The current study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among a large and non-clinical sample of adolescents, and tested the possible moderating effect of perceived teacher and classmate support on this association.
French-speaking Belgian adolescents (n = 11,342) self-reported height and weight, HRQoL (KIDSCREEN-10), as well as their perception of teacher and classmate relationships. Adjusting for sociodemographics, linear regression analyses with HRQoL as the outcome variable were performed for boys and girls separately. Interactions between BMI and teacher support, and between BMI and classmate support were included to examine the effect of this support on the association between BMI and HRQoL.
Obesity was associated with lower HRQoL for boys (β = − 2.14, p = 0.002) and for girls (β = − 2.96, p = 0.001), while only overweight girls showed a significant impaired HRQoL compared with normal-weight ones (β = − 0.94, p = 0.01). In both sexes, lower perceived teacher and classmate support was associated with lower HRQoL. Interactions between BMI and perceived teacher relationships, and between BMI and perceived classmate relationships, were not significant for boys as for girls.
Perceived school-related social support constitutes an important dimension of adolescent well-being, suggesting the relevance of considering it for promoting greater HRQoL in overweight and obese youth. Future studies are needed to confirm the absence of moderating effect of this support and explore its effect on other weight-related factors, like body image, weight misperception and bullying, associated with decreased HRQoL in adolescents.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Body mass index
Family Affluence Scale
Health Behaviour in School-aged Children
Health-related quality of life
International Obesity Task Force
Lebacq, T. (2015). Enquête de consommation alimentaire 2014–2015, Rapport 1: Anthropométrie (IMC, tour de taille et ratio tour de taille/taille). WIV-ISP. Retrieved February 7, 2018, from, https://fcs.wiv-isp.be/nl/Gedeelde%20%20documenten/FRANS/AM_FR.pdf.
World Health Organization (2017). Global strategy on diet, physical activity & health. childhood overweight and obesity. Retrieved January 30, 2017, from, http://www.who.int/dietphysicalactivity/childhood/en/.
Tsiros, M. D., Olds, T., Buckley, J. D., Grimshaw, P., Brennan, L., Walkley, J., et al. (2009). Health-related quality of life in obese children and adolescents. International Journal of Obesity, 33(4), 387–400.
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), 282–304.
Ul-Haq, Z., Mackay, D. F., Fenwick, E., & Pell, J. P. (2013). Meta-analysis of the association between body mass index and health-related quality of life among children and adolescents, assessed using the pediatric quality of life inventory index. The Journal of Pediatrics, 162(2), 280–286.
World Health Organization (1997). WHOQOL, measuring quality of life. World Health Organization. Retrieved September 2, 2017, from, http://www.who.int/mental_health/media/68.pdf.
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.
Wu, Y. P., Reiter-Purtill, J., & Zeller, M. H. (2014). The role of social support for promoting quality of life among persistently obese adolescents: Importance of support in schools. Journal of School Health, 84(2), 99–105.
World Health Organization (1986). Young people’s health—a challenge for society: Report of a WHO Study Group on Young People and “Health for All by the Year 2000” (Technical Report Series). Switzerland.
Eccles, J. S., & Roeser, R. W. (2011). Schools as developmental contexts during adolescence. Journal of Research on Adolescence, 21(1), 225–241.
Thapa, A., Cohen, J., Guffey, S., & Higgins-D’Alessandro, A. (2013). A review of school climate research. Review of Educational Research, 83(3), 357–385.
Colarossi, L. G., & Eccles, J. S. (2003). Differential effects of support providers on adolescents’ mental health. Social Work Research, 27(1), 19–30.
Suldo, S. M., Friedrich, A. A., White, T., Farmer, J., Minch, D., & Michalowski, J. (2009). Teacher support and adolescents’ subjective well-being: A mixed-methods investigation. School Psychology Review, 38(1), 67.
Murray-Harvey, R. (2010). Relationship influences on students’ academic achievement, psychological health and well-being at school. Educational and Child Psychology, 27(1), 104.
Rueger, S. Y., Malecki, C. K., & Demaray, M. K. (2008). Gender differences in the relationship between perceived social support and student adjustment during early adolescence. School Psychology Quarterly, 23(4), 496.
