Poor Health Related Quality of Life and Unhealthy Lifestyle Habits in Weight-Loss Treatment-Seeking Youth

Abstract

Obesity is associated with unhealthy lifestyle behaviors and poor Health Related Quality of Life (HRQOL). The cumulative effect of lifestyle behaviors on HRQOL has been demonstrated in chronically ill adolescents, but not in adolescents with obesity. The present study aimed to assess the association between HRQOL and adherence to the Mediterranean Diet (MD) and/or low levels of physical activity (PA) in a large sample of outpatient adolescents with overweight or obesity seeking weight loss treatment. Four-hundred-twenty participants were enrolled from 10 Italian outpatient clinics. The demographics and anthropometric features, KIDMED scores, and exercise levels of the participants were collected, together with parental features. The HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL™), Adolescents Version 4.0. PedsQL total score and functioning subscales were lower in adolescents who reported one or two unhealthy habits. Compared with the high/intermediate groups, the risk of low HRQOL was twice as high for each unit increase in BMI SDS, while the percentage was reduced by 12.2% for every unit increase in the KIDMED score and by 32.3% for each hour increase of exercise. The clustering of these two unhealthy behaviors conferred a 120% higher risk of low HRQOL. Similarly, adolescents displaying better diet quality and/or a physically more active lifestyle have better physical and psychological functioning. Further studies are needed to disclose whether these characteristics may be predictive of better adherence to weight loss treatment.

Adherence to Mediterranean diet associated with health-related quality of life in children and adolescents: a systematic review

“…Of the eight studies that reported the value of the correlation with the HRQoL general score, four [ 14 – 17 ] showed positive associations of MD adherence with higher levels of HRQoL with statistically significant values; the β-value ranged from 0.13 to 0.26. In contrast, the study that evaluated the OR [ 24 ] reported a value of 0.878 (95% CI, 0.804–0.959) between better MD adherence and high/intermediate HRQoL (for each increase in one unit of the KIDMED score, the odds of "low total functioning" will decrease by 12%). Of the other three studies with no statistically significant results, two found a positive association, and one found a negative association between MD and HRQoL.…”

“…After full-text revision of 28 articles, 17 articles were excluded because of the following: they included neither MD nor HRQoL ( n = 4), the association between QoL and the MD was not investigated ( n = 6), the publication of another study was already included ( n = 2), there were statistical inconsistencies ( n = 4) and there was one study in which HRQoL presented a value that was not plausible (see Additional File 2 ). Finally, 11 articles were included for qualitative synthesis [ 14 – 24 ].…”

“…The studies were conducted in Spain [ 15 , 18 , 19 , 21 ], Greece [ 14 , 16 ], Chile [ 20 , 22 ], Portugal [ 17 ], Lebanon [ 23 ] and Italy [ 24 ]. Ten studies had a cross-sectional design [ 14 – 17 , 19 – 24 ], while one study was longitudinal [ 18 ]; therefore, it was considered the baseline cross-sectional cohort. The number of total participants included was 6,796 between 10 and 18 years old.…”

“…Social relationships and Peer pressure 5. School environment School type, grade, age, skipping meals, father's education level, number of meals, number of meals with family, and physical activity Self-funded Mozzillo et al, 2021 [ 24 ] Italy Cross-sectional 420 (13–17 years old) Age 13.0–17.0 years; Caucasian ethnicity; overweight or obesity; first visit at the outpatient clinic. The exclusion criteria were secondary causes of obesity (genetic, endocrine, or iatrogenic forms) and other chronic diseases or mental illnesses 44.5% boys Median age: 14.0 years (IQR: 13.2; 15.0) 31.2 (IQR: 28.7; 34.2) 0 h/week (0–3) 82.3 (IQR: 73.6; 93.2) KIDMED index 16 dichotomous items (yes/no): 12 items: behaviors consistent with the Mediterranean diet 4 items: behaviors inconsistent with the Mediterranean diet Pediatric Quality of Life Inventory (PedsQL) 4 Dimensions: 1.…”

“…School environment: 0.00001 10. Social acceptance: 0.00001 KIDMED vs. PedsQL Mozzillo et al, 2021 [ 24 ] 5 (IQR:3; 7) 75 (IQR: 65; 83) 1. Physical functioning: 75 (IQR: 66; 84) 2.…”