Skip to main content
SpringerLink
Log in

The effect of body mass on health-related quality of life among Singaporean adolescents: results from the SCORM study

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

To investigate the relationship between body mass and health-related quality of life (HRQOL) among Singaporean adolescents. Variation in this relationship by age, gender and ethnicity, and association of HRQOL with change in body mass over time and with demographic, socioeconomic and health variables were also assessed.

Methods

HRQOL was assessed for Singaporean adolescents aged 11–18 from their own (N = 1,249) and their parent’s (N = 948) perspective using PedsQL™ 4.0 generic core scales. Body mass, measured as body mass index z-score based on the WHO Reference 2007, was categorized as thin, healthy weight, overweight and obese. Multiple linear regression models assessed the relationship between current body mass and HRQOL, adjusting for demographic, socioeconomic and health variables. Differences between adolescent and parent-proxy reported HRQOL were also investigated.

Results

Obese adolescents (and their parents) reported significantly lower HRQOL, overall and in most domains, compared to healthy weight adolescents. Parents tended to report lower HRQOL for their adolescents than the adolescents did themselves; however, this difference was much larger and statistically significant for obese adolescents.

Conclusions

Obesity is associated with reduced HRQOL among adolescents. The effect in these Singaporean adolescents is similar to that in populations with higher rates of obesity. Awareness of this relationship can make it easier for health professionals, teachers, parents and peers to be supportive of obese adolescents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lobstein, T., Baur, L., & Uauy, R. (2004). Obesity in children and young people: A crisis in public health. Obesity Reviews, 5(Suppl 1), 4–104.

    Article  PubMed  Google Scholar 

  2. Hill, A. J., & Silver, E. K. (1995). Fat, friendless and unhealthy: 9-year old children’s perception of body shape stereotypes. International Journal of Obesity and Related Metabolic Disorders, 19(6), 423–430.

    CAS  PubMed  Google Scholar 

  3. Testa, M. A., & Simonson, D. C. (1996). Assessment of quality-of-life outcomes. New England Journal of Medicine, 334(13), 835–840.

    Article  CAS  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. de Beer, M., Hofsteenge, G. H., Koot, H. M., Hirasing, R. A., Delemarre-van de Waal, H. A., & Gemke, R. J. (2007). Health-related-quality-of-life in obese adolescents is decreased and inversely related to BMI. Acta Paediatrica, 96(5), 710–714.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Friedlander, S. L., Larkin, E. K., Rosen, C. L., Palermo, T. M., & Redline, S. (2003). Decreased quality of life associated with obesity in school-aged children. Archives of Pediatrics and Adolescent Medicine, 157(12), 1206–1211.

    Article  PubMed  Google Scholar 

  8. Hughes, A. R., Farewell, K., Harris, D., & Reilly, J. J. (2007). Quality of life in a clinical sample of obese children. Int J Obesity (London), 31(1), 39–44.

    Article  CAS  Google Scholar 

  9. Pinhas-Hamiel, O., Singer, S., Pilpel, N., Fradkin, A., Modan, D., & Reichman, B. (2006). Health-related quality of life among children and adolescents: Associations with obesity. Int J Obesity (London), 30(2), 267–272.

    Article  CAS  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Swallen, K. C., Reither, E. N., Haas, S. A., & Meier, A. M. (2005). Overweight, obesity, and health-related quality of life among adolescents: The National Longitudinal Study of Adolescent Health. Pediatrics, 115(2), 340–347.

    Article  PubMed  Google Scholar 

  12. 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(4), 366–368.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. Zhang, L., Fos, P., Johnson, W., Kamali, V., Cox, R., Zuniga, M., et al. (2008). Body mass index and health related quality of life in elementary school children: A pilot study. Health and Quality of Life Outcomes, 6(1), 77.

