Perceived social support from teachers and classmates does not moderate the inverse association between body mass index and health-related quality of life in adolescents
- 165 Downloads
The current study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among a large and non-clinical sample of adolescents, and tested the possible moderating effect of perceived teacher and classmate support on this association.
French-speaking Belgian adolescents (n = 11,342) self-reported height and weight, HRQoL (KIDSCREEN-10), as well as their perception of teacher and classmate relationships. Adjusting for sociodemographics, linear regression analyses with HRQoL as the outcome variable were performed for boys and girls separately. Interactions between BMI and teacher support, and between BMI and classmate support were included to examine the effect of this support on the association between BMI and HRQoL.
Obesity was associated with lower HRQoL for boys (β = − 2.14, p = 0.002) and for girls (β = − 2.96, p = 0.001), while only overweight girls showed a significant impaired HRQoL compared with normal-weight ones (β = − 0.94, p = 0.01). In both sexes, lower perceived teacher and classmate support was associated with lower HRQoL. Interactions between BMI and perceived teacher relationships, and between BMI and perceived classmate relationships, were not significant for boys as for girls.
Perceived school-related social support constitutes an important dimension of adolescent well-being, suggesting the relevance of considering it for promoting greater HRQoL in overweight and obese youth. Future studies are needed to confirm the absence of moderating effect of this support and explore its effect on other weight-related factors, like body image, weight misperception and bullying, associated with decreased HRQoL in adolescents.
KeywordsHealth-related quality of life Body mass index Perceived classmate support Perceived teacher support Adolescent
Body mass index
Family Affluence Scale
Health Behaviour in School-aged Children
Health-related quality of life
International Obesity Task Force
The authors would like to thank the schools and students for their participation in the French-speaking Belgian HBSC survey. They also thank the HBSC international coordination centre (University of St Andrews, United Kingdom) and the HBSC data management centre (University of Bergen, Norway) for their scientific support, Patrick De Smet (SIPES, Université libre de Bruxelles, Belgium) for his collaboration in data cleaning and management, Michèle Dramaix (Université libre de Bruxelles, Belgium) for her help in statistical analyses, as well as two anonymous reviewers for their relevant comments.
This work was funded by the Wallonia-Brussels Federation, the Birth and Children Office (ONE), the Walloon Region and the French Community Commission. Researchers performed the study (study design, data collection, analyses, interpretation and writing) independently of the funding bodies.
Compliance with ethical standards
Conflict of interest
The authors declare that they do not have conflict of interest.
The study was approved by the regional education boards of the four different school networks in the Wallonia-Brussels Federation (i.e. Conseil de l’Enseignement des Communes et des Provinces, Direction Générale de l’Enseignement obligatoire de la Fédération Wallonie-Bruxelles, Conseil des Pouvoirs organisateurs de l’Enseignement officiel neutre subventionné, Secrétariat Général de l’Enseignement Catholique).
Given the nature of the survey, informed consent was not considered as necessary by the education authority of school networks in the Wallonia-Brussels Federation.
- 1.Lebacq, T. (2015). Enquête de consommation alimentaire 2014–2015, Rapport 1: Anthropométrie (IMC, tour de taille et ratio tour de taille/taille). WIV-ISP. Retrieved February 7, 2018, from, https://fcs.wiv-isp.be/nl/Gedeelde%20%20documenten/FRANS/AM_FR.pdf.
- 2.World Health Organization (2017). Global strategy on diet, physical activity & health. childhood overweight and obesity. Retrieved January 30, 2017, from, http://www.who.int/dietphysicalactivity/childhood/en/.
- 3.Tsiros, M. D., Olds, T., Buckley, J. D., Grimshaw, P., Brennan, L., Walkley, J., et al. (2009). Health-related quality of life in obese children and adolescents. International Journal of Obesity, 33(4), 387–400.Google Scholar
- 4.Griffiths, L. J., Parsons, T. J., & Hill, A. J. (2010). Self-esteem and quality of life in obese children and adolescents: A systematic review. International Journal of Pediatric Obesity, 5(4), 282–304.Google Scholar
- 5.Ul-Haq, Z., Mackay, D. F., Fenwick, E., & Pell, J. P. (2013). Meta-analysis of the association between body mass index and health-related quality of life among children and adolescents, assessed using the pediatric quality of life inventory index. The Journal of Pediatrics, 162(2), 280–286.Google Scholar
- 6.World Health Organization (1997). WHOQOL, measuring quality of life. World Health Organization. Retrieved September 2, 2017, from, http://www.who.int/mental_health/media/68.pdf.
