Association of Perceived Weight Status and Health-Related Quality of Life in Children and Adolescents: the Weight Disorder Survey of the CASPIAN- IV Study

Background: This study investigates the association of perceived weight status and health-related quality of life (HRQOL) in a representative sample of Iranian children and adolescents. Materials and Methods: In this study, 6-18-year-old students were selected from 30 provinces of Iran. Weight status and perceived weight status of students were determined by physical examination and using the validated questionnaire of the World Health Organization-Global school-based student health survey, respectively. The students’ HRQL was evaluated by the Persian version of the Pediatric Quality of Life inventory (PedsQL™ 4.0TM 4.0) Generic Core Scales. Results: The participants consisted of 23,043 students with mean (standard deviation [SD]) age of 12.55(3.31) years. Underweight was significantly less prevalent than perceived underweight (30.8%vs 10.0%, respectively, P<0.001), whereas normal weight was significantly more prevalent than perceived normal weight (70.8% vs. 52.5%, respectively P<0.001). The mean total PedsQL™ score and its subscales in different categories of perceived weight did not have significant difference (P> 0.05). After adjustment for age, gender, region, socio-economic status, physical activity, screen time, and body mass index (BMI), significant negative association was documented between perceived overweight and total score of HRQOL. School functioning was negatively associated with perceived overweight. Positive significant association existed between perceived overweight and psychosocial functioning. Conclusion: Our findings indicated that weight underestimation is the most common form of weight misperception in Iranian children and adolescents, which could be a cause of concern especially for obesity treatment and prevention programs. Furthermore, considering the negative association between weight overestimation and total HRQOL and school functioning, it is suggested that social standards and norms impacts on weight perception and consequently HRQOL in children and adolescents.