Sizing Me Up represents the first obesity-specific self-report HRQOL measure developed specifically for younger school-aged children (5–13 years). Preliminary results demonstrate that Sizing Me Up has strong psychometric properties, including good internal consistency, test–retest reliability, and convergent validity. Furthermore, these initial data demonstrate the feasibility of reliably and validly assessing the self-report of obesity-specific HRQOL in children as young as 5 years of age. Sizing Me Up is brief (22 items; 8–12 minutes completion time), easy to administer and score, of no-cost, and provides critical content to characterize the impact of children’s size on their daily functioning across a number of age-salient domains.
Sizing Me Up has five core scales (i.e., Emotional Functioning, Physical Functioning, Social Avoidance, Positive Social Attributes, and Teasing/Marginalization) and a Total score. The Emotional Functioning scale uniquely captures children’s self-perceptions of how their size makes them feel (i.e., mad, sad, worried, and frustrated). Although certainly there is a wide-range of assessment tools that measure a child’s more general emotional status, such as depression inventories (33
), self-concept scales (34
), and generic HRQOL measures (20
), to our knowledge, this is the first measure for children that asks children to place their self-perceptions of emotions in the specific context of their obesity. Similarly, the Physical Functioning scale measures children’s self-perceptions of how much their size impacts their comfort and ability to engage in daily age-salient activities at school or within their community. In addition, this scale includes an item that targets weight-based teasing while being physically active, known to be predictive of lower physical activity levels in youth (35
In terms of social relations, two scales emerged on Sizing Me Up. The Social Avoidance scale describes how their size may lead an obese child to avoid or feel discomfort in age-salient social settings (e.g., school, park, gym, sleepovers, and family meal). Alternately, the Teasing/Marginalization scale assesses children’s self-perceptions of feeling left out or teased by others due to their size, peer behaviors that are well documented in the pediatric obesity literature (36
). Finally, the Positive Social Attributes scale encompasses child self-perceptions of positive qualities and emotions they possess in context of their size (e.g., humor, healthiness, happiness, and self-liking). We assert that the inclusion of an HRQOL scale focused on positive attributes may enable clinicians to understand a child’s self-perceived strengths, as well as areas that they may want to improve (24
Additional analyses considered whether children’s self-reported, obesity-specific HRQOL varied by degree of obesity (zBMI), race (white, black), or gender. Within this clinically obese sample (BMI ≥ 95th percentile), higher zBMI was associated with poorer Emotional Functioning. Interesting trends also emerged suggesting higher zBMI is associated with greater Social Avoidance and lower overall obesity-specific quality of life (total score). Thus, these data provide initial evidence that children who have progressed to a greater degree of obesity in this young age range perceive greater HRQOL impairment due to their size. No significant gender differences were noted on Sizing Me Up and only one scale of this obesity-specific HRQOL measure was found to differ between black and white youth. Specifically, African American obese children reported better obesity-specific physical HRQOL than white children. Although we have previously documented that obese black adolescents are more physically comfortable with their size than whites when using a weight- or obesity-specific measure (12
), these are the first data to characterize this in school-age children as young as 5 years of age.
As expected, Sizing Me Up demonstrated moderate agreement on similar scales of the PedsQL and the parallel parent-proxy, obesity-specific measure Sizing Them Up. Of note, Varni and colleagues (25
) noted that imperfect agreement between child self-report and parent-proxy is consistently reported in the HRQOL literature. Used together, Sizing Me Up and Sizing Them Up offer researchers and/or clinical providers tools to assess both child and parent perspectives on how obesity is impacting a child’s daily life.
As noted, the present study represents an initial report on the psychometric properties of the Sizing Me Up measure. This study is not without limitations and consequent directions for future research. Specifically, the current sample may not be generalizable to all obese youth as (i) children and families were treatment seeking, (ii) data collection occurred at one site and while representative of the site’s clinic population, and (iii) children represented primarily two racial groups (e.g., white and black). Based on findings using a generic HRQOL measure (7
), it is possible that obese children within the community who are not seeking treatment have better obesity-specific HRQOL compared to children seeking care in a clinical program. Future research with larger and more ethnically diverse samples of obese youth (e.g., Hispanic, Native American) is also needed. Furthermore, although this measure was intentionally developed and initially validated to assess self-perceptions of clinically obese (BMI ≥ 95th percentile) children, an important area of future study will be to evaluate the psychometric structure in an overweight population and to assess how Sizing Me Up differentiates child self-perceptions across the entire weight spectrum. Finally, although the present study presents key reliability and validity data of Sizing Me Up, an important next step will be to assess the measure’s responsiveness to change related to weight loss/gain to further establish Sizing Me Up as a well-validated patient-reported outcome measure.