- 7.Ravens-Sieberer, U., Erhart, M., Rajmil, L., Herdman, M., Auquier, P., Bruil, J., et al. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: A short measure for children and adolescents’ well-being and health-related quality of life. Quality of Life Research, 19(10), 1487–1500.Google Scholar
- 8.Wu, Y. P., Reiter-Purtill, J., & Zeller, M. H. (2014). The role of social support for promoting quality of life among persistently obese adolescents: Importance of support in schools. Journal of School Health, 84(2), 99–105.Google Scholar
- 9.World Health Organization (1986). Young people’s health—a challenge for society: Report of a WHO Study Group on Young People and “Health for All by the Year 2000” (Technical Report Series). Switzerland.Google Scholar
- 10.Eccles, J. S., & Roeser, R. W. (2011). Schools as developmental contexts during adolescence. Journal of Research on Adolescence, 21(1), 225–241.Google Scholar
- 11.Thapa, A., Cohen, J., Guffey, S., & Higgins-D’Alessandro, A. (2013). A review of school climate research. Review of Educational Research, 83(3), 357–385.Google Scholar
- 12.Colarossi, L. G., & Eccles, J. S. (2003). Differential effects of support providers on adolescents’ mental health. Social Work Research, 27(1), 19–30.Google Scholar
- 13.Suldo, S. M., Friedrich, A. A., White, T., Farmer, J., Minch, D., & Michalowski, J. (2009). Teacher support and adolescents’ subjective well-being: A mixed-methods investigation. School Psychology Review, 38(1), 67.Google Scholar
- 14.Murray-Harvey, R. (2010). Relationship influences on students’ academic achievement, psychological health and well-being at school. Educational and Child Psychology, 27(1), 104.Google Scholar
- 15.Rueger, S. Y., Malecki, C. K., & Demaray, M. K. (2008). Gender differences in the relationship between perceived social support and student adjustment during early adolescence. School Psychology Quarterly, 23(4), 496.Google Scholar
- 16.Auerbach, R. P., Bigda-Peyton, J. S., Eberhart, N. K., Webb, C. A., & Ho, M.-H. R. (2011). Conceptualizing the prospective relationship between social support, stress, and depressive symptoms among adolescents. Journal of Abnormal Child Psychology, 39(4), 475–487.Google Scholar
- 17.Chu, P. S., Saucier, D. A., & Hafner, E. (2010). Meta-analysis of the relationships between social support and well-being in children and adolescents. Journal of Social and Clinical Psychology, 29(6), 624.Google Scholar
- 18.Holt-Lunstad, J., Uchino, B. N., Smith, T. W., & Hicks, A. (2007). On the importance of relationship quality: The impact of ambivalence in friendships on cardiovascular functioning. Annals of behavioral medicine: A publication of the Society of Behavioral Medicine, 33(3), 278–290.Google Scholar
- 19.Cutrona, C. E., Russell, D. W., & Gardner, K. A. (2005). The relationship enhancement model of social support. In: T. A. Revenson, K. Kayser & G. Bodenmann (Eds.), Couples coping with stress. Emerging perspectives on dyadic coping. American Psychological Association: Washington, DC, pp. 73–95.Google Scholar
- 20.Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310.Google Scholar
- 21.Zeller, M. H., & Modi, A. C. (2006). Predictors of health-related quality of life in obese youth. Obesity, 14(1), 122–130.Google Scholar
- 22.Herzer, M., Zeller, M. H., Rausch, J. R., & Modi, A. C. (2011). Perceived social support and its association with obesity-specific health-related quality of life. Journal of Developmental & Behavioral Pediatrics, 32(3), 188.Google Scholar
- 23.Ingerski, L. M., Janicke, D. M., & Silverstein, J. H. (2007). Brief report: Quality of life in overweight youth—the role of multiple informants and perceived social support. Journal of Pediatric Psychology, 32(7), 869–874.Google Scholar
- 24.Currie, C., Inchley, J., Molcho, M., Lenzi, M., Veselska, Z., & Wild, F. (2014). HBSC Study protocol: Background, methodology and mandatory items for the 2013/14 survey. St Andrews.Google Scholar
- 25.The KIDSCREEN Group Europe. (2016). The KIDSCREEN Questionnaires. Quality of life questionnaires for children and adolescents. Handbook (3rd edn.). Lengerich: Pabst Science Publishers.Google Scholar
