Meta-analysis of the association between body mass index and health-related quality of life among children and adolescents, assessed using the PedsQL index

To explore the relationships between BMI and overall, physical and psychosocial health-related quality of life (HRQoL) in children and adolescents. A systematic review was conducted, in accordance with PRISMA guidelines. Medline, Embase, PsycINFO and the Web of Knowledge were searched for relevant articles. Inclusion was restricted to participants under 20 years of age, assessed using the PedsQL index. Random effects meta-analysis, meta-regression and cumulative meta-analysis were conducted. Heterogeneity was assessed using the I2 statistic, and potential publication and small study bias using funnel plots and Egger's test. Eleven eligible studies provided 35 estimates of effect size, derived from 13,210 study participants. Based on self report, children and adolescents with higher than normal BMI had significantly reduced total, physical and psychosocial HRQoL with a clear dose relationship across all categories. Among obese children/adolescents, the overall score was reduced by 10.6 points (95% CI 14.0, 7.2, p<0.001). Parents reported the same pattern but a larger effect size. The total parental score for obese children/adolescents was reduced by 18.9 points (95% CI 26.6, 11.1, p<0.001). No significant publication or small study bias was observed. Parents over-estimate the impact of obesity on the HRQoL of their children. Nonetheless, obese children/adolescents have significantly reduced overall, physical and psychosocial HRQoL.