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Jonides L, Buschbacher V, Barlow SE. Management of child and adolescent obesity: psychological, emotional, and behavioral assessment.  Pediatrics.2002;110:215-221.Google Scholar
Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease.  Pediatrics.1998;101:518-525.Google Scholar
Banis HT, Varni JW, Wallander JL.  et al.  Psychological and social adjustment of obese children and their families.  Child Care Health Dev.1988;14:157-173.Google Scholar
Varni JW, Rubenfeld LA, Talbot D, Setoguchi Y. Determinants of self-esteem in children with congenital/acquired limb deficiencies.  J Dev Behav Pediatr.1989;10:13-16.Google Scholar
Varni JW, Katz ER, Colegrove R, Dolgin M. Perceived physical appearance and adjustment of children with newly diagnosed cancer: a path analytic model.  J Behav Med.1995;18:261-278.Google Scholar
Varni JW, Setoguchi Y. Perceived physical appearance and adjustment of adolescents with congenital/acquired limb deficiencies: a path-analytic model.  J Clin Child Psychol.1996;25:201-208.Google Scholar
Varni JW, Seid M, Kurtin PS. The PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales in healthy and patient populations.  Med Care.2001;39:800-812.Google Scholar
Story MT, Neumark-Stzainer DR, Sherwood NE.  et al.  Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals.  Pediatrics.2002;110:210-214.Google Scholar
Kolotkin RL, Head S, Hamilton M, Tse CK. Assessing impact of weight on quality of life.  Obes Res.1995;3:49-56.Google Scholar
Fontaine KR, Cheskin LJ, Barofsky I. Health-related quality of life in obese persons seeking treatment.  J Fam Pract.1996;43:265-270.Google Scholar
Sullivan M, Karlsson J, Sjostrom L.  et al.  Swedish obese subjects (SOS)—an intervention study of obesity: baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined.  Int J Obes Relat Metab Disord.1993;17:503-512.Google Scholar
Varni JW, Seid M, Knight TS, Burwinkle TM, Brown J, Szer IS. The PedsQL in pediatric rheumatology: reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory Generic Core Scales and Rheumatology Module.  Arthritis Rheum.2002;46:714-725.Google Scholar
Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P. The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module.  Cancer.2002;94:2090-2106.Google Scholar
Varni JW, Seid M, Knight TS, Uzark K, Szer IS. The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making.  J Behav Med.2002;25:175-193.Google Scholar
Dietz WH, Robinson TN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents.  J Pediatr.1998;132:191-193.Google Scholar
Dietz WH, Bellizzi MC. Introduction: the use of body mass index to assess obesity in children.  Am J Clin Nutr.1999;70:123S-125S.Google Scholar
Barlow SE, Dietz WH.for the Maternal and Child Health Bureau, Health Resources and Services Administration, and the Department of Health and Human Services.  Obesity evaluation and treatment: expert committee recommendations.  Pediatrics.1998;102:E29.Google Scholar
Epstein LH, Wu YW, Paluch RA, Cerny FJ, Dorn JP. Asthma and maternal body mass index are related to pediatric body mass index and obesity: results from the Third National Health and Nutrition Examination Survey.  Obes Res.2000;8:575-581.Google Scholar
Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity.  Pediatrics.2002;110:497-504.Google Scholar
Varni JW, Setoguchi Y. Screening for behavioral and emotional problems in children and adolescents with congenital or acquired limb deficiencies.  AJDC.1992;146:103-107.Google Scholar
Janicke DM, Finney JW, Riley AW. Children's health care use: a prospective investigation of factors related to care-seeking.  Med Care.2001;39:990-1001.Google Scholar
Hollingshead AB. Four Factor Index of Social StatusNew Haven, Conn: Yale University; 1975.
Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the Pediatric Quality of Life Inventory.  Med Care.1999;37:126-139.Google Scholar
Nunnally JC, Bernstein IR. Psychometric Theory3rd ed. New York, NY: McGraw-Hill; 1994.
