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Schwimmer JB, Burwinkle TM, Varni JW. Health-Related Quality of Life of Severely Obese Children and Adolescents. JAMA. 2003;289(14):1813–1819. doi:10.1001/jama.289.14.1813
Author Affiliations: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, School of Medicine (Dr Schwimmer), University of California, San Diego; Center for Child Health Outcomes (Ms Burwinkle), Children's Hospital and Health Center (Dr Schwimmer and Ms Burwinkle), San Diego, Calif; and Departments of Architecture and Medicine, Texas A&M University, College Station (Dr Varni).
Context One in 7 US children and adolescents is obese, yet little is known about
their health-related quality of life (QOL).
Objective To examine the health-related QOL of obese children and adolescents
compared with children and adolescents who are healthy or those diagnosed
as having cancer.
Design, Setting, and Participants Cross-sectional study of 106 children and adolescents (57 males) between
the ages of 5 and 18 years (mean [SD], 12.1  years), who had been referred
to an academic children's hospital for evaluation of obesity between January
and June 2002. Children and adolescents had a mean (SD) body mass index (BMI)
of 34.7 (9.3) and BMI z score of 2.6 (0.5).
Main Outcome Measures Child self-report and parent proxy report using a pediatric QOL inventory
generic core scale (range, 0-100). The inventory was administered by an interviewer
for children aged 5 through 7 years. Scores were compared with previously
published scores for healthy children and adolescents and children and adolescents
diagnosed as having cancer.
Results Compared with healthy children and adolescents, obese children and adolescents
reported significantly (P<.001) lower health-related
QOL in all domains (mean [SD] total score, 67 [16.3] for obese children and
adolescents; 83 [14.8] for healthy children and adolescents). Obese children
and adolescents were more likely to have impaired health-related QOL than
healthy children and adolescents (odds ratio [OR], 5.5; 95% confidence interval
[CI], 3.4-8.7) and were similar to children and adolescents diagnosed as having
cancer (OR, 1.3; 95% CI, 0.8-2.3). Children and adolescents with obstructive
sleep apnea reported a significantly lower health-related QOL total score
(mean [SD], 53.8 [13.3]) than obese children and adolescents without obstructive
sleep apnea (mean [SD], 67.9 [16.2]). For parent proxy report, the child or
adolescent's BMI z score was significantly inversely
correlated with total score (r = −0.246; P = .01), physical functioning (r =
−0.263; P<.01), social functioning (r = −0.347; P<.001),
and psychosocial functioning (r = −0.209; P = .03).
Conclusions Severely obese children and adolescents have lower health-related QOL
than children and adolescents who are healthy and similar QOL as those diagnosed
as having cancer. Physicians, parents, and teachers need to be informed of
the risk for impaired health-related QOL among obese children and adolescents
to target interventions that could enhance health outcomes.
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