Weight, weight perceptions and health-related quality of life among youth

BACKGROUND: While the association of overweight/obesity with poor health-related quality of life (HRQOL) has been repeatedly documented in clinical samples of severely obese youth, evidence for an association in population-based samples remains inconclusive. We argue that the evidence is inconclusive because, rather than weight status, more appropriate predictors of HRQOL in population-based studies of youth are perceived weight and weight misperception. This study examines the association between weight status, perceived weight, weight misperceptions and HRQOL.

METHODS: Data are from the 2006 Health Behaviors in School-Age Children survey, a nationally representative sample of students in grades 6-10 during the 2005/6 school-year (n=7,432). Controlling for sociodemographics, we used multivariate linear regressions to examine associations among 3 weight indices (weight status, perceived weight, weight misperception) and dimensions of HRQOL including physical (general health, physical symptoms); emotional (psychological symptoms, depression); and a school/social dimension. All analyses were stratified by gender and controlled for the complex survey design.

RESULTS: Among girls, 27.4% were overweight/obese, 37.2% perceived themselves as “too fat” and 18.4% had overweight misperceptions. Among boys, 33.4% were overweight/obese, 25.8% perceived themselves as “too fat”, and 8.5% had overweight misperceptions. Overweight/obesity were associated with poor HRQOL. However, adding weight perceptions to the models rendered the association between overweight/obesity and HRQOL non-significant. All adolescents who misperceived themselves as overweight reported poorer HRQOL than those with accurate weight perceptions.

CONCLUSION: Parents, teachers and clinicians should be aware that, rather that overweight status, perceptions of being overweight (accurately or not) are associated with a poor HRQOL among boys and girls.