Quality of Life Research

, Volume 24, Issue 1, pp 251–261 | Cite as

Influence of specific individual and environmental variables on the relationship between body mass index and health-related quality of life in overweight and obese adolescents

  • Julia K. Kolodziejczyk
  • Kyle Gutzmer
  • Shana M. Wright
  • Elva M. Arredondo
  • Linda Hill
  • Kevin Patrick
  • Jeannie S. Huang
  • Michael Gottschalk
  • Gregory J. Norman



Overweight and obese adolescents are at risk for low health-related quality of life (HRQOL). We examined the role of individual- and environmental-level variables on the relationship between body mass index (BMI kg/m2) and HRQOL in adolescents.


Linear regressions were performed to conduct mediation and moderation analyses on the relationship between BMI and HRQOL in overweight and obese adolescents (N = 205). HRQOL was measured by the Pediatric Quality of Life Inventory. Hypothesized mediators included depression, measured by the Center for Epidemiologic Studies Depression Scale; body image, measured by the gender-specific body dissatisfaction subscale of the Eating Disorder Inventory; and self-esteem, measured by the Rosenberg Self-Esteem Scale. Mediation was assessed using Baron and Kenny’s approach and Sobel’s test of indirect effects. Anglo-acculturation, measured by the Short Acculturation Scale for Hispanics-Youth, and environmental perception, measured by parent-proxy report of the Neighborhood Environment Walkability Scale, were hypothesized moderators.


Body image mediated the relationship between BMI and HRQOL (b = −0.34, SE = 0.17, adj R 2 = 0.19, p = .051), and self-esteem was a partial mediator (b = −0.37, SE = 0.17, adj R 2 = 0.24, p = .027). Sobel’s test confirmed these results (p < .05). No significant moderation effects were found.


The finding that individual-level factors, such as body image and self-esteem, influence the relationship between BMI and HRQOL while environmental factors, such as neighborhood environment and acculturation, do not extends previous research. The finding that body image and self-esteem partially mediate this relationship presents new areas to investigate in interventions that address BMI in youth.


Overweight Obesity Adolescent Self-esteem Body image Depression 



Body mass index


Health-related quality of life


Primary Care Management of Adolescent Obesity study


Intervention for Youth at Risk for Diabetes study



PACE-PC was supported by a grant from the National Cancer Institute (Bethesda, Maryland), R01 CA121300 (Clinical Trial Registration Number: #NCT00415974). PACE-iDP was supported by a grant from National Institute of Diabetes and Digestive and Kidney Diseases (Bethesda, Maryland), 5 R18 DK064321 (Clinical Trial Registration Number: #NCT00412165). We also gratefully acknowledge support from the physicians and clinic staff at Children’s Primary Care Medical Group (South Bay Locations), Rady Children’s Hospital of San Diego, Pediatric Endocrinology Department, Rady Children’s Physician Management Services, and Kaiser Permanente Pediatrics Department.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Julia K. Kolodziejczyk
    • 1
    • 2
    • 3
  • Kyle Gutzmer
    • 1
    • 3
  • Shana M. Wright
    • 3
  • Elva M. Arredondo
    • 3
  • Linda Hill
    • 1
    • 2
    • 3
  • Kevin Patrick
    • 1
    • 2
  • Jeannie S. Huang
    • 1
    • 2
    • 4
    • 5
  • Michael Gottschalk
    • 4
    • 5
  • Gregory J. Norman
    • 1
    • 2
  1. 1.Department of Family and Preventive MedicineUniversity of California, San DiegoLa JollaUSA
  2. 2.Center for Wireless and Population Health Systems, Qualcomm Institute/Calit2University of California, San DiegoLa JollaUSA
  3. 3.Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  4. 4.Rady Children’s HospitalSan DiegoUSA
  5. 5.Department of PediatricsUniversity of California, San DiegoLa JollaUSA

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