    Article  PubMed  Google Scholar 

  15. Saw, S. M., Chua, W. H., Hong, C. Y., Wu, H. M., Chia, K. S., Stone, R. A., et al. (2002). Height and its relationship to refraction and biometry parameters in Singapore Chinese children. Investigative Ophthalmology and Visual Science, 43(5), 1408–1413.

    PubMed  Google Scholar 

  16. Saw, S. M., Wu, H. M., Hong, C. Y., Chua, W. H., Chia, K. S., & Tan, D. (2001). Myopia and night lighting in children in Singapore. British Journal of Ophthalmology, 85(5), 527–528.

    Article  CAS  PubMed  Google Scholar 

  17. Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Parent proxy-report of their children’s health-related quality of life: An analysis of 13, 878 parents’ reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales. Health Quality Life Outcomes, 5, 2.

    Article  Google Scholar 

  18. Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800–812.

    Article  CAS  PubMed  Google Scholar 

  19. Varni, J. W., Burwinkle, T. M., Rapoff, M. A., Kamps, J. L., & Olson, N. (2004). The PedsQL in pediatric asthma: Reliability and validity of the Pediatric Quality of Life Inventory generic core scales and asthma module. Journal of Behavioral Medicine, 27(3), 297–318.

    Article  PubMed  Google Scholar 

  20. Varni, J. W. (2008). Linguistic validation of the PedsQL™- a Quality of Life Questionnaire. Research and Evaluation, Limited use translation of PedsQL™. [cited 2008 28 October]; Available from: http://www.pedsql.org/PedsQL-Linguistic-Validation-Guidelines.doc.

  21. World Health Organization. (1995). Physical status, the use and interpretation of anthropometry., in WHO Technical Report Series No. 854. Geneva: WHO.

  22. Flegal, K. M., Tabak, C. J., & Ogden, C. L. (2006). Overweight in children: Definitions and interpretation. Health Education Research, 21(6), 755–760.

    Article  PubMed  Google Scholar 

  23. de Onis, M., Onyango, A. W., Borghi, E., Siyam, A., Nishida, C., & Siekmann, J. (2007). Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 85(9), 660–667.

    Article  PubMed  Google Scholar 

  24. World Health Organization. (2007) Growth reference data for 5–19 years. 2007 [cited 2008 15 October]; Available from: http://www.who.int/growthref/en/.

  25. World Health Organization. (2008) BMI-for-age (5-19 years). 2008 [cited 2008 15 October]; Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/index.html.

  26. Curriculum Planning and Development Division: Ministry of Education (Singapore) and School Health Services:Ministry of Health (Singapore). Weight for height table for boys. (Height 108 cm to 190 cm). [cited 2008 2 October]; Available from: http://www.moe.gov.sg/education/programmes/holistic-health-framework/files/weight-height-table-boys.pdf.

  27. Curriculum Planning and Development Division: Ministry of Education (Singapore) and School Health Services:Ministry of Health (Singapore). Weight for height table for girls. (Height 106 cm to 180 cm). [cited 2008 2 October]; Available from: http://www.moe.gov.sg/education/programmes/holistic-health-framework/files/weight-height-table-girls.pdf.

  28. Varni, J. W., Burwinkle, T. M., & Seid, M. (2006). The PedsQL 4.0 as a school population health measure: Feasibility, reliability, and validity. Quality of Life Research, 15(2), 203–215.

    Article  PubMed  Google Scholar 

  29. Cole, T. J., Flegal, K. M., Nicholls, D., & Jackson, A. A. (2007). Body mass index cut offs to define thinness in children and adolescents: International survey. BMJ, 335(7612), 194.

    Article  PubMed  Google Scholar 

  30. Fontaine, K. R., & Barofsky, I. (2001). Obesity and health-related quality of life. Obesity Reviews, 2(3), 173–182.

    Article  CAS  PubMed  Google Scholar 

  31. Upton, P., Lawford, J., & Eiser, C. (2008). Parent-child agreement across child health-related quality of life instruments: A review of the literature. Quality of Life Research, 17(6), 895–913.