- 26.Cole, T. J., & Lobstein, T. (2012). Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatric Obesity, 7(4), 284–294.Google Scholar
- 27.Sherry, B., Jefferds, M. E., & Grummer-Strawn, L. M. (2007). Accuracy of adolescent self-report of height and weight in assessing overweight status: A literature review. Archives of Pediatrics & Adolescent Medicine, 161(12), 1154–1161.Google Scholar
- 28.Fonseca, H., Silva, A., Matos, M. G., Esteves, I., Costa, P., Guerra, A., et al. (2010). Validity of BMI based on self-reported weight and height in adolescents. Acta Paediatrica, 99(1), 83–88.Google Scholar
- 29.Torsheim, T., Wold, B., & Samdal, O. (2000). The teacher and classmate support scale factor structure, test-retest reliability and validity in samples of 13-and 15-year-old adolescents. School Psychology International, 21(2), 195–212.Google Scholar
- 30.Torsheim, T., Cavallo, F., Levin, K. A., Schnohr, C., Mazur, J., Niclasen, B., et al. (2016). Psychometric validation of the revised family affluence scale: A latent variable approach. Child Indicators Research, 9(3), 771–784.Google Scholar
- 31.Hartley, J. E. K., Levin, K., & Currie, C. (2016). A new version of the HBSC Family Affluence Scale-FAS III: Scottish qualitative findings from the international FAS development study. Child Indicators Research, 9(1), 233–245.Google Scholar
- 32.Pedersen, A. B., Mikkelsen, E. M., Cronin-Fenton, D., Kristensen, N. R., Pham, T. M., Pedersen, L., et al. (2017). Missing data and multiple imputation in clinical epidemiological research. Clinical Epidemiology, 9, 157.Google Scholar
- 33.Chau, N., Chau, K., Mayet, A., Baumann, M., Legleye, S., & Falissard, B. (2013). Self-reporting and measurement of body mass index in adolescents: Refusals and validity, and the possible role of socioeconomic and health-related factors. BMC Public Health, 13(1), 815.Google Scholar
- 34.Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173.Google Scholar
- 35.Keating, C. L., Moodie, M. L., & Swinburn, B. A. (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 Pediatric Obesity, 6(5-6), 434–441.Google Scholar
- 36.Ottova, V., Erhart, M., Rajmil, L., Dettenborn-Betz, L., & Ravens-Sieberer, U. (2012). Overweight and its impact on the health-related quality of life in children and adolescents: Results from the European KIDSCREEN survey. Quality of Life Research, 21(1), 59–69.Google Scholar
- 37.Michel, G., Bisegger, C., Fuhr, D. C., & Abel, T. (2009). Age and gender differences in health-related quality of life of children and adolescents in Europe: A multilevel analysis. Quality of Life Research, 18(9), 1147–1157.Google Scholar
- 38.Kolodziejczyk, J. K., Gutzmer, K., Wright, S. M., Arredondo, E. M., Hill, L., Patrick, K., et al. (2015). Influence of specific individual and environmental variables on the relationship between body mass index and health-related quality of life in overweight and obese adolescents. Quality of Life Research, 24(1), 251–261.Google Scholar
- 39.Goldfield, G. S., Moore, C., Henderson, K., Buchholz, A., Obeid, N., & Flament, M. F. (2010). Body dissatisfaction, dietary restraint, depression, and weight status in adolescents. The Journal of School Health, 80(4), 186–192.Google Scholar
- 40.Mond, J., van den Berg, P., Boutelle, K., Hannan, P., & Neumark-Sztainer, D. (2011). Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: Findings from the project EAT study. Journal of Adolescent Health, 48(4), 373–378.Google Scholar
- 41.Walvoord, E. C. (2010). The timing of puberty: Is it changing? Does it matter? Journal of Adolescent Health, 47(5), 433–439.Google Scholar
- 42.Cumming, S. P., Gillison, F. B., & Sherar, L. B. (2011). Biological maturation as a confounding factor in the relation between chronological age and health-related quality of life in adolescent females. Quality of Life Research, 20(2), 237–242.Google Scholar
- 43.Puhl, R. M., & King, K. M. (2013). Weight discrimination and bullying. Best Practice & Research. Clinical Endocrinology & Metabolism, 27(2), 117–127.Google Scholar
- 44.Buttitta, M., Iliescu, C., Rousseau, A., & Guerrien, A. (2014). Quality of life in overweight and obese children and adolescents: A literature review. Quality of Life Research, 23(4), 1117–1139.Google Scholar
