Investigating the Self-Stigma and Quality of Life for Overweight/Obese Children in Hong Kong: a Preliminary Study
Overweight (OW) children are likely to internalize common weight bias and developed weight-related self-stigma (or self-stigma in short). Also, OW children tended to have poor health-related quality of life (HRQoL) with higher level of self-stigma associated with poorer HRQoL. However, the aforementioned findings have yet been investigated in the East. This study aimed to test the differences of self-stigma and HRQoL between OW and non-OW children, and to examine the correlations between self-stigma and HRQoL in a Hong Kong sample. OW children (n = 50, Mage ± SD = 9.36 ± 1.17) and non-OW children (n = 50, Mage ± SD = 9.73 ± 1.28) completed questionnaires that measure self-stigma (Weight Bias Internalization Scale [WBIS] and Weight Self-Stigma Questionnaire [WSSQ]) and HRQoL (child-reported Kid-KINDL and Sizing Me Up [SMU]). All parents completed parent-reported Kid-KINDL and Sizing Them Up (STU) that measure HRQoL of their children. Compared with non-OW children, OW children had higher self-stigma in WBIS (p = 0.003) and WSSQ (p < 0.001); lower HRQoL in SMU (p < 0.001) and STU (p < 0.001). More significant correlations with stronger magnitude (r = −0.28 to −0.61) were shown between self-stigma and HRQoL in OW children than in non-OW children. This study showed that OW children had significantly higher self-stigma and lower HRQoL than did non-OW children in Hong Kong. Moreover, negative correlations between self-stigma and HRQoL were found in OW children. Future studies may want to investigate whether reducing self-stigma of OW children can improve their HRQoL.
KeywordsAsia Children Health-related quality of life Overweight Self-stigma
We sincerely thank for all the participants, including the children and parent. We also thank the assistance from the following organizations: Buddhist Wong Cheuk Um Primary School and Hong Kong Playground Association.
This research was supported in part by (received funding from) the startup fund in the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
Compliance with Ethical Standards
Conflict of Interests
All the authors declare that they have no conflicts of interest.
- Census and Statistic Department. (2017). Table E032: Domestic households by household size and monthly household income. https://www.censtatd.gov.hk/hkstat/sub/sp150.jsp?productCode=D5250036. Accessed 14 Mar 2018.
- Centre for Health Protection. (2015). Healthy weight healthy kids. NCD Watch. http://www.chp.gov.hk/files/pdf/ncd_watch_mar2015.pdf. Accessed 14 Mar 2018.
- Chan, P. L., Ng, S. S., & Chan, D. Y. (2014). Psychometric properties of the Chinese version of the kid-KINDL-R questionnaire for measuring the health-related quality of life of school-aged children. Hong Kong Journal of Occupational Therapy, 24(1), 28–34. https://doi.org/10.1016/j.hkjot.2014.05.001.CrossRefGoogle Scholar
- Chan, Y., Chan, Y. Y., Cheng, S. L., Chow, M. Y., Tsang, Y. W., Lee, C., et al. (2017). Investigating quality of life and self-stigma in Hong Kong children with specific learning disabilities. Research in Developmental Disabilities, 68, 131–139. https://doi.org/10.1016/j.ridd.2017.07.014.CrossRefGoogle Scholar
- Chang, C.-C., Lin, C.-Y., Gronholm, P. C., & Wu, T.-H. (in press). Cross-validation of two commonly used self-stigma measures, Taiwan versions of the internalized stigma mental illness scale and self-stigma scale-short, for people with mental illness. Assessment. https://doi.org/10.1177/1073191116658547.
- Ciupitu-Plath, C. (2016). Weight stigma experiences and internalization among boys and girls accessing obesity care in Berlin, Germany (Doctoral thesis, Technical University of Berlin). https://doi.org/10.14279/depositonce-4998.
