Relationship between overweight and health-related quality of life in secondary school children in Fiji: results from a cross-sectional population-based study

Objective
To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity.

Methods
The study comprised 8947 children from forms 3–6 (age 12–18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.

Results
HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12–14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15–18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen’s d 0.2–0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen’s d <0.2).

Discussion
The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.

Invited commentary: job strain and health behaviors—developing a bigger picture

Investigation of the association between job stressors and health behaviors has a long history that has been marked by mixed findings. Fransson et al. (Am J Epidemiol. 2012;176(12):1078–1089) find robust prospective and cross-sectional associations between job strain and leisure-time physical inactivity in combined data from 14 cohort studies. Further research to better understand the observed heterogeneity in the contributing cohorts and other studies will be crucial for application to intervention design and tailoring. The population health significance of these findings requires consideration of other job strain–health behavior (particularly the parallel analyses conducted for body mass index and smoking in the same data set) and job strain–health outcome associations, as well as these same associations for other job stressors. Job strain can be seen as a “fundamental cause” of work-related disease, in that intervention to reduce exposure to job strain could have beneficial impacts on many outcomes, making a compelling case for intervention. The significantly strengthened evidence linking job stressors to health behaviors provided by Fransson et al. may help to further direct workplace health promotion research, policy, and practice towards an approach that better integrates intervention on working conditions and health behaviors. The benefits to population health could be substantial.

Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

Aim: 

Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors

Objective : To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors.

Methods : Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities.

Results : Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy.

Conclusions : Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events.