- 45.Mannan, M., Mamun, A., Doi, S., & Clavarino, A. (2016). Prospective associations between depression and obesity for adolescent males and females-a systematic review and meta-analysis of longitudinal studies. PLoS ONE, 11(6), e0157240.Google Scholar
- 46.Brennan, M. A., Lalonde, C. E., & Bain, J. L. (2010). Body image perceptions: Do gender differences exist. Psi Chi Journal of Undergraduate Research, 15(3), 130–138.Google Scholar
- 47.Bleidorn, W., Arslan, R. C., Denissen, J. J. A., Rentfrow, P. J., Gebauer, J. E., Potter, J., et al. (2016). Age and gender differences in self-esteem—a cross-cultural window. Journal of Personality and Social Psychology, 111(3), 396.Google Scholar
- 48.Chen, G., Ratcliffe, J., Olds, T., Magarey, A., Jones, M., & Leslie, E. (2014). BMI, health behaviors, and quality of life in children and adolescents: A school-based study. Pediatrics, 133(4), e868–e874.Google Scholar
- 49.Cui, W., Zack, M. M., & Wethington, H. (2014). Health-related quality of life and body mass index among US adolescents. Quality of Life Research, 23(7), 2139–2150.Google Scholar
- 50.Lazzeri, G., Rossi, S., Kelly, C., Vereecken, C., Ahluwalia, N., & Giacchi, M. V. (2014). Trends in thinness prevalence among adolescents in ten European countries and the USA (1998–2006): A cross-sectional survey. Public Health Nutrition, 17(10), 2207–2215.Google Scholar
- 51.Reiter-Purtill, J., Ridel, S., Jordan, R., & Zeller, M. H. (2010). The benefits of reciprocated friendships for treatment-seeking obese youth. Journal of Pediatric Psychology, 35(8), 905–914.Google Scholar
- 52.Uchino, B. N., Holt-Lunstad, J., Uno, D., & Flinders, J. B. (2001). Heterogeneity in the social networks of young and older adults: Prediction of mental health and cardiovascular reactivity during acute stress. Journal of Behavioral Medicine, 24(4), 361–382.Google Scholar
- 53.Fingerman, K. L., Hay, E. L., & Birditt, K. S. (2004). The best of ties, the worst of ties: Close, problematic, and ambivalent social relationships. Journal of Marriage and the Family, 66(3), 792–808.Google Scholar
- 54.von Weiss, R. T., Rapoff, M. A., Varni, J. W., Lindsley, C. B., Olson, N. Y., Madson, K. L., et al. (2002). Daily hassles and social support as predictors of adjustment in children with pediatric rheumatic disease. Journal of Pediatric Psychology, 27(2), 155–165.Google Scholar
- 55.Tak, Y. R., & McCubbin, M. (2002). Family stress, perceived social support and coping following the diagnosis of a child’s congenital heart disease. Journal of Advanced Nursing, 39(2), 190–198.Google Scholar
- 56.Zhang, X., Ra, C. K., Zhang, D., Zhang, Y., & MacLeod, K. E. (2016). The impact of school social support and bullying victimization on psychological distress among california adolescents. Californian Journal of Health Promotion, 14(2), 56–67.Google Scholar
- 57.Bokhorst, C. L., Sumter, S. R., & Westenberg, P. M. (2010). Social support from parents, friends, classmates, and teachers in children and adolescents aged 9 to 18 years: Who is perceived as most supportive? Social Development, 19(2), 417–426.Google Scholar
- 58.Caron, J., & Guay, S. (2005). Soutien social et santé mentale: Concept, mesures, recherches récentes et implications pour les cliniciens // Soutien social et santé mentale. Soutien social au Québec, 30(2), 15–41.Google Scholar
- 59.Mikolajczyk, R. T., & Richter, M. (2008). Associations of behavioural, psychosocial and socioeconomic factors with over-and underweight among German adolescents. International Journal of Public Health, 53(4), 214–220.Google Scholar
- 60.Fonseca, H., de Matos, M. G., Guerra, A., & Gomes-Pedro, J. (2009). Emotional, behavioural and social correlates of missing values for BMI. Archives of Disease in Childhood, 94(2), 104–109.Google Scholar
- 61.Gage, N. A., Prykanowski, D. A., & Larson, A. (2014). School climate and bullying victimization: A latent class growth model analysis. School Psychology Quarterly, 29(3), 256.Google Scholar
- 62.Campo, R. A., Uchino, B. N., Holt-Lunstad, J., Vaughn, A., Reblin, M., & Smith, T. W. (2009). The assessment of positivity and negativity in social networks: The reliability and validity of the social relationships index. Journal of community psychology, 37(4), 471–486.Google Scholar