BUFFALO, N.Y. -- Although popular culture continues to presume that height is a measure of personal satisfaction in life, a new study by a team of psychologists and endocrinologists at the University at Buffalo refutes the idea that taller is necessarily better.
The study, which compared the quality of life of adults who were treated for growth-hormone deficiency as children with their healthy same-sex siblings who experienced normal growth, appears in the current issue of the Journal of Clinical Endocrinology and Metabolism.
The researchers, led by UB pediatric psychologist David Sandberg, Ph.D., a specialist in the psychological aspects of growth-hormone deficiency, found that as adults, children who were treated were as well-adjusted as their physically healthy brothers and sisters. They also were doing much better as adults than previous studies using non-sibling control groups or norms from questionnaires would had indicated.
Results showed, unexpectedly, that there was little or no relationship between the former patients' adult height or how much they grew over the course of therapy and their reports of psychological and social functioning. An important difference that did emerge was in marital rates: Siblings were twice as likely to be married as former patients.
"This study questions whether there is a direct relationship between how tall you are as an adult and how satisfied you are with your daily life experiences," Sandberg said. "Changes in height brought about by growth hormone do not automatically translate into changes in quality of life.
"If adult quality of life is what we're concerned with, then we should probably be looking at factors in addition to height. Maybe we should take into account experiences related to having a chronic medical problem in general, and how this might affect adult adaptation."
Sandberg stressed that the findings do not suggest that growth-hormone treatment has no benefit for patients' quality of life as adults.
To prove that, hormone-deficient children who received treatment would have to be compared with a similar group of children who were not treated, a situation that Sandberg said would be unrealistic, as well as unethical. Moreover, he pointed out that without growth hormone treatment, people who are hormone-deficient would be so short as adults their ability to perform regular activities of daily living would be impaired.
The study does bring into question the value of using the very expensive treatment, which can cost $30,000 a year, in children not clearly growth-hormone-deficient, he noted.
Synthetic growth hormone has enabled physicians to treat children with growth hormone deficiency, allowing them to reach or approximate their natural height and avoid the physical disability and psychological distress presumed to accompany marked shortness.
Its availability also has increased pressure on physicians to provide growth hormone to short children who are not deficient in the hormone, and has engendered a debate on the proper use of growth hormone and the relationship between stature and quality of life.
Sandberg's study involved 140 former patients -- 117 males and 23 females -- and 53 siblings, all over the age of 18. The mean age of the treatment group at the time of the study was 26. Information on several quality-of-life measures was collected by telephone interviews. The treatment and follow-up study were conducted at Children's Hospital of Buffalo. Both the data-gathering method and the relatively large and complete study population give the findings special credence, Sandberg said.
"Most studies use self-administered questionnaires, which are mailed to patients, giving you limited control over the process. Also, by using same-sex siblings, we account as much as possible for participants' genetic and social background."
The results showed no significant difference between the former patients and their same-sex siblings in educational attainment, gainful employment, the likelihood they were living independently, and social support or adjustment, which involved aspects such as one's network of friends and social activities.
There were slight differences between the groups on a measure of general health. Former patients reported more health problems, and those missing other hormones, in addition to growth hormone, experienced more health and social difficulties, a predictable outcome in light of the fact that some patients still have health problems, Sandberg noted.
Sandberg said he has no explanation for the differences in marital rates. The finding has been reported in previous studies, he noted, and height does not appear to be a factor.
"We are aware clinically that some of these patients can experience difficulties in their intimate relationships. Growth-hormone deficiency on its own does not appear to be responsible for this result. Other aspects of their medical status as adults may be important, particularly if they are deficient in other hormones. We should also consider the possibility that their experiences as children and adolescents related to their growth hormone deficiency and its treatment may be a factor."
The study places in perspective the relationship between height and happiness.
"We shouldn't get caught up in the idea that making someone taller as adults will necessarily improve their quality of life," Sandberg said. "Our goal is to allow each person to reach the normal range so their short stature doesn't constitute a physical disability. Maybe beyond that we aren't going to find benefits. Quality of life is an enormously complex concept."
Also participating in the study were Margaret H. MacGillivray, Richard R. Clopper, Caroline Fung, Linda LeRoux and Dana E. Alliger, all of UB and Children's Hospital. The study was supported in part by grants from the Genentech Foundation for Growth and Development, Inc.
Journal
The Journal of Clinical Endocrinology & Metabolism