The Journal of the Arkansas Medical Society Med Journal May 2019 Final 2 | Page 14

SCIENTIFIC ARTICLE
Relationship Between Visceral Fat and Health-related Quality of Life
in Fifth and Sixth Graders in a Rural Public School in Arkansas
Roy Dale Grant Jr., BS; 1 Alicia Landry, PhD, RDN, LDN, SNS; 2 Rachel Schichtl, MS, RDN, CFCS; 3 Nina Roofe, PhD, RDN, LD, FAND 4
1
Master of Science Dietetic Intern (graduating August 2018), University of Central Arkansas
2
Assistant Professor & Master of Science Dietetic Internship Director, Department of Family & Consumer Sciences, University of Central Arkansas
3
Assistant Professor & Didactic Program in Dietetics Director, Department of Family & Consumer Sciences, University of Central Arkansas
4
Associate Professor & Chair, Department of Family & Consumer Sciences, University of Central Arkansas
Keywords:
pediatric obesity, health-related
quality of life, visceral fat, percent body fat, body
mass index, body image
ABSTRACT
O
bese children are more likely
to suffer from body dys-
morphia, depression, and
decreased quality of life. Thirty-five
fifth- and sixth-grade students (male, n=17;
female, n=18) at a rural public school were
asked to participate in this descriptive, cor-
relational design to describe the relationship
between visceral fat level (VFL), body image
dissatisfaction (BID), and health-related qual-
ity of life (HRQoL). Body composition mea-
sures of body mass index (BMI) z-score and
VFL had a significant, positive correlation with
percent body fat (r=.851, p=.000; r=.937,
p=.000 respectively) and BMI z-score and
VFL had a positive correlation with one an-
other (r=.745, p=.000, respectively). BID and
HRQoL were significantly, negatively related
(r=-.450, p=.011, respectively). When stu-
dents were divided into three groups based
on BMI z-score, obese participants were more
likely than overweight or normal weight par-
ticipants to report BID (p=.002 and p=.001,
respectively). As BID increased, HRQoL de-
creased, and those who were obese had the
highest levels of BID. Future interventions
should aim at reducing BID while working to
alleviate the incidence of obesity in this age
group. Expanding this study to include urban
and high minority schools will increase gen-
eralizability of findings.
INTRODUCTION
Overweight and obesity account for 33.9% of
children aged 10-17 in Arkansas, ranking the state
the ninth most overweight/obese in the nation for
children of this age group. 1 Pre-adolescence is a cru-
cial stage because of emotional and social changes
that occur and influence body image. In females,
this change takes place between 9 and 12 years of
age, while in males, this occurs between 10 and 13
years of age. 2 Children who are overweight/obese
are at risk for physical health problems as well as
social, emotional, and psychological problems im-
pacting health-related quality of life (HRQoL). 3 More
than half of girls (55-59%) and about one-third of
boys (33-35%) between the ages of 6 and 8 years
state that the ideal body is thinner than their current
body size. Body-image dissatisfaction (BID) may
arise from discrepancies between actual and ideal
weight. 4, 5 Evidence suggests visceral fat level (VFL)
is a more effective predictor of overall health and is
linked more closely to metabolic syndrome. Meta-
bolic syndrome is associated with a 70% increase in
the risk of sudden cardiac death. Healthy VFL score
is <10, and an excessive VFL score is >10. 6 Find-
ings from the Bogalusa Heart Study 7 and from the
American Academy of Child Adolescent Psychiatry 8
show that the obesity trend is rising among children
and adolescents, and that parental obesity impacts
pediatric obesity.
Financial Impact
Socioeconomic status (SES) is dependent not
only on income but also educational achievement,
financial security, and subjective perceptions of
social status, social class, and health status. 9 In
the 2002-2005 Medical Expenditure Panel Survey
(MEPS), children who were obese had $194 higher
outpatient visit expenditures, paid $114 more in
prescription drug expenditures, and paid $12 more
for emergency room visits than children of normal
or underweight. Children who were overweight had
$79 higher outpatient visit expenditures, paid $64
more in prescription drug expenditures, and paid
$25 more for emergency room visits than nor-
mal or underweight children. Children who
had an elevated body mass index (BMI) were
254 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
associated with $14.1 billion in additional outpatient
visit costs, prescription drug costs, and emergency
room costs annually. 10
METHODS
Study Design
This study used a descriptive and corre-
lational design to describe the relationship be-
tween rural public-school students’ VFL, BID, and
HRQoL. Researchers received Institutional Review
Board approval from the university before con-
ducting the study.
Participant Recruitment
A sample of fifth- and sixth-grade students
from a rural public school participated. Out of a pos-
sible 142 participants (grade 5 n=64, grade 6 n=78),
35 elected to participate. Of those, 49% were male
(n=17) and 51% were female (n=18), ranging in age
from 10 to 13 years (M=11.26, SD=.701).
Data Collection Procedures and Measures
A 23-question survey, including the PedsQL
Core 4.0 for HRQoL, was used to collect data from
the participants. BMI Figural Stimuli Silhouette (SIL)
was used to determine self-perception of body mass
and the desired body mass. A stadiometer was used
to determine height. Body composition,
including VFL, was analyzed using the
InBody 570 Body Composition Ana-
lyzer. BMI z-score was calculated using
CDC charts. BMI z-scores were then
categorized as normal, overweight,
or obese. The Stunkard Scale and the
InBody 570 Body Composition Analyzer
was used in this study to measure
self-perceived body image and VFL of
students (Figures 1 and 2).
Figure 2. InBody 570
Body Composition
Analyzer
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