title: BMI, health behaviors, and quality of life in children and adolescents: a school-based study.
abstract: OBJECTIVE
  To explore the relationship between weight status (BMI) and health-related quality of life in children and adolescents through application of the Child Health Utility 9D, a new generic preference-based instrument.
  
  
  METHODS
  Data were collected from primary and high school students in rural and metropolitan regions of South Australia. Consenting participants (2588 in grades 4-6 and 765 in grades 9-10) were weighed and measured and categorized as underweight, healthy weight, overweight, or obese according to International Obesity Taskforce BMI cutoff points (primary outcome). Participants also completed a questionnaire including the Child Health Utility 9D and standardized measures of physical activity, sedentary behavior, sleep patterns, and eating behavior (secondary outcomes). Descriptive and multivariate linear regression analyses were undertaken to calculate mean utility differences.
  
  
  RESULTS
  In comparison with healthy-weight primary school students, adjusted mean utilities were lower for overweight (-0.016, P = .02) or obese (-0.039, P = .001) students. For high school students, the adjusted mean utilities were also lower for overweight and obese students but were nonsignificant (-0.018, P > .10). Physical activity, sedentary behavior, sleep patterns, and eating behavior were all found to be significantly associated with utilities.
  
  
  CONCLUSIONS
  Irrespective of BMI, young people engaging in more physical activities or less sedentary behavior, and having healthier sleep patterns or eating behavior exhibited higher utilities. Associations between utilities and sleep patterns or eating behavior were stronger than the associations with BMI. Future economic evaluations for obesity interventions should more formally investigate the relationship between changes over time in weight status and health-related quality of life for children and adolescents.
authors.affiliation: Flinders Health Economics Group, and.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
authors.forename: Tim
authors.initials: T
authors.lastname: Olds
authors.forename: Anthea
authors.initials: A
authors.lastname: Magarey
authors.forename: Michelle
authors.initials: M
authors.lastname: Jones
authors.forename: Eva
authors.initials: E
authors.lastname: Leslie
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D011788:Quality of Life; D012574:Schools; D057185:Sedentary Behavior; D012890:Sleep
keywords: Australia; BMI; adolescent; children; health-related quality of life; utility