There are numerous obesity-specific HRQOL instruments, although most are for use in adults.12 There is general guidance on suitable HRQOL instruments,13 and there are reviews of generic HRQOL instruments,14 in addition to reviews of disease-specific instruments.15 The most widely employed instrument for assessing general HRQOL in youth, the Pediatric Quality of Life Inventory (PedsQL™),16 was also employed in this study and reported previously.8 The Child Health Utility (CHU9D) is a another generic pediatric quality of life instrument developed in the UK.17 Alternatively, the Impact of Weight on Quality of Life (IWQOL)-Kids tool, like SMU, was also developed by the team at Cincinnati Children’s Hospital.12 The Kid-KINDL includes six domains, compared to PedsQL’s four domains.18 In their 2019 comparison study, Pakpour et al18 also found that the SMU tool was significantly related to BMI, and the other two generic instruments (PedsQL and Kid-KINDL) did not.
We chose the SMU tool for this project because it was specifically developed for children and adolescents with obesity, it was available free of charge, and in Spanish, which was essential for our study as it included fifty-percent Spanish-speakers. Both the PedsQL and the SMU instruments showed improvements in total quality of life in our study, however, the SMU tool was able to examine secondary issues specific to youth living with obesity (e.g., Teasing/Marginalization, etc). We believe those secondary issues are important to consider when working with youth who have obesity.
Some strengths of our study included that all participating youth met the criteria for having overweight or obesity (BMI ≥ 85th percentile for age) and were referred by a health care provider. The community where this research was conducted has approximately 50% population of Latino ancestry, primarily of Mexican decent, and this was reflected in our study participant demographics. This allowed for an ethnically/racially mixed study population. The intervention was also designed to include health care providers, family members, and community resources – it was not siloed into one “partner” group. However, some of the weaknesses of our study include the small sample size, the limited ethnic/racial diversity (Mexican-Americans and non-Hispanic whites only), and the large number of dropouts as the follow-up period progressed into six and twelve months after the intervention concluded.
Assessment and tracking of obesity-specific HRQOL is essential to understanding the unique physical and psychological factors linked to youth obesity. The positive improvements observed via the SMU tool after this lifestyle and community-based intervention demonstrate that psychosocial health, particularly in regards to obesity-specific domains, significantly improved in this group of youth. Results in this study of SMU paralleled those findings from Peds-QLTM tool, a more widely-used tool, which was also used in this study and reported previously8. A systematic review19 called for more interventions that target adolescence age groups, which our study included. More recently, Soltero et al20 reported similar positive improvements in quality of life through a culturally-tailored, randomized controlled community intervention trial targeting Latino youth. Programs like these, which bring together community resources, families, and healthcare providers, while also using culturally- and linguistically-appropriate approaches, can offer successful and economical interventions to improve outcomes for youth with overweight or obesity. This improvement was seen using the SMU tool in our study. Quality of life assessment tools used for the general population might miss the unique experiences of those living with obesity, and this is particularly true for youth.