Auerbach, R. P., Bigda-Peyton, J. S., Eberhart, N. K., Webb, C. A., & Ho, M.-H. R. (2011). Conceptualizing the prospective relationship between social support, stress, and depressive symptoms among adolescents. Journal of Abnormal Child Psychology, 39(4), 475–487.
Chu, P. S., Saucier, D. A., & Hafner, E. (2010). Meta-analysis of the relationships between social support and well-being in children and adolescents. Journal of Social and Clinical Psychology, 29(6), 624.
Holt-Lunstad, J., Uchino, B. N., Smith, T. W., & Hicks, A. (2007). On the importance of relationship quality: The impact of ambivalence in friendships on cardiovascular functioning. Annals of behavioral medicine: A publication of the Society of Behavioral Medicine, 33(3), 278–290.
Cutrona, C. E., Russell, D. W., & Gardner, K. A. (2005). The relationship enhancement model of social support. In: T. A. Revenson, K. Kayser & G. Bodenmann (Eds.), Couples coping with stress. Emerging perspectives on dyadic coping. American Psychological Association: Washington, DC, pp. 73–95.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310.
Zeller, M. H., & Modi, A. C. (2006). Predictors of health-related quality of life in obese youth. Obesity, 14(1), 122–130.
Herzer, M., Zeller, M. H., Rausch, J. R., & Modi, A. C. (2011). Perceived social support and its association with obesity-specific health-related quality of life. Journal of Developmental & Behavioral Pediatrics, 32(3), 188.
Ingerski, L. M., Janicke, D. M., & Silverstein, J. H. (2007). Brief report: Quality of life in overweight youth—the role of multiple informants and perceived social support. Journal of Pediatric Psychology, 32(7), 869–874.
Currie, C., Inchley, J., Molcho, M., Lenzi, M., Veselska, Z., & Wild, F. (2014). HBSC Study protocol: Background, methodology and mandatory items for the 2013/14 survey. St Andrews.
The KIDSCREEN Group Europe. (2016). The KIDSCREEN Questionnaires. Quality of life questionnaires for children and adolescents. Handbook (3rd edn.). Lengerich: Pabst Science Publishers.
Cole, T. J., & Lobstein, T. (2012). Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatric Obesity, 7(4), 284–294.
Sherry, B., Jefferds, M. E., & Grummer-Strawn, L. M. (2007). Accuracy of adolescent self-report of height and weight in assessing overweight status: A literature review. Archives of Pediatrics & Adolescent Medicine, 161(12), 1154–1161.
Fonseca, H., Silva, A., Matos, M. G., Esteves, I., Costa, P., Guerra, A., et al. (2010). Validity of BMI based on self-reported weight and height in adolescents. Acta Paediatrica, 99(1), 83–88.
Torsheim, T., Wold, B., & Samdal, O. (2000). The teacher and classmate support scale factor structure, test-retest reliability and validity in samples of 13-and 15-year-old adolescents. School Psychology International, 21(2), 195–212.
Torsheim, T., Cavallo, F., Levin, K. A., Schnohr, C., Mazur, J., Niclasen, B., et al. (2016). Psychometric validation of the revised family affluence scale: A latent variable approach. Child Indicators Research, 9(3), 771–784.
Hartley, J. E. K., Levin, K., & Currie, C. (2016). A new version of the HBSC Family Affluence Scale-FAS III: Scottish qualitative findings from the international FAS development study. Child Indicators Research, 9(1), 233–245.
Pedersen, A. B., Mikkelsen, E. M., Cronin-Fenton, D., Kristensen, N. R., Pham, T. M., Pedersen, L., et al. (2017). Missing data and multiple imputation in clinical epidemiological research. Clinical Epidemiology, 9, 157.
Chau, N., Chau, K., Mayet, A., Baumann, M., Legleye, S., & Falissard, B. (2013). Self-reporting and measurement of body mass index in adolescents: Refusals and validity, and the possible role of socioeconomic and health-related factors. BMC Public Health, 13(1), 815.
