Relationship between weight status and health-related quality of life in school-aged children in China

Mandana Zanganeh, Peymane Adab, Bai Li, Miranda Pallan, Wei Jia Liu, Rong Lin, Wei Liu, James Martin, KK Cheng, Emma Frew

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Background: Some studies from high-income countries suggest that overweight and/or obesity in children are negatively associated with health-related quality of life (HRQOL). However, the relationship between weight status and HRQOL is not well established in China, where obesity trends follow a different pattern compared with high-income countries. The risk of obesity is greater in children from higher socioeconomic backgrounds and higher in boys compared with girls.

Objective: The aim of this study was to examine the relationship between weight status and HRQOL in children between 6 and 7 years old in this unique country context.

Methods: Baseline HRQOL and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention trial in China. HRQOL was measured using the Chinese version of the Child Health Utility-9D (CHU-9D-CHN) and the Pediatric Quality of Life Inventory™ (PedsQL™) instruments. CHU-9D-CHN utility scores were generated using 2 scoring algorithms (UK and Chinese tariffs). Height and weight measures were taken at school by trained researchers using standardized methods, and BMI z scores were calculated using the World Health Organization 2007 growth charts. The relationship between HRQOL and weight status was examined using multivariable analyses, adjusting for age, gender, and socioeconomic status.

Results: Full data were available for 1539 children (mean age, 6 years). In both unadjusted and adjusted analyses, HRQOL, using both the CHU-9D-CHN and the PedsQL™, was marginally higher in children who were overweight or living with obesity compared with children with healthy weight, although this difference did not reach statistical significance. Separate analyses and models by gender showed that the relationship between weight status and HRQOL scores was similar in boys and girls.

Conclusions: Our results suggest no statistically significant difference in HRQOL between children with overweight/obesity compared with those with healthy weight. These results have implications for the methods of economic evaluation for obesity treatment and prevention interventions within this population cohort and country setting, as there appears to be no discernible consequences on children’s HRQOL from living with overweight and obesity.
Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalJournal of Health Economics and Outcomes Research
Issue number1
Publication statusPublished - 7 Mar 2022

Bibliographical note

This study was funded through a charitable donation from Zhejiang Yong Ning Pharmaceutical Ltd Co. to the University of Birmingham. The analyses were further supported by a University of Birmingham College of Medical and Dental Sciences PhD studentship. The study was additionally funded through a philanthropic donation from Zhejiang Yong Ning Pharmaceutical Ltd Co (No. ISRCTN11867516) from 2014 to 2018.


  • weight status
  • overweight
  • obesity
  • health-related quality of life
  • children
  • China


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