Skip to main content
SpringerLink
Log in

Psychosocial Quality-of-Life, Lifestyle and Adiposity: A Longitudinal Study in Pre-schoolers (Ballabeina Study)

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Purpose

In obesity prevention, understanding psychosocial influences in early life is pivotal. Reviews reported contradictory results and a lack of longitudinal studies focusing on underlying lifestyle factors. This study tested whether psychosocial Quality-Of-Life (QOL) was associated with pre-schoolers’ lifestyle and adiposity changes over one school year and whether lifestyle moderated the latter. It was hypothesised that QOL might not impact adiposity in everybody but that this might depend on preceding lifestyle.

Method

Longitudinal data from 291 Swiss pre-schoolers (initially 3.9–6.3 years) was available. The following measures were used in longitudinal regressions: psychosocial QOL by PedsQL, adiposity (BMI z-score, waist, fat%), diet (food frequency), sedentary time and accelerometer-based activity.

Results

Concerning lifestyle, low psychosocial QOL was only related to unfavourable changes in diet (less fruit β = 0.21 and more fat intake β = −0.28) and lower physical activity (β = 0.21). Longitudinal QOL-adiposity relations appeared only after moderation by lifestyle factors (beta-range 0.13–0.67). Low psychosocial QOL was associated with increased adiposity in children with an unhealthy diet intake or high sedentary time. By contrast, low psychosocial QOL was associated with decreasing adiposity in high fruit consumers or more physically active pre-schoolers.

Conclusion

Results emphasise the need for testing moderation in the QOL-adiposity relation. An unhealthy diet can be a vulnerability factor and high physical activity a protective factor in QOL-related adiposity. Consequently, QOL and lifestyle should be targeted concurrently in multi-factorial obesity prevention. The environment should be an ‘activity encouraging, healthy food zone’ that minimises opportunities for stress-induced eating. In addition, appropriate stress coping skills should be acquired.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Moreno L, Pigeot I, Ahrens W, editors. Epidemiology of obesity in children and adolescents—prevalence and etiology. London: Springer; 2011.

    Google Scholar 

  2. Karasu SR. Of mind and matter: psychological dimensions in obesity. Am J Psychother. 2012;66(2):111–28.

    PubMed  Google Scholar 

  3. Puder JJ, Munsch S. Psychological correlates of childhood obesity. Int J Obes. 2010;34:S37–43. doi:10.1038/Ijo.2010.238.

    Article  Google Scholar 

  4. Wilson SM, Sato AF. Stress and paediatric obesity: what we know and where to go. Stress Health. 2013. doi:10.1002/smi.2501.

    PubMed  Google Scholar 

  5. Pervanidou P, Chrousos GP. Stress and obesity/metabolic syndrome in childhood and adolescence. Int J Pediatr Obes. 2011;6 Suppl 1:21–8. doi:10.3109/17477166.2011.615996.

    Article  PubMed  Google Scholar 

  6. Incledon E, Wake M, Hay M. Psychological predictors of adiposity: systematic review of longitudinal studies. Int J Pediatr Obes. 2011;6(2–2):e1–11. doi:10.3109/17477166.2010.549491.

    Article  PubMed  Google Scholar 

  7. Liem E, Stolk R, Oldehinkel A, Sauer P. The association between depressive symptoms in childhood and overweight in adolescence. The TRAILS study. Horm Res. 2008;70:65–6.

    Article  Google Scholar 

  8. Gatineau M, Dent M. Obesity and mental health. Oxford: National Obesity Observatory; 2011.

    Google Scholar 

  9. Tsatsoulis A, Fountoulakis S. The protective role of exercise on stress system dysregulation and comorbidities. Ann N Y Acad Sci. 2006;1083:196–213. doi:10.1196/annals.1367.020.

    Article  CAS  PubMed  Google Scholar 

  10. Balantekin KN, Roemmich JN. Children’s coping after psychological stress. Choices among food, physical activity, and television. Appetite. 2012;59(2):298–304. doi:10.1016/j.appet.2012.05.016.

    Article  PubMed  Google Scholar 

  11. Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med. 2011;45(11):886–95. doi:10.1136/bjsports-2011-090185.

    Article  PubMed  Google Scholar 

  12. Kappos AD. The impact of electronic media on mental and somatic children’s health. Int J Hyg Environ Health. 2007;210(5):555–62. doi:10.1016/j.ijheh.2007.07.003.

