Quality of Life in School-Age Children With Obesity

Shannon Baker Powell; Martha Keehner Engelke; Melvin S. Swanson


Pediatr Nurs. 2018;44(4):183-188. 

In This Article

Abstract and Introduction


The purpose of the study was two-fold: to describe the self-reported physical and psychosocial quality of life of 37 school-age children (24 girls, 13 boys, grades 1 to 12) living with severe obesity and having difficulty managing their illness; and to examine the descriptive comments of school nurses providing case management to these students. Quality-of-life scores measured by the Pediatric Quality of Life Inventory Version 4.0 SF15 were lower among children with obesity compared to the healthy norm. School nurses' descriptive comments support physical and psychosocial health concerns reflected by quality-of-life scores, and demonstrate the key role of the school nurse in assessing the needs of students living with severe obesity. Comments by school nurses suggest a holistic approach, including environmental and psychosocial interventions might be the most effective strategy for nurses and other professionals working with schoolage children with obesity.


Childhood obesity is a multifactorial problem affecting the lives of 31.8% of children and adolescents in the United States, with higher rates among Hispanic and non-Hispanic Black youth (Ogden et al., 2016). Increased obesity rates are also higher in lowincome households (Levine, 2011). Childhood overweight is defined as a body mass index (BMI) in the 85th to 94th percentile, and obesity as a BMI in the 95th percentile and higher (National Institutes of Health [NIH], 2012). Obese youth face many physical health problems associated with obesity, including type 2 diabetes, increased cholesterol, hypertension, asthma, orthopedic problems, and sleep apnea (Centers for Disease Control and Prevention [CDC], 2016; Pulgarón, 2013). Psychosocial concerns associated with childhood obesity include depression, low selfesteem and quality of life, behavioral problems, and difficulty in school (Morrison, Shin, Tarnopolsky, & Taylor, 2015). The rate of childhood obesity among school-age children today is approximately 1 in 5 (Ogden et al., 2016). Recent evidence suggests the prevalence of obesity is stable although still a concern (Ogden et al., 2016). Childhood obesity is a complex problem that should be addressed in the school setting because youth spend a significant portion of their time in school.

Children and adolescents with obesity report a significantly lower level of quality of life when compared to those who are of normal weight (Morrison et al., 2015; Trevino, Pham, & Edelstein, 2013; Wallander et al., 2013). Components of health-related quality of life include both physical and psychosocial aspects. Children's physical health-related quality of life includes general limitations and children's ability to participate in physical activities. Psychosocial health-related quality of life includes emotional health and social functioning (Varni, Burwinkle, Seid, & Skarr, 2003).

Previous interventions targeting obesity have primarily focused on education related to diet and physical activity. These interventions have most often been implemented by classroom teachers, or occasionally, by other personnel, such as physical education teachers, school nurses, or research staff (Ickes, McMullen, Haider, & Sharma, 2014). School-based interventions by Wang and colleagues (2010) incorporated cooking classes, school gardens, changes in school meals, and food diaries. Other interventions have included recording dietary intake (Kanyamee, Fongkaew, Chotibang, Aree, & Kennedy, 2013), diet journaling, and exercise logs (Wong & Cheng, 2013). Classroom lessons and activities relating to healthy diet and increased physical activity have also been implemented (Johnston et al., 2013; Llargues et al., 2011; Manger et al., 2012; Sachetti et al., 2013; Walther et al., 2009). Pbert and colleagues (2013) implemented a school nurse counseling intervention that centered on healthy eating and physical activity guidelines. Schoolbased interventions have been successful, although most target the general population and lack a focus on the specific population of children living with overweight and obesity.

School nurses, who often interact daily with students, are in an advantageous position to assess and address quality of life in school-age children. The National Association of School Nurses (NASN) (2013) developed a position statement that specifically addresses the role of the school nurse in working with students who are overweight or obese. The position statement clearly articulates the important role of the school nurse:

"It is the position of the National Association of School Nurses that school nurses have the knowledge and expertise to promote the prevention of overweight and obesity, and address the needs of overweight and obese youth in schools. The school nurse collaborates with students, families, school personnel, and health care providers to promote healthy weight and identify overweight and obese youth who may be at risk for health problems. The school nurse can refer and follow up with students who may need to see a health care provider. The school nurse also educates and advocates for changes in the school and district that promote a healthy lifestyle for all students (NASN, 2013, p. 62)."

Though school nurses are recognized as vital resources in efforts to decrease childhood obesity, school nurse practice varies greatly in this area; many school nurses have difficulty addressing the needs of school age children with obesity. A recent qualitative study found that whether school nurses were working in one school or covering several schools, they had difficulty addressing the needs of overweight and obese students because of time constraints and competing demands (Powell, Engelke, & Neil, 2017).

In summary, although a significant amount of literature exists on school-age children with obesity, there is a need to better understand factors that contribute to the lower quality of life of these students, particularly students who are severely obese. Interventions are likely to be more successful with this information, particularly for students struggling at school because of their obesity.