How is weight stigma related to children's health-related quality of life? A model comparison approach

Purpose. Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with Health-Related Quality of Life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of pre-adolescent children, four competing models (i.e., additive, mediation, moderation, and moderated-mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL. Methods: A community sample of 600 children aged 8-to-11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences, and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood Test, BIC Difference, and Wald Test were used for model comparisons. Results: The mediation model outperformed both additive and moderation models, and was found to be equally informative (but more parsimonious) as compared to the moderated-mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic). Conclusions: The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.