    Article  PubMed  Google Scholar 

  13. Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007;91(4):449–58. doi:10.1016/j.physbeh.2007.04.011.

    Article  CAS  PubMed  Google Scholar 

  14. Dallman MF, Pecoraro N, Akana SF, et al. Chronic stress and obesity: a new view of “comfort food”. Proc Nat Acad Sci U S A. 2003;100(20):11696–701. doi:10.1073/pnas.1934666100.

    Article  CAS  Google Scholar 

  15. Epel E, Tomiyama AJ, Dallman MF. Stress and reward neural networks, eating, and obesity. In: Brownell K, Gold M, editors. Handbook of food and addiction. 2012. p. 462.

    Google Scholar 

  16. Gibson EL. Emotional influences on food choice: sensory, physiological and psychological pathways. Physiol Behav. 2006;89(1):53–61. doi:10.1016/j.physbeh.2006.01.024.

    Article  PubMed  Google Scholar 

  17. Chen X, Sekine M, Hamanishi S, et al. Lifestyles and health-related quality of life in Japanese school children: a cross-sectional study. Prev Med. 2005;40(6):668–78. doi:10.1016/j.ypmed.2004.09.034.

    Article  PubMed  Google Scholar 

  18. Lammle L, Woll A, Mensink GB, Bos K. Distal and proximal factors of health behaviors and their associations with health in children and adolescents. Int J Environ Res Public Health. 2013;10(7):2944–78. doi:10.3390/ijerph10072944.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jacka FN, Kremer PJ, Berk M, et al. A prospective study of diet quality and mental health in adolescents. PLoS One. 2011;6(9), e24805. doi:10.1371/journal.pone.0024805.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Epel E, Lapidus R, McEwen B, Brownell K. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001;26(1):37–49.

    Article  CAS  PubMed  Google Scholar 

  21. Macht M. How emotions affect eating: a five-way model. Appetite. 2008;50(1):1–11. doi:10.1016/j.appet.2007.07.002.

    Article  PubMed  Google Scholar 

  22. Roemmich JN, Gurgol CM, Epstein LH. Influence of an interpersonal laboratory stressor on youths’ choice to be physically active. Obes Res. 2003;11(9):1080–7. doi:10.1038/oby.2003.148.

    Article  PubMed  Google Scholar 

  23. Becker JB, Berkley KJ, Geary N, Hampson E, Herman JP, Young EA. Sex differences in the brain: from genes to behavior. New York: Oxford University Press; 2008.

    Google Scholar 

  24. Reinfjell T, Hjemdal O, Aune T, Vikan A, Diseth TH. The Pediatric Quality of Life Inventory (PedsQL) 4.0 as an assessment measure for depressive symptoms: a correlational study with young adolescents. Nord J Psychiatry. 2008;62(4):279–86. doi:10.1080/08039480801983950.

    Article  PubMed  Google Scholar 

  25. Cameron AJ, Magliano DJ, Dunstan DW, et al. A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. Int J Obes (Lond). 2012;36(2):295–303. doi:10.1038/ijo.2011.103.

    Article  CAS  Google Scholar 

  26. Tsiros MD, Olds T, Buckley JD, et al. Health-related quality of life in obese children and adolescents. Int J Obes (Lond). 2009;33(4):387–400. doi:10.1038/ijo.2009.42.

    Article  CAS  Google Scholar 

  27. Puder J, Pinto AM, Bonvin A, et al. Health-related quality of life in migrant preschool children. BMC Public Health. 2013;13(1):384. doi:10.1186/1471-2458-13-384.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chan CM, Wang WC. Quality of life in overweight and obese young Chinese children: a mixed-method study. Health Qual Life Outcomes. 2013;11:33. doi:10.1186/1477-7525-11-33.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jansen PW, Mensah FK, Clifford S, Nicholson JM, Wake M. Bidirectional associations between overweight and health-related quality of life from 4–11 years: Longitudinal Study of Australian Children. Int J Obes. 2013;37(10):1307–13. doi:10.1038/Ijo.2013.71.

    Article  CAS  Google Scholar 

  30. Sawyer MG, Harchak T, Wake M, Lynch J. Four-year prospective study of BMI and mental health problems in young children. Pediatrics. 2011;128(4):677–84. doi:10.1542/peds.2010-3132.

