Quality of life after in-patient rehabilitation in children with obesity.
OBJECTIVE
Treating obesity concerns not only medical concomitants and future complications but also quality of life. The study was planned to investigate the effect of obesity and obesity treatment on quality of life in children.


METHODS
In the study presented, quality of life as well as psychosocial, clinical, sociodemographic and family related information was obtained from both children and their parents, at four time points by questionnaires: (1) Prior to in-patient rehabilitation (at home); (2) at the end of the in-patient rehabilitation (in clinics); (3) three months after admission into rehabilitation clinics; and (4) twelve months after admission into rehabilitation clinics.


METHODS
Quality of life (QoL) was assessed in children using the revised German KINDL(R) quality of life questionnaire, a 24 item instrument yielding six dimensions and a total score as well as a chronic generic and an obesity module. Psychosocial determinants included assessments of stress, emotional support, coping and internal locus of control as well as expectations and motivations with regard to the rehabilitation programme.


METHODS
Seven large German in-patient rehabilitation clinics participated in the study in which 1019 children participated. These children were suffering from obesity (n=584) or asthma/atopic dermatitis (n=330) or both (n=105).


RESULTS
Children as well as parents did not differ across the diagnostic groups in sociodemographic and general clinical variables. QoL in children was dependent on age and gender with increased age over 13 y and female gender being associated with lower self reported QoL. Differences between diagnostic groups were significant, indicating higher impairments in QoL in children with obesity. Multiple regression analysis showed that stress level, coping, as well as lack of emotional support and poor global health explained 37% of the variance of the KINDL(R) total score at the first measure point in the obesity group. Predicting QoL at the end of rehabilitation from data collected at the beginning of the study, psychosocial variables explained 28% of the variance. The results indicate that QoL of children with obesity is affected by age and gender and can be explained by stress, coping and support as well as global health ratings. QoL of obese children differs from the QoL of children with asthma/atopic dermatitis and improves from before to after rehabilitation. QoL after rehabilitation is predicted by psychosocial indicators, health resources and strains.


CONCLUSIONS
The results of the study suggest that QoL assessment in children with obesity is relevant in understanding what life is like for children with obesity, which aspects of their life affect their well-being and how quality of life can be improved through rehabilitation programmes.
Ravens-Sieberer
U
U
Child and Adolescent Health, Robert Koch Institute, Stresemannstrasse 90, D-10963 Berlin, Germany. Ravens-SiebererU@rki.de
Redegeld
M
M
Bullinger
M
M
D000293:Adolescent; D000367:Age Factors; D001249:Asthma / Q000150:complications; D002648:Child; D003876:Dermatitis, Atopic / Q000150:complications; D005260:Female; D006304:Health Status; D006801:Humans; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000523:psychology* / Q000534:rehabilitation*; D011788:Quality of Life; D012044:Regression Analysis; D012737:Sex Factors; D012944:Social Support; D013312:Stress, Physiological; D011795:Surveys and Questionnaires; D013997:Time Factors