Quality of Life Research

, Volume 21, Issue 1, pp 59–69 | Cite as

Overweight and its impact on the health-related quality of life in children and adolescents: results from the European KIDSCREEN survey

  • Veronika OttovaEmail author
  • Michael Erhart
  • Luis Rajmil
  • Lucia Dettenborn-Betz
  • Ulrike Ravens-Sieberer



To analyse the impact of overweight on HRQoL in a European sample of children and adolescents.


Analyses were conducted using data on 17,159 children and adolescents aged 8–18 from 10 European countries (Germany, Spain, France, Netherlands, Austria, United Kingdom, Switzerland, Hungary, Czech Republic and Poland) participating in the KIDSCREEN Health Interview Survey. In the studied sample (N = 13,041), there were slightly more girls (52.6%) than boys (47.4%). Gender- and age-specific cut-offs of Cole et al. (BMJ 320:1240, 2000) were used to define overweight and obesity. The two groups were collapsed into one ‘overweight’ category. HRQoL was assessed on 10 dimensions using the KIDSCREEN-52. Univariate analysis of covariance (ANCOVA) was performed for group comparisons (normal weight vs. overweight). Partial eta squared (η p 2 ) was used as a measure of effect strength.


Overall, 14.2% (N = 1,849) of the sample was overweight, with prevalence rates ranging between 9.4% in France and 17.6% in Spain. Across all countries, overweight children and adolescents had lower mean HRQoL scores than normal weight children and adolescents. The strongest HRQoL impairments emerged on the physical well-being (η p 2  = 0.012) and self-perception dimensions (η p 2  = 0.021), both P < 0.001.


This is one of the first studies comparing the impact of HRQoL at European level using a generic and internationally valid HRQoL instrument, and the results show that, irrespective of national background, overweight children and adolescents are significantly impaired on their HRQoL, in particular on the physical well-being and the self-perception domain.


Health-related quality of life Overweight Child Adolescent Europe 



Body mass index


Family affluence scale


Health-related quality of life



The KIDSCREEN Project ( was a cross-national effort centering around the development of a cross-culturally standardized instrument for the assessment of children’s and adolescents’ health-related quality of life. The project was funded by the European Commission, contract No.: QLG-CT-2000–00751/EC 5th Framework-Programme.

Competing interests

The authors declare that they have no competing interests.