    Article  PubMed  Google Scholar 

  31. Williams JW, Canterford L, Hesketh KD, et al. Changes in body mass index and health related quality of life from childhood to adolescence. Int J Pediatr Obes. 2011;6(2–2):e442–8. doi:10.3109/17477166.2010.526226.

    Article  PubMed  Google Scholar 

  32. Michels N, Sioen I, Boone L, et al. Cross-lagged associations between children’s stress and adiposity: The Children’s Body Composition and Stress Study. Psychosom Med. 2015;77(1):50–8. doi:10.1097/psy.0000000000000122.

    Article  PubMed  Google Scholar 

  33. Yin ZN, Davis CL, Moore JB, Treiber FA. Physical activity buffers the effects of chronic stress on adiposity in youth. Ann Behav Med. 2005;29(1):29–36. doi:10.1207/s15324796abm2901_5.

    Article  PubMed  Google Scholar 

  34. Niederer I, Kriemler S, Zahner L, et al. Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (Ballabeina): study design of a cluster randomized controlled trial. Bmc Public Health. 2009;9:94. doi:10.1186/1471-2458-9-94.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL (TM) 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3(6):329–41. doi:10.1367/1539-4409(2003)003<0329:Tpaapp>2.0.Co;2.

    Article  PubMed  Google Scholar 

  36. Varni JW, Seid M, Kurtin PS. PedsQL (TM) 4.0: reliability and validity of the Pediatric Quality of Life Inventory (TM) version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800–12. doi:10.1097/00005650-200108000-00006.

    Article  CAS  PubMed  Google Scholar 

  37. Varni JW, Burwinkle TM, Seid M. The PedsQL (TM) 4.0 as a school population health measure: feasibility, reliability, and validity. Qual Life Res. 2006;15(2):203–15. doi:10.1007/s11136-005-1388-z.

    Article  PubMed  Google Scholar 

  38. Ebenegger V, Marques-Vidal P, Barral J, Kriemler S, Puder JJ, Nydegger A. Eating habits of preschool children with high migrant status in Switzerland according to a new food frequency questionnaire. Nutr Res. 2010;30(2):104–9. doi:10.1016/j.nutres.2010.01.006.

    Article  CAS  PubMed  Google Scholar 

  39. Huybrechts I, De Backer G, De Bacquer D, Maes L, De Henauw S. Relative validity and reproducibility of a food-frequency questionnaire for estimating food intakes among Flemish preschoolers. Int J Environ Res Public Health. 2009;6(1):382–99. doi:10.3390/ijerph6010382.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Pate RR, Almeida MJ, McIver KL, Pfeiffer KA, Dowda M. Validation and calibration of an accelerometer in preschool children. Obesity. 2006;14(11):2000–6. doi:10.1038/Oby.2006.234.

    Article  PubMed  Google Scholar 

  41. Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26(14):1557–65. doi:10.1080/02640410802334196.

    Article  PubMed  Google Scholar 

  42. Cole TJ, Freeman JV, Preece MA. British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med. 1998;17(4):407–29. doi:10.1002/(SICI)1097-0258(19980228)17:4<407::AID-SIM742>3.0.CO;2-L [pii].

    Article  CAS  PubMed  Google Scholar 

  43. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005;56(5):303–7. doi:10.1080/09637480500195066.

    Article  PubMed  Google Scholar 

  44. Mokha JS, Srinivasan SR, Dasmahapatra P, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr. 2010;10:73. doi:10.1186/1471-2431-10-73.

    PubMed  PubMed Central  Google Scholar 

  45. NIH. Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology assessment conference statement—December 12–14, 1994. Am J Clin Nutr. 1996;64(3):S524–S32.

    Google Scholar 

  46. Schaefer F, Georgi M, Zieger A, Scharer K. Usefulness of bioelectric impedance and skinfold measurements in predicting fat-free mass derived from total body potassium in children. Pediatr Res. 1994;35(5):617–24.

    Article  CAS  PubMed  Google Scholar 

  47. Burgi F, Meyer U, Granacher U, et al. Relationship of physical activity with motor skills, aerobic fitness and body fat in preschool children: a cross-sectional and longitudinal study (Ballabeina). Int J Obes. 2011;35(7):937–44. doi:10.1038/Ijo.2011.54.

    Article  CAS  Google Scholar 

  48. Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83(404):1198–202. doi:10.2307/2290157.

