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How is weight stigma related to children’s health-related quality of life? A model comparison approach

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Abstract

Purpose

Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with health-related quality of life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of preadolescent children, four competing models (i.e., additive, mediation, moderation, and moderated mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL.

Methods

A community sample of 600 children aged 8–11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood test, BIC difference, and Wald test were used for model comparisons.

Results

The mediation model outperformed both additive and moderation models and was found to be equally informative (but more parsimonious) as compared to the moderated mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic).

Conclusions

The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.

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Notes

  1. In order to control for potential confounders, all the analyses were repeated including children’s sex and age, and fathers’ and mothers’ educational level, as covariates. All the reported findings remained unchanged.

  2. Following an anonymous reviewer’s suggestion, a supplementary analysis was carried out to verify whether a non-linear (i.e., quadratic) function may better explain the relations among the variables. Results, however, revealed that the inclusion of a quadratic zBMI term did not improve the predictivity of the models, and the paths linking the quadratic zBMI term with both stigma experiences (standardized path = 0.10, p = 0.129) and HRQoL (standardized path = −0.04, p = 0.469) were not significant.

  3. The subsample retained for the laboratory study included 58 children with obesity, 32 with overweight, 69 with average weight, and 2 with underweight. Even though zBMI values resulting from parent-reported and directly recorded data were highly correlated, parent-reported data lead to a significant underestimation of children’s zBMI (M = 0.99, SD = 1.26) compared to direct measures (M = 1.29, SD = 1.22; t(160) = −5.24, p < 0.001). The difference between the two measures is small in size (Cohen’s d = −0.41, 95% CI −0.64, −0.19) and, importantly, is unrelated with both HRQoL, r = −0.03, p = 0.662, and weight stigma, r = −0.03, p = 0.700. We also tested the mediation model in this subsample, with zBMI based on directly recorded data as the main predictor. Results confirmed that the fit of the model was adequate (CFI = 0.98, TLI = 0.97, RMSEA = 0.04), with weight stigma fully mediating the relation between zBMI and the HRQoL (mean effect: −0.54, 99% CI −0.86, −0.22).

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Authors and Affiliations

  1. Department of Psychology, University of Bologna, Piazza Aldo Moro, 90, 47521, Cesena, FC, Italy

    Veronica Guardabassi & Carlo Tomasetto

  2. Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy

    Alberto Mirisola

Authors
  1. Veronica Guardabassi
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  2. Alberto Mirisola
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  3. Carlo Tomasetto
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Correspondence to Veronica Guardabassi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Guardabassi, V., Mirisola, A. & Tomasetto, C. How is weight stigma related to children’s health-related quality of life? A model comparison approach. Qual Life Res 27, 173–183 (2018). https://doi.org/10.1007/s11136-017-1701-7

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  • DOI: https://doi.org/10.1007/s11136-017-1701-7

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