- Huang, W.-Y., Chen, S.-P., Pakpour, A. H., & Lin, C.-Y. (2018). The mediation role of self-esteem for self-stigma on quality of life for people with schizophrenia: A retrospectively longitudinal study. Journal of Pacific Rim Psychology, 12(e10), 1–7.Google Scholar
- Lee, C.-T., Tsai, M.-C., Lin, C.-Y., & Strong, C. (2017). Longitudinal effects of self-report pubertal timing and menarcheal age on adolescent psychological and behavioral outcomes in female youths from northern Taiwan. Pediatrics and Neonatology, 58, 313–320. https://doi.org/10.1016/j.pedneo.2016.04.004.CrossRefGoogle Scholar
- Lin, Y.-C., & Lin, C.-Y. (2017). Minor symptoms talk: How children react to encountered bullying. Child Indicators Research. https://doi.org/10.1007/s12187-017-9505-4.
- Lin, Y.-C., Strong, C., Tsai, M.-C., Lin, C.-Y., & Fung, X. C. C. (2018b). Validating sizing them up, a parent-proxy weight-related quality-of-life measure, with community-based children. International Journal of Clinical and Health Psychology, 18(1), 81–89. https://doi.org/10.1016/j.ijchp.2017.10.001.CrossRefGoogle Scholar
- Miri, S. F., Javadi, M., Lin, C.-Y., Irandoost, K., Rezazadeh, A., & Pakpour, A. H. (2017). Health related quality of life and weight self-efficacy of life style among normal-weight, overweight and obese Iranian adolescents: A case control study. International Journal of Pediatrics, 5(11), 5975–5984.Google Scholar
- O'Brien, K. S., Latner, J. D., Puhl, R. M., Vartanian, L. R., Giles, C., Griva, K., et al. (2016). The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite, 102, 70–76. https://doi.org/10.1016/j.appet.2016.02.032.CrossRefGoogle Scholar
- Palmeira, L., Pinto-Gouveia, J., & Cunha, M. (2016). The role of weight self-stigma on the quality of life of women with overweight and obesity: A multi-group comparison between binge eaters and non-binge eaters. Appetite, 105, 782–789. https://doi.org/10.1016/j.appet.2016.07.015.CrossRefGoogle Scholar
- Pierce, J. W., & Wardle, J. (1997). Cause and effect beliefs and self-esteem of overweight children. Journal of Child Psychology and Psychiatry, 38(6), 645–650. https://doi.org/10.1111/j.1469-7610.1997.tb01691.x.CrossRefGoogle Scholar
- Ravens-Sieberer, U., & Bullinger, M. (2000). KINDL R questionnaire for measuring health-related quality of life in children and adolescents revised version manual. http://www.kindl.org/english/manual/ Accessed 14 Mar 2018.
- So, H. K., Nelson, E. A., Li, A. M., Wong, E. M., Lau, J. T., Guldan, G. S., et al. (2008). Secular changes in height, weight and body mass index in Hong Kong children. BMC Public Health, 8(1), 320. doi: https://doi.org/10.1186/1471-2458-8-320.
- The Government of the Hong Kong Special Administrative Region Press Releases. (October 11, 2016). Hong Kong world obesity day 2016 focuses on childhood obesity. http://www.info.gov.hk/gia/general/201610/11/P2016101100232.htm Accessed 14 Mar 2018.
- Wallander, J. L., Taylor, W. C., Grunbaum, J. A., Franklin, F. A., Harrison, G. G., Kelder, S. H., et al. (2009). Weight status, quality of life, and self-concept in African American, Hispanic, and white fifth-grade children. Obesity, 17(7), 1363–1368. https://doi.org/10.1038/oby.2008.668.Google Scholar
- Zhang, J., Seo, D. C., Kolbe, L., Lee, A., Middlestadt, S., Zhao, W., et al. (2011). Comparison of overweight, weight perception, and weight-related practices among high school students in three large Chinese cities and two large US cities. Journal of Adolescent Health, 48(4), 366–372. https://doi.org/10.1016/j.jadohealth.2010.07.015.CrossRefGoogle Scholar
- Zuba, A., & Warschburger, P. (2017). The role of weight teasing and weight bias internalization in psychological functioning: A prospective study among school-aged children. European Child & Adolescent Psychiatry, 1–11. https://doi.org/10.1007/s00787-017-0982-2.