Transcript Slide 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.
The Worldwide Obesity Epidemic
Increasing percentage number of overweight children around the world [1, 2]
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]
Complications of Childhood Obesity
[6]
Psychosocial Complications of Obesity
overweight/
obesity
concern about
weight and
shape
emotional
problems
body
dissatisfaction
weight based
stigmatisation/
teasing
eating disorder
symptoms
HRQoL
low
self esteem
depression/
anxiety
resiliency
Wellness factors:
QoL
[7]
Health-related Quality of Life (HRQoL)
physical
psychological
social
other
wellbeing
dimensions
health-related
QoL
wellbeing
dimensions
global
QoL
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]
Health-related Quality of Life (HRQoL)
Biological
function
Symptoms
Functional
status
Health
status
HRQoL
[9]
Health-related Quality of Life (HRQoL)
[10]
Health-related Quality of Life (HRQoL)
[10]
Psychosocial Complications of Obesity
overweight/
obesity
Mediating variables
emotional
problems
[11]
:
concern about
weight and
shape
body
dissatisfaction
weight based
stigmatisation/
teasing
eating disorder
symptoms
HRQoL
low
self esteem
depression/
anxiety
resiliency
QoL
[12, 13]
The Obesity to HRQoL relationship
mediated by Body Image Concerns
overweight/
obesity
concern about
weight and
shape
emotional
problems
body
dissatisfaction
weight based
stigmatisation/
teasing
eating disorder
symptoms
HRQoL
low
self esteem
depression/
anxiety
resiliency
QoL
[14]
The Weight Status to HRQoL relationship
mediated by Body Image Perception
Weight
status
Body image
perception
emotional
problems
body
dissatisfaction
weight based
stigmatisation/
teasing
eating disorder
symptoms
HRQoL
low
self esteem
depression/
anxiety
resiliency
QoL
[15]
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:
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
The Weight Status to HRQoL relationship
mediated by Body Image Perception
Weight
status
Body image
perception
emotional
problems
body
dissatisfaction
weight based
stigmatisation/
teasing
eating disorder
symptoms
HRQoL
QoL
[19]
low
self esteem
resiliency
depression/
anxiety
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]
Mediation Analysis
Pearson’s r correlations
Regressions
Body image
perception
a
b
Parametric sobel test approach [22]
Non-parametric bootstrapping approach [11]
Indirect effect of axb should be significant
BMI
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
c
HRQoL
Mediation Results
Body image
perception
BMI
(-1.618**)
.213
Physical
wellbeing
Body image
perception
(full mediation)
BMI
(-1.456*)
.197
Autonomy &
parent relations
Body image
perception
(full mediation)
BMI
(-1.591*)
.179
(full mediation)
Total
HRQoL
Mediation Results
HRQoL
Body image
perception
Limitations of this study
Sampling
Conceptualization of HRQoL
Measurement of HRQoL and body image perceptions
Distribution of HRQoL scores
Study design
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
References
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