  1. 1.
    World Health Organization (WHO). (2005). Adipositas: Eine Herausforderung für die Europäische Region der WHO. Faktenblatt EURO/13/05. Kopenhagen, Bukarest. 12. September 2005. Accessed November 17 2010.
  2. 2.
    Haug, E., Rasmussen, M., Samdal, O., Iannotti, R., Kelly, C., Borraccino, A., et al. (2009). Overweight in school-aged children and its relationship with demographic and lifestyle factors: results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) Study. International Journal of Public Health, 54(Suppl 2), S167–S179.CrossRefGoogle Scholar
  3. 3.
    Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R., Currie, D., et al. (Eds.). (2008). Inequalities in young people’s health: HBSC international report from the 2005/2006 Survey. Health Policy for Children and Adolescents. Copenhagen: WHO Regional Office for Europe.Google Scholar
  4. 4.
    Cattaneo, A., Monasta, L., Stamatakis, E., Lioret, S., Castetbon, K., Frenken, F., et al. (2010). Overweight and obesity in infants and pre-school children in the European Union: A review of existing data. Obesity Reviews, 11, 389–398.PubMedCrossRefGoogle Scholar
  5. 5.
    Lobstein, T., & Frelut, M.-L. (2003). Prevalence of overweight among children in Europe. Obesity Reviews, 4, 195–200.PubMedCrossRefGoogle Scholar
  6. 6.
    Madsen, K. A., Weedn, A. E., & Crawford, P. B. (2010). Disparities in peaks, plateaus, and declines in prevalence of high BMI among adolescents. Pediatrics, 126, 434–442.PubMedCrossRefGoogle Scholar
  7. 7.
    Wang, Y., & Lobstein, T. (2006). Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity, 1, 11–25.PubMedCrossRefGoogle Scholar
  8. 8.
    Low, L. C. K. (2010). Childhood obesity in developing countries. World Journal of Pediatrics, 6(3), 197–198.PubMedCrossRefGoogle Scholar
  9. 9.
    Wille, N., Bullinger, M., Holl, R., Hoffmeister, U., Mann, R., Goldapp, C., et al. (2010). Health-related quality of life in overweight and obese youths: Results of a multicenter study. Health Qual Life Outcomes, 8, 36.PubMedCrossRefGoogle Scholar
  10. 10.
    Freedman, D. S., Khan, L. K., Serdula, M. K., Dietz, W. H., Srinivasan, S. R., & Berenson, G. S. (2005). The relation of childhood bmi to adult adiposity: The Bogalusa heart study. Pediatrics, 115(1), 22–27.PubMedGoogle Scholar
  11. 11.
    Braet, C., Mervielde, I., & Vandereycken, W. (1997). Psychological aspects of childhood obesity: A controlled study in a clinical and nonclinical sample. Journal of Pediatric Psychology, 22(1), 59–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Williams, J., Wake, M., Hesketh, K., Maher, E., & Waters, E. (2005). Health-related quality of life of overweight and obese children. JAMA, 293(1), 70–76.PubMedCrossRefGoogle Scholar
  13. 13.
    Griffiths, L. J., Parsons, T. J., & Hill, A. J. (2010). Self-esteem and quality of life in obese children and adolescents: A systematic review. International Journal of Pediatric Obesity, 5(4), 1–23.CrossRefGoogle Scholar
  14. 14.
    The KIDSCREEN Group Europe. (2006). The KIDSCREEN Questionnaires. Quality of life questionnaires for children and adolescents. Handbook. Lengerich: Pabst Science Publishers.Google Scholar
  15. 15.
    Ravens-Sieberer, U., Gosch, A., Rajmil, L., Erhart, M., Bruil, J., Power, M., et al. (2008). The KIDSCREEN-52 quality of life measure for children and adolescents: psychometric results from a cross-cultural survey in 13 European countries. Value Health, 11(4), 645–658.PubMedCrossRefGoogle Scholar
  16. 16.
    Ravens-Sieberer, U., Auquier, P., Erhart, M., Gosch, A., Rajmil, L., Bruil, J., et al. (2007). The KIDSCREEN-27 quality of life measure for children and adolescents: psychometric results from a cross-cultural survey in 13 European countries. Quality of Life Research, 16(8), 1347–1356.PubMedCrossRefGoogle Scholar
  17. 17.
    Ravens-Sieberer, U., Erhart, M., Rajmil, L., Herdman, M., Auquier, P., Bruil, J., et al. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: a short measure for children and adolescents’ well-being and health-related quality of life. Quality of Life Research, 19(10), 1487–1500.PubMedCrossRefGoogle Scholar
  18. 18.
    Berra, S., Ravens-Sieberer, U., Erhart, M., Tebe, C., Bisegger, C., Duer, W., et al. (2007). Methods and representativeness of European surveys in children and adolescents: the KIDSCREEN study. BMC Public Health, 7, 182.PubMedCrossRefGoogle Scholar
