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Impact of body mass index on the health-related quality of life

Impact of body mass index on 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.

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Impact of body mass index on the health-related quality of life

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  1. Impact of body mass index on 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.

  2. The Worldwide Obesity Epidemic Increasing percentage number of overweight children around the world [1, 2]

  3. Weight Status 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]

  4. Complications of Childhood Obesity [6]

  5. Psychosocial Complications of Obesity Wellness factors: [7]

  6. Health-related Quality of Life (HRQoL) physical psychological social other wellbeing dimensions health-related QoL global QoL wellbeing dimensions 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]

  7. Health-related Quality of Life (HRQoL) HRQoL [9]

  8. Health-related Quality of Life (HRQoL) [10]

  9. Health-related Quality of Life (HRQoL) [10]

  10. Psychosocial Complications of Obesity Mediating variables [11] : [12, 13]

  11. The Obesity to HRQoL relationship mediated by Body Image Concerns [14]

  12. The Weight Status to HRQoL relationship mediated by Body Image Perception [15]

  13. 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:

  14. 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

  15. The Weight Status to HRQoL relationship mediated by Body Image Perception [19]

  16. 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]

  17. Mediation Analysis HRQoL BMI • Pearson’s r correlations • Regressions • Parametric sobel test approach [22] • Non-parametric bootstrapping approach [11] • Indirect effect of axbshould 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 Body image perception a b c

  18. Mediation Results Autonomy & parent relations Physical wellbeing Total HRQoL BMI BMI BMI -.393** 4.654** Body image perception Body image perception Body image perception (-1.618**) .213 (full mediation) -.393** 4.201** (-1.456*) .197 (full mediation) -.393** 4.528** (-1.591*) .179 (full mediation)

  19. Mediation Results HRQoL BMI Body image perception

  20. Limitations of this study • Sampling • Conceptualization of HRQoL • Measurement of HRQoL and body image perceptions • Distribution of HRQoL scores • Study design

  21. 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

  22. References • 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 • Growing Up in Ireland (2011). Overweight and Obesity Among 9-Year-Olds. Minister for Children and Youth Affairs. • World Health Organisation (2012). WHO AnthroPlus for Personal Computers Manual. http://www.who.int/growthref/tools/who_anthroplus_manual.pdf • 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 • 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 ClinNutr. 1994;59(2):307-316. • 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. • Russell-Mayhew, S., McVey, G., Bardick, A., & Ireland, A. (2012). Mental Health, Wellness, and Childhood Overweight/Obesity. Journal of Obesity, 2012. • Fontaine, K. R., & Barofsky, I. (2001). Obesity and health‐related quality of life. Obesity reviews, 2(3), 173-182. • 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. • 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. • 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.

  23. 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. • 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. • 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. • 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. • 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. • 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. • Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual review of psychology, 53(1), 187-213. • 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. • Balding, J. (2002). HRBQ - providing baseline data. Education & Health, 20, 4, 71-71. • KIDSCREEN Group Europe (2006). The Kidscreen Questionnaires. Quality of life questionnaires for children and adolescents. Handbook. • 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. • Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10(9), 1-13. • Hutchinson, N., & Calland, C. (2011). Body image in the primary school. Routledge. • The Magnificent Toby Plum. http://www.magnificentlyu.com

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