    Article  PubMed  Google Scholar 

  32. Chang, P. C., & Yeh, C. H. (2005). Agreement between child self-report and parent proxy-report to evaluate quality of life in children with cancer. Psychooncology, 14(2), 125–134.

    Article  PubMed  Google Scholar 

  33. Quek, C. M., Koh, K., & Lee, J. (1993). Parental body mass index: A predictor of childhood obesity? Annals of the Academy of Medicine, Singapore, 22(3), 342–347.

    CAS  PubMed  Google Scholar 

  34. Campo, J. V., Comer, D. M., Jansen-Mcwilliams, L., Gardner, W., & Kelleher, K. J. (2002). Recurrent pain, emotional distress, and health service use in childhood. Journal of Pediatrics, 141(1), 76–83.

    Article  PubMed  Google Scholar 

  35. Janicke, D. M., Finney, J. W., & Riley, A. W. (2001). Children’s health care use: A prospective investigation of factors related to care-seeking. Medical Care, 39(9), 990–1001.

    Article  CAS  PubMed  Google Scholar 

  36. Ng, T. P., Lim, L. C., Jin, A., & Shinfuku, N. (2005). Ethnic differences in quality of life in adolescents among Chinese, Malay and Indians in Singapore. Quality of Life Research, 14(7), 1755–1768.

    Article  PubMed  Google Scholar 

  37. Kolotkin, R. L., Zeller, M., Modi, A. C., Samsa, G. P., Quinlan, N. P., Yanovski, J. A., et al. (2006). Assessing weight-related quality of life in adolescents. Obesity (Silver Spring), 14(3), 448–457.

    Article  Google Scholar 

  38. Ismail, A., Campbell, M. J., Ibrahim, H. M., & Jones, G. L. (2006). Health related quality of life in Malaysian children with thalassaemia. Health Quality Life Outcomes, 4, 39.

    Article  Google Scholar 

  39. Wee, H. L., Chua, H. X., & Li, S. C. (2006). Meaning of health-related quality of life among children and adolescents in an Asian country: A focus group approach. Quality of Life Research, 15(5), 821–831.

    Article  CAS  PubMed  Google Scholar 

  40. WHO Expert Consultation. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363(9403), 157–163.

    Article  Google Scholar 

Download references

Acknowledgments

Thanks to Mohamed Dirani, Terri Young, Liang Goh, Dana Hornbeak and Qiao Fan for helpful comments relating to overall study design or specific measurement issues.

Funding

The SCORM study was supported by the National Medical Research Council [NMRC/0975/2005]; and the Singapore Children Society [RNO/059/06].

Author information

Authors and Affiliations

  1. Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore

    Truls Østbye & Rahul Malhotra

  2. Department of Community and Family Medicine, Duke University Medical Centre, Durham, NC, USA

    Truls Østbye

  3. Health Services Research and Evaluation Division, Ministry of Health, Singapore, Singapore

    Hwee-Bee Wong

  4. Department of Epidemiology and Public Health, National University of Singapore, Singapore, Singapore

    Hwee-Bee Wong & Seang-Mei Saw

  5. Singapore Clinical Research Institute, Singapore, Singapore

    Say-Beng Tan

  6. Centre of Quantitative Biology and Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore

    Say-Beng Tan

  7. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

    Seang-Mei Saw

  8. Duke-National University of Singapore Graduate Medical School, Singapore, Singapore

    Seang-Mei Saw

Authors
  1. Truls Østbye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hwee-Bee Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Say-Beng Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seang-Mei Saw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rahul Malhotra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Østbye, T., Malhotra, R., Wong, HB. et al. The effect of body mass on health-related quality of life among Singaporean adolescents: results from the SCORM study. Qual Life Res 19, 167–176 (2010). https://doi.org/10.1007/s11136-009-9578-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-009-9578-8

Keywords

Search

Navigation