Health-related quality of life in obese youth in the lower Mississippi Delta


Objective: Adults and children in rural settings are at greater risk for overweight and obesity than those in urban settings. Multiple studies have suggested that quality of life is lower for obese individuals. This study addresses the association of obesity with health-related Quality of Life (QOL) among youth in the rural Mississippi Delta. Methods: QOL data on children aged 3 - 17 years using the PedsQL were collected as part of a cross-sectional telephone survey in the Delta. Weight was grouped by AAP categorizations as underweight, normal, overweight (85 - 95th BMI percentile), obese (95 - 97th percentile), and extremely obese (> 97th percentile). Results: 437 youth participated. Multiple linear regression models were used to predict PedsQL component scores. Results showed main effects for age (p = 0.006), race (p < 0.001), and BMI group (p = 0.049) on psychosocial QOL. Older children ages 9 - 17, white and black children, and obese or extremely obese children scored lower on psychosocial QOL than younger children, other race, and non- obese. A strong age by weight group interaction (p = 0.014) showed that obesity and extreme obesity was associated with lower scores on psychosocial QOL only for older children ages 12 - 17. Conclusions: Investigating the QOL in this rural community where the majority of adults and children are obese aids in our understanding the relationship between sociocultural factors and HRQOL. In the context of an obese majority obesity and extreme obesity remain important contributions to reduced psychosocial (emotional, social, school performance) quality of life for adolescents but not for younger children).

