impact of body mass index health-related quality of life on the health-related quality of life in...

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.

The Worldwide Obesity Epidemic

Increasing percentage number of overweight children around the world [1, 2]

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

Complications of Childhood Obesity

[6]

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]

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]

Biological function Symptoms Functional

statusHealth status

HRQoL


[9]


[10]

Psychosocial Complications of Obesity

overweight/ obesity

emotional problems



low self esteem

depression/ anxiety


shape


teasing

HRQoL resiliency

QoL

Mediating variables [11] :

[12, 13]

overweight/ obesity

emotional problems



low self esteem

depression/ anxiety


shape


teasing

HRQoL resiliency

QoL

The Obesity to HRQoL relationship mediated by Body Image Concerns

[14]

Weight status

emotional problems



low self esteem

depression/ anxiety

Body image perception


teasing

HRQoL resiliency

QoL

The Weight Status to HRQoL relationship mediated by Body Image Perception

[15]

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:

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

Weight status

emotional problems



low self esteem

depression/ anxiety



teasing

HRQoL resiliency

QoL

The Weight Status to HRQoL relationship mediated by Body Image Perception

[19]

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]

Mediation Analysis

HRQoL


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

Mediation Results

Total HRQoL


BMI


BMI Autonomy & parent relations


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)

Mediation Results

HRQoL


BMI

Limitations of this study

Sampling

Conceptualization of HRQoL

Measurement of HRQoL and body image perceptions

Distribution of HRQoL scores

Study design

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

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.

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

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