequences for later health outcome. European journal of pediatrics 159.13: 8-13.
7) Russell-Mayhew, S., McVey, G., Bardick, A., & Ireland, A. (2012). Mental Health, Wellness, and Childhood Overweight/Obesity. Journal of Obesity, 2012.
8) Fontaine, K. R., & Barofsky, I. (2001). Obesity and health‐related quality of life. Obesity reviews, 2(3), 173-182.9) Ferrans, C. E., Zerwic, J. J., Wilbur, J. E., & Larson, J. L. (2005). Conceptual Model of Health‐Related Quality
of Life. Journal of Nursing Scholarship, 37(4), 336-342.10) Bronfenbrenner, U. (1973). The social ecology of human development: A retrospective conclusion.
Bronfenbrenner, U.(2005). Making human beings human–bioecological perspectives on human development , 67-93.
11) Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate behavioral research, 42(1), 185-227.
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12) Jansen, W., van de Looij-Jansen, P. M., de Wilde, E. J., & Brug, J. (2008). Feeling fat rather than being fat may be associated with psychological well-being in young Dutch adolescents. Journal of Adolescent Health, 42(2), 128-136.
13) Chaiton, M., Sabiston, C., O'loughlin, J., McGrath, J. J., Maximova, K., & Lambert, M. (2009). A structural equation model relating adiposity, psychosocial indicators of body image and depressive symptoms among adolescents. International Journal of Obesity, 33(5), 588-596.
14) Tsiros, M. D., Olds, T., Buckley, J. D., Grimshaw, P., Brennan, L., Walkley, J., ... & Coates, A. M. (2009). Health-related quality of life in obese children and adolescents. International Journal of Obesity, 33(4), 387-400.
15) Bell, L. M., Byrne, S., Thompson, A., Ratnam, N., Blair, E., Bulsara, M., ... & Davis, E. A. (2007). Increasing body mass index z-score is continuously associated with complications of overweight in children, even in the healthy weight range. Journal of Clinical Endocrinology & Metabolism, 92(2), 517-522.
16) Uys, D. C., & Wassenaar, D. R. (1996). The perceptual and affective components of body image disturbances in anorexic and normal females. South African Journal of Psychology, 26, 236-242.
17) Ricciardelli, L. A., & McCabe, M. P. (2001). Children's body image concerns and eating disturbance: a review of the literature. Clinical psychology review, 21(3), 325-344.
18) Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual review of psychology, 53(1), 187-213.19) McCabe, M., & Ricciardelli, L. (2012). Parent, peer and media influences on body image and strategies to both
increase and decrease body size among adolescent boys and girls. Adolescence, 36(142), 225-240.20) Balding, J. (2002). HRBQ - providing baseline data. Education & Health, 20, 4, 71-71.21) KIDSCREEN Group Europe (2006). The Kidscreen Questionnaires. Quality of life questionnaires for children
and adolescents. Handbook. 22) Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological
research: Conceptual, strategic, and statistical considerations. Journal of personality and social psychology, 51(6), 1173.
23) Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10(9), 1-13.
24) Hutchinson, N., & Calland, C. (2011). Body image in the primary school. Routledge.25) The Magnificent Toby Plum. http://www.magnificentlyu.com