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173.
Keating, C. L., Moodie, M. L., & Swinburn, B. A. (2011). The health-related quality of life of overweight and obese adolescents—a study measuring body mass index and adolescent-reported perceptions. International Journal of Pediatric Obesity, 6(5-6), 434–441.
Ottova, V., Erhart, M., Rajmil, L., Dettenborn-Betz, L., & Ravens-Sieberer, U. (2012). Overweight and its impact on the health-related quality of life in children and adolescents: Results from the European KIDSCREEN survey. Quality of Life Research, 21(1), 59–69.
Michel, G., Bisegger, C., Fuhr, D. C., & Abel, T. (2009). Age and gender differences in health-related quality of life of children and adolescents in Europe: A multilevel analysis. Quality of Life Research, 18(9), 1147–1157.
Kolodziejczyk, J. K., Gutzmer, K., Wright, S. M., Arredondo, E. M., Hill, L., Patrick, K., et al. (2015). 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. Quality of Life Research, 24(1), 251–261.
Goldfield, G. S., Moore, C., Henderson, K., Buchholz, A., Obeid, N., & Flament, M. F. (2010). Body dissatisfaction, dietary restraint, depression, and weight status in adolescents. The Journal of School Health, 80(4), 186–192.
Mond, J., van den Berg, P., Boutelle, K., Hannan, P., & Neumark-Sztainer, D. (2011). Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: Findings from the project EAT study. Journal of Adolescent Health, 48(4), 373–378.
Walvoord, E. C. (2010). The timing of puberty: Is it changing? Does it matter? Journal of Adolescent Health, 47(5), 433–439.
Cumming, S. P., Gillison, F. B., & Sherar, L. B. (2011). Biological maturation as a confounding factor in the relation between chronological age and health-related quality of life in adolescent females. Quality of Life Research, 20(2), 237–242.
Puhl, R. M., & King, K. M. (2013). Weight discrimination and bullying. Best Practice & Research. Clinical Endocrinology & Metabolism, 27(2), 117–127.
Buttitta, M., Iliescu, C., Rousseau, A., & Guerrien, A. (2014). Quality of life in overweight and obese children and adolescents: A literature review. Quality of Life Research, 23(4), 1117–1139.
Mannan, M., Mamun, A., Doi, S., & Clavarino, A. (2016). Prospective associations between depression and obesity for adolescent males and females-a systematic review and meta-analysis of longitudinal studies. PLoS ONE, 11(6), e0157240.
Brennan, M. A., Lalonde, C. E., & Bain, J. L. (2010). Body image perceptions: Do gender differences exist. Psi Chi Journal of Undergraduate Research, 15(3), 130–138.
Bleidorn, W., Arslan, R. C., Denissen, J. J. A., Rentfrow, P. J., Gebauer, J. E., Potter, J., et al. (2016). Age and gender differences in self-esteem—a cross-cultural window. Journal of Personality and Social Psychology, 111(3), 396.
Chen, G., Ratcliffe, J., Olds, T., Magarey, A., Jones, M., & Leslie, E. (2014). BMI, health behaviors, and quality of life in children and adolescents: A school-based study. Pediatrics, 133(4), e868–e874.
Cui, W., Zack, M. M., & Wethington, H. (2014). Health-related quality of life and body mass index among US adolescents. Quality of Life Research, 23(7), 2139–2150.
Lazzeri, G., Rossi, S., Kelly, C., Vereecken, C., Ahluwalia, N., & Giacchi, M. V. (2014). Trends in thinness prevalence among adolescents in ten European countries and the USA (1998–2006): A cross-sectional survey. Public Health Nutrition, 17(10), 2207–2215.
Reiter-Purtill, J., Ridel, S., Jordan, R., & Zeller, M. H. (2010). The benefits of reciprocated friendships for treatment-seeking obese youth. Journal of Pediatric Psychology, 35(8), 905–914.
Uchino, B. N., Holt-Lunstad, J., Uno, D., & Flinders, J. B. (2001). Heterogeneity in the social networks of young and older adults: Prediction of mental health and cardiovascular reactivity during acute stress. Journal of Behavioral Medicine, 24(4), 361–382.
