Health-Related Quality of Life across Recent Pediatric Obesity Classification Recommendations.

William R Black,Marshall T Beauchamp,Brooke Sweeney,Meredith L Dreyer Gillette,Ann M Davis,Sarah E Hampl,Kelsey B Borner

doi:10.3390/children8040303

Abstract

Extreme body mass index (BMI) values (i.e., above the 97th and below the 3rd percentiles) are inaccurately represented on the Centers for Disease Control and Prevention’s growth curves, which may limit the utility of BMI percentile and BMI z-score for capturing changes in clinical outcomes for patients at extreme weights. Modeling child obesity severity based upon the percentage of BMI in excess of the 95th percentile (BMI95pct) has been proposed as an improved metric to better capture variability in weight at extreme ends of growth curves, which may improve our understanding of relationships between weight status and changes in clinical outcomes. However, few studies have evaluated whether the use of BMI95pct would refine our understanding of differences in clinical psychosocial constructs compared to previous methods for categorization. This cross-sectional study evaluated child obesity severity based on BMI95pct to examine potential group differences in a validated, obesity-specific measure of Health-Related Quality of Life (HRQoL). Four hundred and sixty-five children with obesity completed Sizing Me Up, a self-report measure of HRQoL. Children were classified into categories based on BMI95pct (i.e., class I: ≥100% and <120%; class II: ≥120% and <140%; class III: ≥140%). The results indicate that children with class III obesity reported lower HRQoL than children with class I and class II obesity; however, there were no differences between Class II and Class I. In much of the previous literature, children with class II and class III obesity are often combined under the category “Severe Obesity” based upon BMI above the 99th percentile. This study suggests that grouping children from various classes together would neglect to capture critical differences in HRQoL. Future research including children with severe obesity should consider obesity classes to best account for functioning and clinical outcomes.

Highlights

Participants were well balanced across obesity classes
This study demonstrates that impairment in psychosocial functioning is not uniform across children with severe obesity and that children with the greatest amount of excess body weight self-report subjectively greater impairment compared to children with both class I obesity and class II severe obesity
95th percentile) and/or children with severe obesity (i.e., ≥99th BMI percentile) [35,36,37,38], the current study showed that children with class III severe obesity had Health-Related Quality of Life (HRQoL), which differed significantly from those with less severe obesity

Summary

Introduction

Pediatric obesity affects one sixth of all U.S children, and 5.8% of these children are considered to have severe obesity [1,2]. Obesity is defined by a Body-Mass-Index (BMI) ≥ 95th percentile for age and gender, while severe obesity classifies those with BMIs. ≥ 99th percentile on the 2000 Centers for Disease Control and Prevention (CDC) growth curves [2]. These curves were developed using statistical smoothing and normalizing procedures that allowed for the calculation of percentiles between the 3rd and 97th percentile and data outside of these ranges were not modeled as part of these curves. While BMI percentile and standardized BMI scores (BMIz or BMI z-score) are regularly used as objective measures of treatment outcomes and for providing obesity education to patients and families [3,4], these original curves most accurately reflect patients with BMI scores between the 3rd and 97th percentiles

Objectives

Results

Discussion

Conclusion