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Health-related quality of life and body mass index among US adolescents

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Abstract

Purpose

To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents.

Methods

From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes—self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days—in four BMI categories—obese, overweight, normal weight, and underweight—of approximately 6,000 US adolescents aged 12–17 years. We also estimated the percentages for boys and girls separately.

Results

Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95 % CI 15–22) of obese adolescents reported fair or poor health compared to only 5 % (95 % CI 4–7) of normal-weight adolescents. Thirty-seven percent (95 % CI 33–42) of obese adolescents reported excellent or very good health, compared to 65 % (94 % CI 63–67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls.

Conclusions

Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls.

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Notes

  1. All of these remaining adolescents had complete records of their measured heights and weights.

  2. These cut-off methods have also been used in many previous studies to represent the degree of severity for “Unhealthy Days” measures [34]. For instance, adolescents who reported ≥14 days of mentally unhealthy days would be considered as having frequent mental distress.

  3. Very few adolescents (<0.1%) gave “Do not know/Not sure” answers or refused to answer the questions.

  4. This variable is an index for the ratio of family income to poverty, based on the Department of Health and Human Services’ (HHS) poverty guidelines [27]. In 2008, for a family of four, a PIR of 130% was equivalent to $29,000 and a PIR of 350 % was approximately equivalent to $77,000 [35].

  5. Adolescents were defined as physically active if they answered yes to either the survey question asking if they ever participated in any vigorous-intensity sports, fitness, or recreational activities or the question asking if they ever participated in any moderate-intensity sports, fitness, or recreational activities. Adolescents were classified physically inactive if they answered no to both of these questions.

  6. The software we used, SAS-callable SUDAAN 10, requires creating interaction terms to obtain predicted marginal proportions for each sex.

  7. We also examined the interactions between BMI and income as well as between BMI and race/ethnicity, and found that these interactions were not statistically significant after controlling for all other covariates in the model and thus were not reported.

  8. Originally, we considered other statistical models such as proportional-odds ordinal logistic regression, but the proportional-odds assumption was not met. Because we are more interested in estimating the magnitude of differences such as percentages for our outcome variables, the nominal multinomial logistic regression model fits our data adequately with fewer assumptions.

  9. We chose to report percentages because, based on our experience, they are more easily understood than other statistics such as odds ratios and regression coefficients.

  10. These adjusted percentages are based on the predicted marginal proportions estimated from the multinomial logistic regression as the average of the predicted responses in each category if all the respondents had been in that category after adjustment for the covariates.

  11. Although the effects of these covariates (e.g., race/ethnicity and PIR) on adolescent HRQOL are of interest to many researchers, we did not discuss them in the Results section because the main focus of our paper was to examine the relationship between BMI and HRQOL after controlling/adjusting for these confounders/covariates.

Abbreviations

HRQOL:

Health-related quality of life

BMI:

Body mass index

NHANES:

National Health and Nutrition Examination Surveys

MEC:

Mobile examination center

PIR:

Poverty-income ratio

Adjusted OR:

Adjusted odds ratio

CI:

Confidence intervals

N :

Sample size

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Acknowledgments

The project was undertaken while Dr. Cui was under contract with CDC through the Oak Ridge Institute for Science and Education (ORISE) fellowship program.

Conflict of interest

The authors report no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-78, Atlanta, GA, 30341, USA

    Wanjun Cui & Matthew M. Zack

  2. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Holly Wethington

Authors
  1. Wanjun Cui
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  2. Matthew M. Zack
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  3. Holly Wethington
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Corresponding author

Correspondence to Wanjun Cui.

Additional information

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Appendix

Appendix

See Tables 1–4.

Table 1 Body mass index categories, sociodemographic characteristics, risky behaviors, and interview years among adolescents, 12–17-year old—National Health and Nutrition Examination Survey, 2001–2010 (N = 7,031)
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Table 2 Adjusted percentages of the CDC’S health-related quality-of-life measures among adolescents, 12–17-year old, by body mass index category—National Health and Nutrition Examination Survey, 2001–2010
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Table 3 Adjusted percentages of the CDC’s HEALTH-related quality-of-life measures among adolescents, 12–17-year old, by body mass index category for each sex—National Health and Nutrition Examination Survey, 2001–2010
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Table 4 Results of multinomial logistic regression: odds ratios for the body mass index categories and all covariates among adolescents, 12–17 years old—National Health and Nutrition Examination Survey, 2001–2010
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Cui, W., Zack, M.M. & Wethington, H. Health-related quality of life and body mass index among US adolescents. Qual Life Res 23, 2139–2150 (2014). https://doi.org/10.1007/s11136-014-0646-3

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