In a study published in the April 9, 2003 issue of the Journal of the American Medical Association (JAMA), a team headed by University of California, San Diego (UCSD) pediatric gastroenterologist Jeffrey Schwimmer, M.D., noted the likelihood of impaired quality of life for obese children was 5.5 times greater than for a healthy child and as likely to be impaired as that of very sick children with cancer.
"The likelihood of significant quality-of-life impairment was profound for obese children," said Schwimmer, who also directs the Weight and Wellness Center, a childhood obesity program at Children's Hospital and Health Center, San Diego. "We were most surprised, however, that the quality-of-life scores self-reported by children and assessed by parents were as bad as scores previously reported by children with cancer who were undergoing chemotherapy."
Prior to the new findings with obese children, the previously published study with young cancer patients had been the lowest health-related quality-of-life scores when compared to healthy kids and children with juvenile rheumatoid arthritis, type 1 diabetes and congenital heart disease.
The JAMA study included 106 children ages 5-18 and their parents who took a test called the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales. On questions related to physical, emotional, social and school issues, the children self-reported their quality-of-life ratings, and parents provided their assessments.
For example, children were asked to rate their health and activities (e.g. ability to walk more than one block, difficulties with sports activities or low energy), their feelings (e.g. were they afraid, scared, sad, angry, worried, having trouble sleeping), as well as how well they get along with others (e.g. friendships, teasing) and school problems (e.g. paying attention in class, trouble keeping up with schoolwork). With similar questions, parents were asked to assess their children's physical, emotional, social and school functioning.
In addition to the PedsQL questionnaire, the children were evaluated at Children's Hospital and Health Center, San Diego with physical and laboratory exams for obesity-related medical conditions such as diabetes, obstructive sleep apnea, polycystic ovary syndrome, fatty liver disease, and elevated insulin and cholesterol levels. The most common medical problems found were fatty liver disease, high insulin levels, and abnormalities in cholesterol and lipids that are associated with increased cardiovascular disease.
"Even in the absence of these physical conditions, children and parents reported a low quality of life," Schwimmer said.
The researchers also found that unlike adults, where women most frequently report negative quality of life, young girls and boys were equally impacted by obesity.
Hispanic children and their parents, who represent an increasing percentage of the population, were also among those who participated in the study. "The highest rate of childhood obesity is seen in Mexican-American boys," Schwimmer said. "Even though this was a fairly common condition among Hispanics, the children and their parents still reported severely impacted quality of life."
Noting that these data are the first published measurements in the United States of health-related quality of life for obese children, Schwimmer said physicians, parents and teachers need to be informed of the risk for impaired quality of life among overweight children to target interventions and enhance health outcomes. However, treatment for children is hindered by a number of factors, he added.
"Many people, including physicians, don't realize that what they perceive as merely a 'chubby' child may actually be an obese child," Schwimmer said. "For example, a healthy seven-year-old should be quite lean."
"In addition, pediatricians often are not trained in obesity treatment and insurance companies frequently don't pay for obesity treatment. But, they do pay for the complications such as diabetes, liver disease or orthopedic problems," he said.
According to the Centers for Disease Control (CDC), the number of obese children in the U.S. has increased from 5-6 percent in the 1970s to 15 percent today. The CDC notes that the health consequences related to being overweight can begin in childhood or adolescence, making obese children at increased risk for various chronic diseases in later life. For example, one study (Freedman et al, 1999) showed that nearly 60 percent of overweight children had at least one cardiovascular risk factor compared to 10 percent of normal weight children. In another study cited by the CDC (Stunkard et al, 1967), overweight in children has been linked to social discrimination, a negative self-image in adolescence that often persists into adulthood, parental neglect (Lissau and Sorenson, 1994) and behavioral and learning problems (Mellbin and Vuille, 1989).
The study published in JAMA was funded by a grant from the National Center for Research Resources to UCSD's General Clinical Research Center. Co-authors were Tasha M. Burwinkle, M.D., Center for Child Health Outcomes, Children's Hospital and Health Center, San Diego; and James W. Varni, Ph.D., formerly a UCSD professor of psychiatry, when the study took place, and currently a professor of architecture and medicine, Texas A&M University, College Station, Texas.
UCSD and Children's Hospital have an affiliated children's health program that includes pediatric patient care, research, education and community service programs.
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JAMA