  19. 19.
    Robitail, S., Simeoni, M.-C., Erhart, M., Ravens-Sieberer, U., Bruil, J., & Auquier, P. (2006). Validation of the European Proxy KIDSCREEN-52 Pilot Test Health-Related Quality of Life Questionnaire: First Results. Journal of Adolescent Health, 39(4), 596.e1–596.e10.CrossRefGoogle Scholar
  20. 20.
    Wang, Y. (2004). Epidemiology of childhood obesity—Methodological aspects and guidelines: What is new? International Journal of Obesity, 28(Suppl 3), 21–28.CrossRefGoogle Scholar
  21. 21.
    Janssen, I., Katzmarzyk, P. T., Boyce, W. F., Vereecken, C., Mulvihill, C., Roberts, C., et al. (2005). Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obesity Reviews, 6(2), 123–132.PubMedCrossRefGoogle Scholar
  22. 22.
    Brooks-Gunn, J., Warren, M. P., Rossa, J., & Gargiulo, J. (1987). Validity of self-reported measures of girl’s pubertal status. Child Development, 58, 829–841.PubMedCrossRefGoogle Scholar
  23. 23.
    Strauss, R. S. (1999). Comparison of measured and self-reported weight and height in a cross-sectional sample of young adolescents. International Journal of Obesity, 23, 904–908.PubMedCrossRefGoogle Scholar
  24. 24.
    Elgar, F. J., Roberts, C., Tudor-Smith, C., & Moore, L. (2005). Validity of self-reported height and weight and predictors of bias in adolescents. Journal of Adolescent Health, 37(5), 371–375.PubMedCrossRefGoogle Scholar
  25. 25.
    Goodman, E., Hinden, B. R., & Khandelwal, S. (2000). Accuracy of teen and parental reports of obesity and body mass index. Pediatrics, 106(1), 52–58.PubMedCrossRefGoogle Scholar
  26. 26.
    Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 320, 1240.PubMedCrossRefGoogle Scholar
  27. 27.
    International Standard Classification of Education (ISCED). Accessed 17 Nov 2010.
  28. 28.
    Currie, C., Elton, R. A., Todd, J., & Platt, S. (1997). Indicators of socioeconomic status for adolescents: The WHO health behaviour in school-aged children survey. Health Education Research, 12(3), 385–397.PubMedCrossRefGoogle Scholar
  29. 29.
    Bortz, J. (2005). Statistik für Human- und Sozialwissenschaftler. Heidelberg: Springer.Google Scholar
  30. 30.
    Schwimmer, J. B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of severely obese children and adolescents. JAMA, 289(14), 1813–1819.PubMedCrossRefGoogle Scholar
  31. 31.
    Shoup, J. A., Gattshall, M., Dandamudi, P., & Estabrooks, P. (2008). Physical activity, quality of life, and weight status in overweight children. Quality of Life Research, 17, 407–412.PubMedCrossRefGoogle Scholar
  32. 32.
    Tyler, C., Johnston, C. A., Fullerton, G., & Foreyt, J. P. (2007). Reduced quality of life in very overweight Mexican American adolescents. Journal of Adolescent Health, 40, 366–368.PubMedCrossRefGoogle Scholar
  33. 33.
    Ravens-Sieberer, U., Redegeld, M., & Bullinger, M. (2001). Quality of life after in-patient rehabilitation in children with obesity. International Journal of Obesity, 25(Suppl 1), 63–65.CrossRefGoogle Scholar
  34. 34.
    Analitis, F., Velderman, M. K., Ravens-Sieberer, U., Detmar, S., Erhart, M., Herdman, M., et al. (2009). Being bullied: Associated factors in children and adolescents 8 to 18 years old in 11 European countries. Pediatrics, 123(2), 569–577.PubMedCrossRefGoogle Scholar
  35. 35.
    Ricciardelli, L. A., & McCabe, M. P. (2001). Children’s body image concerns and eating disturbance: A review of the literature. Clin Psychol Rev, 21(3), 325–344.PubMedCrossRefGoogle Scholar
  36. 36.
    Connors, M. E. (1996). Developmental vulnerabilities for eating disorders. In L. Smolak, M. P. Levine, & R. Striegel-Moore (Eds.), The developmental psychopathology of eating disorders (pp. 285–310). New Jersey: Lawrence Erlbaum.Google Scholar
  37. 37.
    Burrows, A., & Cooper, M. (2002). Possible risk factors in the development of eating disorders in overweight pre-adolescent girls. International Journal of Obesity, 26, 1268–1273.PubMedCrossRefGoogle Scholar
  38. 38.
    Stice, E., & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation. Developmental Psychology, 38(5), 669–678.PubMedCrossRefGoogle Scholar
  39. 39.
    Fallon, E. M., Tanofsky-Kraff, M., Norman, A.-C., McDuffie, J. R., Taylor, E. D., Cohen, M. L., et al. (2005). Health-related quality of life in overweight and nonoverweight black and white adolescents. Journal of Pediatrics, 147(4), 443–450.PubMedCrossRefGoogle Scholar
