Open Access Research

Promising insights into the health related quality of life for children with severe obesity

David T Selewski1*, David N Collier2, Jackie MacHardy3, Heather E Gross3, Edward M Pickens4, Alan W Cooper5, Selam Bullock6, Marian F Earls7, Keeley J Pratt8, Kelli Scanlon3, Jonathan D McNeill3, Kassandra L Messer9, Yee Lu1, David Thissen10, Darren A DeWalt11 and Debbie S Gipson1

Author Affiliations

1 Division of Nephrology, Department of Pediatrics, University of Michigan, CS Mott Children’s Hospital Room 12-250, 1540 E Hospital Drive, SPC 4297, Ann Arbor, MI 48109-4297, USA

2 Department of Pediatrics and Pediatric Healthy Weight Research and Treatment Center, Brody School of Medicine, East Carolina University, Greenville, NC, USA

3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

4 University Pediatrics at Highgate, Durham, NC, USA

5 Carolina Pediatrics of the Triad, Greensboro, NC, USA

6 Kids First Pediatrics of Raleigh, Raleigh, NC, USA

7 Guilford Child Health, Greensboro, NC, USA

8 Department of Human Services, The Ohio State University, Columbus, OH, USA

9 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA

10 Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

11 Division of General Internal Medicine, University of North Carolina, Chapel Hill, NC, USA

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Health and Quality of Life Outcomes 2013, 11:29  doi:10.1186/1477-7525-11-29

Published: 1 March 2013



Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity.


The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile.


136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05).


Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life.

Quality of life; Obesity; Patient Reported Outcomes Measurement Information System (PROMIS); Child; Depression