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Qual Life Res. 2013 Nov;22(9):2607-15. doi: 10.1007/s11136-013-0358-0. Epub 2013 Feb 20.

The effect of weight status, lifestyle, and body image perception on health-related quality of life in children: a quantile approach.

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Department of Statistical Sciences, University of Bologna, 40126, Bologna, Italy.



To evaluate the effect of excess weight, lifestyle factors, and body image on HRQoL in a sample of school-aged children.


Cross-sectional data of 4,338 thirteen-year-old children were collected in 2007 as part of the So.N.I.A project, a nutritional surveillance study in a northern Italian region. A two-stage sampling design was used in order to gain a Health District representative sample of the regional population. HRQoL was assessed using the EQ-5D-Y questionnaire completed by the children at school. The association between weight categories, defined by means of the International Obesity Task Force cut points, physical exercise, and body image perception and HRQoL as measured by the EQ-Visual Analogue Scale was studied by means of a quantile regression analysis.


Of the participants, 891 (20.5 %) and 210 (4.84 %) were overweight and obese, respectively, with 1,922 (44.3 %) children exercising <2 h per week. Results from the quantile regression showed a decreased HRQoL for girls compared with boys, overweight or obese children who do little weekly exercise, and body image dissatisfaction, especially in the lower tail of the VAS distribution.


Excess weight, sedentary behavior, and an unsatisfactory self-perception are associated with reduced HRQoL in this population-based sample. Quantile regression can help to highlight differences in the effects along all of the outcome distribution.

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