Fingerman, K. L., Hay, E. L., & Birditt, K. S. (2004). The best of ties, the worst of ties: Close, problematic, and ambivalent social relationships. Journal of Marriage and the Family, 66(3), 792–808.
von Weiss, R. T., Rapoff, M. A., Varni, J. W., Lindsley, C. B., Olson, N. Y., Madson, K. L., et al. (2002). Daily hassles and social support as predictors of adjustment in children with pediatric rheumatic disease. Journal of Pediatric Psychology, 27(2), 155–165.
Tak, Y. R., & McCubbin, M. (2002). Family stress, perceived social support and coping following the diagnosis of a child’s congenital heart disease. Journal of Advanced Nursing, 39(2), 190–198.
Zhang, X., Ra, C. K., Zhang, D., Zhang, Y., & MacLeod, K. E. (2016). The impact of school social support and bullying victimization on psychological distress among california adolescents. Californian Journal of Health Promotion, 14(2), 56–67.
Bokhorst, C. L., Sumter, S. R., & Westenberg, P. M. (2010). Social support from parents, friends, classmates, and teachers in children and adolescents aged 9 to 18 years: Who is perceived as most supportive? Social Development, 19(2), 417–426.
Caron, J., & Guay, S. (2005). Soutien social et santé mentale: Concept, mesures, recherches récentes et implications pour les cliniciens // Soutien social et santé mentale. Soutien social au Québec, 30(2), 15–41.
Mikolajczyk, R. T., & Richter, M. (2008). Associations of behavioural, psychosocial and socioeconomic factors with over-and underweight among German adolescents. International Journal of Public Health, 53(4), 214–220.
Fonseca, H., de Matos, M. G., Guerra, A., & Gomes-Pedro, J. (2009). Emotional, behavioural and social correlates of missing values for BMI. Archives of Disease in Childhood, 94(2), 104–109.
Gage, N. A., Prykanowski, D. A., & Larson, A. (2014). School climate and bullying victimization: A latent class growth model analysis. School Psychology Quarterly, 29(3), 256.
Campo, R. A., Uchino, B. N., Holt-Lunstad, J., Vaughn, A., Reblin, M., & Smith, T. W. (2009). The assessment of positivity and negativity in social networks: The reliability and validity of the social relationships index. Journal of community psychology, 37(4), 471–486.
The authors would like to thank the schools and students for their participation in the French-speaking Belgian HBSC survey. They also thank the HBSC international coordination centre (University of St Andrews, United Kingdom) and the HBSC data management centre (University of Bergen, Norway) for their scientific support, Patrick De Smet (SIPES, Université libre de Bruxelles, Belgium) for his collaboration in data cleaning and management, Michèle Dramaix (Université libre de Bruxelles, Belgium) for her help in statistical analyses, as well as two anonymous reviewers for their relevant comments.
This work was funded by the Wallonia-Brussels Federation, the Birth and Children Office (ONE), the Walloon Region and the French Community Commission. Researchers performed the study (study design, data collection, analyses, interpretation and writing) independently of the funding bodies.
Conflict of interest
The authors declare that they do not have conflict of interest.
The study was approved by the regional education boards of the four different school networks in the Wallonia-Brussels Federation (i.e. Conseil de l’Enseignement des Communes et des Provinces, Direction Générale de l’Enseignement obligatoire de la Fédération Wallonie-Bruxelles, Conseil des Pouvoirs organisateurs de l’Enseignement officiel neutre subventionné, Secrétariat Général de l’Enseignement Catholique).
Given the nature of the survey, informed consent was not considered as necessary by the education authority of school networks in the Wallonia-Brussels Federation.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lebacq, T., Dujeu, M., Méroc, E. et al. Perceived social support from teachers and classmates does not moderate the inverse association between body mass index and health-related quality of life in adolescents. Qual Life Res 28, 895–905 (2019). https://doi.org/10.1007/s11136-018-2079-x
- Health-related quality of life
- Body mass index
- Perceived classmate support
- Perceived teacher support