    Article  Google Scholar 

  49. Helm R, Mark A. Analysis and evaluation of moderator effects in regression models: state of art, alternatives and empirical example. Rev Manag Sci. 2012;6(4):307–32. doi:10.1007/s11846-010-0057-y.

    Article  Google Scholar 

  50. Suchert V, Hanewinkel R, Isensee B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: a systematic review. Prev Med. 2015;76:48–57. doi:10.1016/j.ypmed.2015.03.026.

    Article  PubMed  Google Scholar 

  51. Gopinath B, Louie JC, Flood VM, et al. Influence of obesogenic behaviors on health-related quality of life in adolescents. Asia Pac J Clin Nutr. 2014;23(1):121–7. doi:10.6133/apjcn.2014.23.1.13.

    PubMed  Google Scholar 

  52. Michels N, Sioen I, Boone L, et al. Longitudinal association between child stress and lifestyle. Health Psychol. 2015;34(1):40–50.

    Article  PubMed  Google Scholar 

  53. Hampel P, Petermann F. Age and gender effects on coping in children and adolescents. J Youth Adolesc. 2005;34(2):73–83. doi:10.1007/s10964-005-3207-9.

    Article  Google Scholar 

  54. Hatzinger M, Brand S, Perren S, von Wyl A, von Klitzing K, Holsboer-Trachsler E. Hypothalamic-pituitary-adrenocortical (HPA) activity in kindergarten children: importance of gender and associations with behavioral/emotional difficulties. J Psychiatr Res. 2007;41(10):861–70. doi:10.1016/j.jpsychires.2006.07.012.

    Article  PubMed  Google Scholar 

  55. Brasholt M, Chawes B, Kreiner-Moller E, Vahlkvist S, Sinding M, Bisgaard H. Objective assessment of levels and patterns of physical activity in preschool children. Pediatr Res. 2013;74(3):333–8. doi:10.1038/pr.2013.99.

    Article  PubMed  Google Scholar 

  56. Bradley RH, Houts R, Nader PR, O'Brien M, Belsky J, Crosnoe R. The relationship between body mass index and behavior in children. J Pediatr. 2008;153(5):629–34. doi:10.1016/j.jpeds.2008.05.026.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Griffiths LJ, Dezateux C, Hill A. Is obesity associated with emotional and behavioural problems in children? Findings from the Millennium Cohort Study. Int J Pediatr Obes. 2011;6(2–2):E423–E32. doi:10.3109/17477166.2010.526221.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Waladkhani AR, Hellhammer J. Dietary modification of brain function: effects on neuroendocrine and psychological determinants of mental health- and stress-related disorders. Adv Clin Chem. 2008;45:99–138.

    Article  CAS  PubMed  Google Scholar 

  59. Holmes ME, Eisenmann JC, Ekkekakis P, Gentile D. Physical activity, stress, and metabolic risk score in 8- to 18-year-old boys. J Phys Act Health. 2008;5(2):294–307.

    PubMed  Google Scholar 

Download references

Acknowledgment

We thank Iris Niederer, Flavia Bürgi, Vincent Ebenegger and all students and assistants who had helped to make this study possible. A special thanks to all the children, their parents, the school teachers and the respective school health services.

Author information

Authors and Affiliations

  1. Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, B-9000, Belgium

    Nathalie Michels

  2. Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland

    Kriemler Susi

  3. Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Pedro M. Marques-Vidal

  4. Department of Pediatrics, Pediatric Gastroenterology Unit, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland

    Andreas Nydegger

  5. Diabetes and Metabolism & Division of Pediatric Endocrinology, Service of Endocrinology, Diabetes and Obesity, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland

    Jardena J. Puder

Authors
  1. Nathalie Michels
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kriemler Susi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pedro M. Marques-Vidal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Nydegger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jardena J. Puder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathalie Michels.

Ethics declarations

The authors declare that they have no conflict of interest. The study was approved by the respective cantonal ethical committees. A signed informed consent from a parent or a legal representative was obtained.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Michels, N., Susi, K., Marques-Vidal, P.M. et al. Psychosocial Quality-of-Life, Lifestyle and Adiposity: A Longitudinal Study in Pre-schoolers (Ballabeina Study). Int.J. Behav. Med. 23, 383–392 (2016). https://doi.org/10.1007/s12529-016-9537-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-016-9537-z

Keywords

Search

Navigation