Pedhazur EJ, Schmelkin LP. Measurement, Design, and Analysis: An Integrated ApproachHillsdale, NJ: Erlbaum; 1991.
McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health survey (SF-36), II: psychometric and clinical tests of validity in measuring physical and mental health constructs.  Med Care.1993;31:247-263.Google Scholar
McHorney CA, Ware JE, Rogers W, Raczek AE, Lu JFR. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts: results from the Medical Outcomes Study.  Med Care.1992;30:MS253-MS265.Google Scholar
Cohen J. Statistical Power Analysis for the Behavioral Sciences2nd ed. Hillsdale, NJ: Erlbaum; 1988.
 SPSS Version 8.0 for Windows.  Chicago, Ill: SPSS Inc; 1998.
National Heart, Lung, and Blood Institute.  Morbidity and mortality chartbook. Available at: Accessed December 20, 2002.
Birmaher B, Ryan ND, Williamson DE.  et al.  Childhood and adolescent depression: a review of the past 10 years, part I.  J Am Acad Child Adolesc Psychiatry.1996;35:1427-1439.Google Scholar
Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL. The PedsQL in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales and type 1 diabetes module.  Diabetes Care.2003;26:631-637.Google Scholar
Uzark K, Jones K, Burwinkle TM, Varni JW. The Pediatric Quality of Life Inventory in children with heart disease.  Progress Pediatr Cardiol.In press.Google Scholar
Eiser C. Cancer. In: Koot H, Wallander J, eds. Quality of Life in Child and Adolescent Illness: Concepts, Methods, and Findings. New York, NY: Brunner-Routledge; 2001:267-295.
Spirito A, DeLawyer D, Stark L. Peer relations and social adjustment of chronically ill children and adolescents.  Psychol Rev.1991;11:539-564.Google Scholar
Varni JW, Katz ER, Colegrove R, Dolgin M. Perceived social support and adjustment of children with newly diagnosed cancer.  J Dev Behav Pediatr.1994;15:20-26.Google Scholar
Centers for Disease Control, National Center for Health Statistics.  Overweight children and adolescents 6-19 years of age, according to sex, age, race, and Hispanic origin: United States, selected years 1963-65 through 1999-2000. Available at: Accessed October 19, 2002.
Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000.  JAMA.2002;288:1728-1732.Google Scholar
Ravens-Sieberer U, Redegeld M, Bullinger M. Quality of life after in-patient rehabilitation in children with obesity.  Int J Obes Relat Metab Disord.2001;25(suppl 1):S63-S65.Google Scholar
Kolotkin RL, Crosby RD, Williams GR. Health-related quality of life varies among obese subgroups.  Obes Res.2002;10:748-756.Google Scholar
Doll HA, Petersen SE, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire.  Obes Res.2000;8:160-170.Google Scholar
Mo-suwan L, Lebel L, Puetpaiboon A, Junjana C. School performance and weight status of children and young adolescents in a transitional society in Thailand.  Int J Obes Relat Metab Disord.1999;23:272-277.Google Scholar
Vetiska J, Glaab L, Perlman K, Daneman D. School attendance of children with type 1 diabetes.  Diabetes Care.2000;23:1706-1707.Google Scholar
Diette GB, Markson L, Skinner EA, Nguyen TT, Algatt-Bergstrom P, Wu AW. Nocturnal asthma in children affects school attendance, school performance, and parents' work attendance.  Arch Pediatr Adolesc Med.2000;154:923-928.Google Scholar
Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood.  N Engl J Med.1993;329:1008-1012.Google Scholar
Veale D, Poussin G, Benes F, Pepin JL, Levy P. Identification of quality of life concerns of patients with obstructive sleep apnea at the time of initiation of continuous positive airway pressure: a discourse analysis.  Qual Life Res.2002;11:389-399.Google Scholar
Original Contribution
April 9, 2003

Health-Related Quality of Life of Severely Obese Children and Adolescents

Author Affiliations

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).

JAMA. 2003;289(14):1813-1819. doi:10.1001/jama.289.14.1813

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 [3] 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.