During the past two decades, the increasing prevalence of children and adolescents in the United States who are overweight or obese has raised concerns about the physical and psychosocial health of this population. The deleterious effects of obesity on physical health are more documented than the effects on psychosocial health. Swallen and colleagues used data from the National Longitudinal Study of Adolescent Health to determine the relationship between obesity and health-related quality of life in adolescents, particularly with regard to sex and race variables.

The authors used a subsample of 4,827 students in grades seven to 12 with information about behavior and psychosocial factors that potentially affect adolescent health. In determining outcome measures, the authors attempted to approximate the Pediatric Quality of Life Inventory by extracting data related to physical health and to emotional, social, and school functioning, which were analyzed in relation to body mass index (BMI) and sociodemographic factors.

There were statistically significant correlations between BMI and general health and functional limitations, but not for illness symptoms, depression, self-esteem, and school/social functioning. Functional limitations were correlated with participants who were underweight as well as overweight. Girls were significantly more likely than boys to report poor general health, low self-esteem, depression, functional limitations, and many illness symptoms. Overweight and obese girls were not more likely than girls with normal BMI to have poor emotional health. Psychosocial factors were influenced by body mass only in adolescents 12 to 14 years of age. In terms of racial differences, BMI correlated with functional limitations in whites but not in blacks.

The authors conclude that although this study showed links between BMI and general health and physical functioning in adolescents, there were no such associations between BMI and depression, school/social functioning, or self-esteem, except in adolescents 12 to 14 years of age. Subtle differences among sex, age, and race might warrant further investigation. Unless there is systematic misreporting (adolescents may have skewed conceptions about their health and well-being), increased tolerance of elevated BMI or simply the increasing normality of BMI might explain this study’s findings that overweight and obesity do not have a negative psychosocial impact on most adolescents.