Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 340-347 (doi:10.1542/peds.2004-0678)
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Overweight, Obesity, and Health-Related Quality of Life Among Adolescents: The National Longitudinal Study of Adolescent Health

Karen C. Swallen, PhD, MPH*,{ddagger}, Eric N. Reither, MA, MS*,§, Steven A. Haas, PhD{ddagger} and Ann M. Meier, PhD||

* Center for Demography and Ecology
{ddagger} Center for Demography of Health and Aging
§ Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
|| Department of Sociology, University of Minnesota, Minneapolis, Minnesota

Objective. Childhood and adolescent overweight and obesity have increased substantially in the past 2 decades, raising concerns about the physical and psychosocial consequences of childhood obesity. We investigated the association between obesity and health-related quality of life in a nationally representative sample of adolescents.

Methods. A cross-sectional analysis was conducted using the 1996 National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7 to 12 during the 1994–1995 school year, and 4743 adolescents with direct measures of height and weight. Using Centers for Disease Control and Prevention growth charts to determine percentiles, we used 5 body mass categories. Underweight was at or below the 5th percentile, normal BMI was between the 5th and 85th percentiles, at risk for overweight was between the 85th and 95th percentiles, overweight was between the 95th and 97th percentiles + 2 BMI units, and obese was at or above the 97th percentile + 2 BMI units. Four dimensions of health-related quality of life were measured: general health (self-reported general health), physical health (absence or presence of functional limitations and illness symptoms), emotional health (the Center for Epidemiologic Studies Depression Scale and Rosenberg's self-esteem scale), and a school and social functioning scale.

Results. We found a statistically significant relationship between BMI and general and physical health but not psychosocial outcomes. Adolescents who were overweight had significantly worse self-reported health (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.34–3.51), as did obese adolescents (OR: 4.49; 95% CI: 2.87–7.03). Overweight (OR: 1.81; 95% CI: 1.22–2.68) and obese (OR: 1.91; 95% CI: 1.24–1.95) adolescents were also more likely to have a functional limitation. Only among the youngest adolescents (ages 12–14) did we find a significant deleterious impact of overweight and obesity on depression, self-esteem, and school/social functioning.

Conclusions. Using a nationally representative sample, we found that obesity in adolescence is linked with poor physical quality of life. However, in the general population, adolescents with above normal body mass did not report poorer emotional, school, or social functioning.

Key Words: adolescence • adolescent obesity • health-related quality of life • population-based studies

Abbreviations: HRQOL, health-related quality of life • Add Health, National Longitudinal Study of Adolescent Health • PedsQL, Pediatric Quality of Life Inventory • CESD, Center for Epidemiological Studies Depression Scale • OR, odds ratio • CI, confidence interval

Accepted Jul 6, 2004.




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