Supplementary Material for: Weight-related impairment in children and adolescents with overweight and obesity: A cross-sectional study on associations with sociodemographic characteristics and health-related quality of life

Introduction: This study investigated associations between weight-related impairment (WrI), degree of overweight/obesity, and health-related quality of life (HrQoL) in children and adolescents with overweight or obesity.
Methods: Data were collected within the LIFE Child cohort study conducted in Leipzig, Germany. We used a repeated cross-sectional dataset containing 539 data points of 270 10- to 17-year-old children with overweight (n = 83 data points), obesity (n = 276 data points), or severe obesity (n = 180 data points) who had completed questionnaires on WrI (Kindl-R, total score) and HrQoL (Kidscreen-27, scores physical wellbeing, psychological wellbeing, peer relations, family relations, school). Associations between weight status, WrI, and HrQoL were assessed using regression analyses, adjusting for age, sex, and socio-economic status.
Results: Children with obesity or severe obesity showed significantly more WrI than children with overweight. Regarding HrQoL, however, only physical and psychological wellbeing were significantly associated with weight group. Higher WrI was strongly associated with lower HrQoL in all domains (b ranging between -6.07 and -3.16, all p < .001). The association between WrI and psychological wellbeing was stronger in children with obesity or severe obesity than in children with overweight. In multivariate models, only WrI, but not the degree of overweight/obesity was associated with the different domains of HrQoL.
Conclusion: The findings suggest that WrI and not weight per se impacts HrQoL of children and adolescents with overweight and obesity.

引言：本研究旨在探讨超重或肥胖儿童青少年群体中，体重相关损害（weight-related impairment, WrI）、超重/肥胖程度与健康相关生活质量（health-related quality of life, HrQoL）三者间的关联。
方法：数据采集自德国莱比锡开展的LIFE儿童队列研究（LIFE Child cohort study）。本研究采用重复横断面数据集，共纳入270名10至17岁的超重、肥胖或重度肥胖儿童青少年，累计获得539条有效数据，其中超重组83条、肥胖组276条、重度肥胖组180条。所有受试者均完成了两类评估问卷：体重相关损害采用Kindl-R量表，以其总分作为WrI指标；健康相关生活质量采用Kidscreen-27量表，涵盖躯体健康、心理健康、同伴关系、家庭关系、学业表现五个维度的得分。本研究通过回归分析评估体重状态、WrI与HrQoL之间的关联，并校正了年龄、性别与社会经济地位的混杂效应。
结果：肥胖或重度肥胖儿童的WrI程度显著高于超重儿童。但在HrQoL层面，仅躯体健康与心理健康维度与体重分组存在显著关联。更高的WrI水平与所有HrQoL维度的得分降低呈强相关性（回归系数b介于-6.07至-3.16之间，所有p值均<0.001）。相较于超重儿童，肥胖或重度肥胖儿童群体中，WrI与心理健康维度的关联强度更强。多变量模型分析显示，仅WrI与HrQoL的各维度存在显著关联，而非超重/肥胖程度本身。
结论：本研究结果表明，影响超重与肥胖儿童青少年健康相关生活质量的核心因素为体重相关损害，而非体重状态本身。