  40. 40.
    Warschburger, P., Buchholz, H. T., & Petermann, F. (2001). Entwicklung eines krankheitsspezifischen Interviews zur Erfassung der Lebensqualität adipöser Kinder und Jugendlicher. Z Klin Psychol Psychiatr Psychother, 49(1), 247–261.Google Scholar
  41. 41.
    Knöpfli, B. H., Radtke, T., Lehmann, M., Schätzle, B., Eisenblätter, J., Gachnang, A., et al. (2008). Effects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boys. Journal of Adolescent Health, 42, 119–127.PubMedCrossRefGoogle Scholar
  42. 42.
    Arif, A. A., & Rohrer, J. E. (2006). The relationship between obesity, hyperglycemia symptoms, and health-related quality of life among Hispanic and non-Hispanic white children and adolescents. BMC Family Practice, 7, 3.PubMedCrossRefGoogle Scholar
  43. 43.
    Kurth, B.-M., & Ellert, U. (2008). Gefühltes oder tatsächliches Übergewicht: worunter leiden Jugendliche mehr? Dtsch Arztebl, 105(23), 406–412.Google Scholar
  44. 44.
    Warschburger, P., Fromme, C., & Petermann, F. (2005). Konzeption und Analyse eines gewichtsspezifischen Lebensqualitätsfragebogens für übergewichtige und adipöse Kinder und Jugendliche (GW-LQ-KJ). Z Klin Psychol Psychiatr Psychother, 53(1), 356–369.Google Scholar
  45. 45.
    Kolotkin, R. L., Zeller, M., Modi, A. C., Samsa, G. P., Polanichka Quinlan, N., Yanovski, J. A., et al. (2006). Assessing weight-related quality of life in adolescents. Obesity, 14(3), 448–457.PubMedCrossRefGoogle Scholar
  46. 46.
    Huybrechts, I., De Bacquer, D., Van Trimpont, I., De Backer, G., & De Henauw, S. (2006). Validity of parentally reported weight and height for preschool-aged children in Belgium and its impact on classification into body mass index categories. Pediatrics, 118, 2109–2118.PubMedCrossRefGoogle Scholar
  47. 47.
    Akinbami, L. J., & Ogden, C. L. (2009). Childhood overweight prevalence in the United States: The impact of parent-reported height and weight. Obesity, 17(8), 1574–1580.PubMedCrossRefGoogle Scholar
  48. 48.
    Lobstein, T., Rigby, N., & Leach, R. (2005). International obesity task force. EU platform briefing paper. IOTF: Brussels. Accessed 24 Nov 2010.
  49. 49.
    Zeller, M. H., & Modi, A. C. (2006). Predictors of health-related quality of life in obese youth. Obesity, 14, 122–130.PubMedCrossRefGoogle Scholar
  50. 50.
    Van Egmond-Fröhlich, A., Bräuer, W., Goldschmidt, H., Hoff-Emden, H., Oepen, J., & Zimmermann, E. (2006). Effects of a programme for structured outpatient follow-up care after inpatient rehabilitation of obese children and adolescents—A multicentre, randomized study. Rehabilitation, 45, 40–51.PubMedCrossRefGoogle Scholar
  51. 51.
    Abresch, R. T., McDonald, D. A., Widman, L. M., McGinnis, K., & Hickey, K. J. (2007). Impact of spinal cord dysfunction and obesity on the health-related quality of life of children and adolescents. Journal of Spinal Cord Medicine, 30(Suppl 1), 112–118.Google Scholar
  52. 52.
    Janicke, D. M., Marciel, K. K., Ingerski, L. M., Novoa, W., Lowry, K. W., Sallinen, B. J., et al. (2007). Impact of psychosocial factors on quality of life in overweight youth. Obesity, 15(7), 1799–1807.PubMedCrossRefGoogle Scholar
  53. 53.
    Ingerski, L. M., Janicke, D. M., & Silverstein, J. H. (2007). Quality of life in overweight youth—The role of multiple informants and perceived social support. Journal of Pediatric Psychology, 32(7), 869–874.PubMedCrossRefGoogle Scholar
  54. 54.
    Doyle, A. C., le Grange, D., Goldschmidt, A., & Wilfley, D. E. (2007). Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders. Obesity, 15(1), 145–154.PubMedCrossRefGoogle Scholar
  55. 55.
    Luppino, F. S., de Wit, L. M., Bouvy, P. F., Stijnen, T., Cuijpers, P., Penninx, B. W., et al. (2010). Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry, 67(3), 220–229.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Veronika Ottova
    • 1
    Email author
  • Michael Erhart
    • 1
  • Luis Rajmil
    • 2
    • 3
  • Lucia Dettenborn-Betz
    • 1
  • Ulrike Ravens-Sieberer
    • 1
  1. 1.Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Research Unit Child Public HealthUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Agency for Health Information, Assessment and QualityBarcelonaSpain
  3. 3.Health Services Research UnitBarcelonaSpain

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