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Ward, W. , Weber, J. , Gossett, J. , Simpson, P. , Bogle, M. and Robbins, J. (2012) Health-related quality of life in obese youth in the lower Mississippi Delta. Open Journal of Preventive Medicine, 2, 332-338. doi: 10.4236/ojpm.2012.23048.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lutfiyya, M.N., Lipsky, M.S., Wisdom-Behounek, J. and Inpanbutr-Martinkus, M. (2007) Is rural residency a risk factor for overweight and obesity for US children? Obesity, 15, 2348-2356. doi:10.1038/oby.2007.278
[2] Gamm, L.D., Huchison, L.L., Dabney, B.J. and Dorsey, A.M. (2010) Rural healthy people. A companion document to health people 2010 vols. 1-3. A&M University System Health Services Center School of Rural Public Health, Southwest Rural Health Research Center 2003, College Stations.
[3] Pearson, T.A. and Lewis, C. (1998) Rural epidemiology: Insights from a rural population laboratory. American Journal of Epidemiology, 148, 949-957. doi:10.1093/oxfordjournals.aje.a009571
[4] Davis, C.L., Flickinger, B., Moore, D., Bassali, R., Domel-Baxter, S. and Yin, Z. (2005) Prevalence of cardiovascular risk factors in school children in a rural Georgia community. American Journal of the Medical Sciences, 330, 53-59. doi:10.1097/00000441-200508000-00001
[5] Neovius, M. and Rasmussen, F. (2008) Place of residence and obesity in 1,578,694 young Swedish men between 1969 and 2005. Obesity, 16, 671-676. doi:10.1038/oby.2007.115
[6] Schafft, K.W., Jensen, E.B. and Hinrichs, C.C. (2009) Food deserts and over-weight schoolchildren: Evidence from Pennsylvania. Rural Sociology, 74, 153-177. doi:10.1111/j.1549-0831.2009.tb00387.x
[7] Eichner, J.E., Moore, W.E., Perveen, G., Kobza, C.E., Abbott, K.E. and Stephens, A.L. (2007) Overweight and obesity in an ethnically diverse rural school district: The healthy kids project. Obesity, 16, 501-504. doi:10.1038/oby.2007.60
[8] Hill, J.O. and Trowbridge, F.L. (1998) The causes and health consequences of obesity in children and adolescents. Pediatrics, 101, 570-574. doi:10.1542/peds.101.3.570
[9] Reidpath, D.D., Burns, C., Garrard, J., Mahoney, M. and Townsend, M. (2002) An ecological study of the rela- tionship between social and environmental determinants of obesity. Health and Place, 8, 141-145. doi:10.1016/S1353-8292(01)00028-4
[10] Schwimmer, J.B., Burwinkle, T.M. and Varni, J.W. (2003) Health-related quality of life of severely obese children and adolescents. Journal of the American Medical Association, 289, 1813-1819. doi:10.1001/jama.289.14.1813
[11] Pinhas-Hamiel, O., Singer, S., Pilpel, N., Fradkin, A., Modan, D. and Reichman, B. (2006) Health-related quality of life among children and adolescents: associations with obesity. International Journal of Obesity, 30, 267- 272. doi:10.1038/sj.ijo.0803107
[12] Swallen, K.C., Reither, E.N., Haas, S.A. and Meier, A.M. (2005) Overweight obesity and health-related quality of life among adolescents: The national longitudinal study of adolescent health. Pediatrics, 115, 340-347. doi:10.1542/peds.2004-0678
[13] Williams, J., Wake, M., Hesketh, K., Maher, E. and Waters, E. (2005) Health-related quality of life of overweight and obese children. Journal of the American Medical Association, 293, 70-76. doi:10.1001/jama.293.1.70
[14] Arif, A.A. and Rohrer, J.E. (2006) The relationship be- tween obesity hyperglycemia symptoms and health-related quality of life among Hispanic and non-Hispanic white children and adolescents. BMC Family Practice, 7, 3. doi:10.1186/1471-2296-7-3
[15] Flodmark, C.E. (2005) The happy obese child. Interna- tional Journal of Obesity, 2, S31-S33. doi:10.1038/sj.ijo.0803060
[16] United States Department of Agriculture (USDA) (2005) Measuring rurality: Rural-urban continuum codes. Economic Research Service editor.
[17] Thorton, A. (1997) Demographic social and economic characteristics. In: Harrison, G., Ed., Lower Mississippi Delta Nutrition Intervention Research Consortium editors. Nutrition and Health Status in the Lower Mississippi Delta of Arkansas, Louisiana and Mississippi: A Review of Existing Data, Westat, Rockville, 9-23.
[18] Smith, J., Lensing, S. and Horton, J.A. (1999) Prevalence of self-reported nutri-tion-related health problems in the Lower Mississippi Delta. American Journal of Public Health, 89, 1418-1421. doi:10.2105/AJPH.89.9.1418
[19] Lower Mississippi Delta Nutrition Intervention Research Consortium (2004) Self-reported health of residents of the Mississippi Delta. Journal of Health Care for the Poor and Underserved, 15, 645-662. doi:10.1353/hpu.2004.0056
[20] Stuff, J. E., Horton, J. A. and Bogle, M. L. (2004) High prevalence of food in-security and hunger in households in the rural lower Mississippi Delta. The Journal of Rural Health, 20, 173-180. doi:10.1111/j.1748-0361.2004.tb00025.x
[21] French, S.A. Story, M. and Perry, C.L. (1995) Self-es- teem and obesity in children and adolescents: A literature review. Obesity Research, 3, 479-490.
[22] Champagne, D.M., Bogle, M.L., McGee, B.B., Yadrick, K., Allen, H.R. and Kramer, T.R. (2004) Dietary intake in the lower Missis-sippi Delta region: Results from the foods of our Delta study. Journal of the American Die- tetic Association, 104, 199-207. doi:10.1016/j.jada.2003.11.011
[23] Stein, A.D., Leder-man, R.I. and Shea, S. (1993) The be- havioral risk factor system questionnaire: Reliability in a state wide system. American Journal of Public Health, 83, 1768-1772. doi:10.2105/AJPH.83.12.1768
[24] Kish, L. (1965) Sur-vey Sampling. John Wiley and Sons, Inc., New York.
[25] Varni, J.W., Seid, M. and Rode, C.A. (1999) The PedsQL: Measurement model for the pediatric quality of life in- ventory. Medical Care, 37, 126-139. doi:10.1097/00005650-199902000-00003
[26] Keating, C., Moodie, M. and Swinburn, B. (2011) The health-related quality of life of overweight and obese adolescents—A study measuring body mass index and adolescent-reported perceptions. International Journal of Obesity, 6, 434-441.
[27] Williams, J., Canterford, L., Hesketh, K., Hardy, P., Waters, E., Patton, G. and Wake, M. (2011) Changes in body mass index and health related quality of life from childhood to adolescence. International Journal of Obesity, 6, 442-448.
[28] Wake, M., Canterford, L., Patton, G., Hesketh, K., Hardy, P., Williams, J., Waters, E. and Carlin, J. (2010) Comor- bidities of overweight/obesity experienced in adolescence: Lon-gitudinal study. Archives of Disease in Childhood, 95, 162-168.
[29] Varni, J.W., Seid, M., Knight, T.S., Uzark, K. and Szer, I.S. (2002) The Peds QL (TM) 4.0 generic core scales: Sensitivity, responsiveness, and impact on clinical decision-making. Journal of Behavioral Medicine, 25, 175- 193. doi:10.1023/A:1014836921812
[30] Varni, J.W., Burwinkle, T.M. and Seid, M. (2006) The Peds QL? 4.0 as a school population health measure: Feasibility, reliability, and validity. Quality of Life Research, 15, 203-215. doi:10.1007/s11136-005-1388-z
[31] Center for Disease Control (CDC) (2005) Overweight and obesity: Defining overweight and obesity. US Department of Health and Human Services. http//
[32] Friedman, M.A. and Brownell, K.D. (1995) Psychological correlates of obesity: moving to the next research generation. Psychological Bulletin, 117, 3-20. doi:10.1037/0033-2909.117.1.3
[33] Franklin, J., Denyer, G., Steinbeck, K.S., Caterson, I.D. and Hill, A.J. (2006) Obesity and risk for low self-esteem: A statewide study of Australian children. Pediatrics, 118, 2481-2487. doi:10.1542/peds.2006-0511
[34] Msall, M. (2005) Measuring functional skills in preschool children at risk for neurodevelopmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 11, 263-273. doi:10.1002/mrdd.20073
[35] Must, A., Spadano, J., Coakley, E.H., Field, A.E., Colditz, G. and Dietz, W.H. (1999) The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282, 1523-1529. doi:10.1001/jama.282.16.1523
[36] Ogden, C.L., Carroll, M.D., Curtin, L.R., McDowell, M.A., Tabak, C.J. and Flegal, K.M. (2006) Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association, 295, 1549-1555. doi:10.1001/jama.295.13.1549
[37] Manson, J.E., Skerrett, P.J., Greenland, P. and Vanltallie, T.B. (2004) The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Archives of Internal Medicine, 163, 249-253. doi:10.1001/archinte.164.3.249
[38] Vos, R., Huisman, S., Houdijk, E., PiJl, H. and Wit, J. (2011) The effect of family-based multidisciplinary cognitive behavioral treatment on health-related quality of life in childhood obesity. Quality of Life Research, 12, 110.
[39] Wille, N., Bullinger, M., Holl, R., Hoffmeister, U., Mann, R., Goldapp, C., Reinehr, T. and Westenh?fer, J. (2010) Health-related quality of life in overweight and obese youths: Results of a multicenter study. Health and Quality of Life Outcomes, 8, 36. doi:10.1186/1477-7525-8-36

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