Impaired Health-Related Quality of Life in Preschoolers With Obesity

Current estimates suggest 12.1% of preschoolers are obese (BMI ≥ 95th percentile for age and sex; Ogden, Carroll, Kit, & Flegal, 2012). Excess weight gain during the preschool years is problematic because it has been found to track throughout childhood (Nader et al., 2006) to adulthood (Guo, Wu, Chumlea, & Roche, 2002) and because some preschoolers with obesity already exhibit risk factors for cardiovascular disease (Gopinath et al., 2011). Despite these alarming trends, obesity remains underrecognized in this age-group, and its impact on preschooler’s functioning appears to be underestimated. Numerous studies have documented that parents of preschoolers with obesity perceive their child as being of healthy weight (e.g., Carnell, Edwards, Croker, Boniface, & Wardle, 2005) and are not concerned about their child’s excess weight gain because they feel their child “will grow out of it” (Jain et al., 2001). Retrospective studies have also found that pediatricians document and address weight concerns less frequently in preschoolers compared with older children and adolescents (Barlow, Trowbridge, Klish, & Dietz, 2002). It is thus possible that the negative health consequences of obesity may seem too far off to prompt caregivers of preschoolers with obesity and their health care providers to take action. Emerging evidence suggests that having obesity during the preschool years may have immediate physical and psychosocial consequences, however. Using data from the 1999–2008 National Health and Nutrition Examination Survey, Cockrell-Skinner et al. (2010) found parents were significantly more likely to report run/walk limitations for preschoolers with severe obesity (BMI ≥ 99th percentile) than for preschoolers who were of a healthy weight. Socially, preschoolers with obesity may experience weight-based stigmatization, as experimental research has demonstrated that children as young as 3 years of age ascribe significantly more negative adjectives (e.g., ugly and stupid) to overweight figures and rate overweight figures as less preferred playmates than nonoverweight figures (Cramer & Steinwert, 1998; Margulies, Floyd, & Hojnoski, 2008). Two studies have also found parents report significantly more peer problems for preschoolers with obesity than for preschoolers who are of a healthy weight. Findings have been mixed regarding whether preschoolers with obesity experience more emotional and behavioral problems than preschoolers who are not obese (Datar, Sturm, & Magnabosco, 2004; Griffiths, Dezateux, & Hill, 2011; Sawyer et al., 2006). Further investigation of the immediate consequences of obesity on preschooler functioning and development is clearly warranted. Assessment of health-related quality of life (HRQOL) is one method for examining how being obese may affect preschoolers’ physical and psychosocial functioning. Multiple studies have demonstrated significantly lower HRQOL for older children and adolescents with obesity compared with their healthy weight peers (Tsiros et al., 2009). Only one study has examined differences in HRQOL by weight for preschoolers (Wake, Hardy, Sawyer, & Carlin, 2008). Although not statistically different, parents in this large community sample did proxy-report lower physical and psychosocial functioning for preschoolers with obesity compared with preschoolers who were of a healthy weight. The authors concluded that even though parents do not report concern about their preschooler's weight, they are likely to be concerned about more immediate health and behavioral problems that may result from excess weight gain (e.g., sleep difficulties and respiratory problems). However, it is not known whether these concerns can be leveraged to promote concern about weight. The current study begins to address this question by examining whether parents seeking treatment for their preschooler with obesity evaluated their child’s HRQOL differently than parents of a nonclinical comparison sample of preschool-aged children. HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL) parent proxy-report form. HRQOL data for preschoolers with obesity were collected as part of a larger pilot study to develop a clinic- and home-based behavioral obesity intervention for preschoolers and their families. As this study was an iterative process, data for 18 preschoolers who participated in an earlier iteration have been published (Stark et al., 2011), whereas data for the latter iterations consisting of 42 preschoolers have not. Using a methodology similar to Schwimmer et al. (2003), we compared baseline parent proxy-reported HRQOL for our sample of treatment-seeking preschoolers with obesity with a nonclinical comparison sample of preschoolers drawn from the PedsQL database. Based on the HRQOL literature for older pediatric age groups, and the limited information on physical and psychosocial functioning for preschoolers with obesity, we hypothesized that parent proxy-reported HRQOL would be significantly lower for treatment-seeking preschoolers with obesity compared with preschoolers in the nonclinical comparison group on the Total Scale score and Physical and Psychosocial Health Summary scores of the PedsQL.