Child-Report and Parent-Report of Health-Related Quality of Life Among 9–11 Years Old Obese School Children in Terengganu, Malaysia
Last reviewed: March 2026
Key Findings
- The study compared child self-reported and parent proxy-reported health-related quality of life (HRQoL) among obese primary school children aged 9–11 years in Terengganu using the PedsQL 4.0 instrument.
- Obese children reported significantly lower HRQoL scores compared to normal-weight peers, particularly in physical functioning and social functioning domains.
- Discrepancies existed between child and parent reports, with parents tending to underestimate the psychosocial impact of obesity on their children’s quality of life.
- The prevalence of overweight and obesity among school adolescents in Terengganu was approximately 15% and 12% respectively, consistent with national trends of rising childhood obesity.
Background
Childhood obesity has emerged as one of the most pressing public health challenges of the 21st century, with prevalence rates rising steadily across both developed and developing nations. In Malaysia, the National Health and Morbidity Survey (NHMS) 2015 reported that the national prevalence of obesity among adolescents under 18 years had escalated to 11.9%, up from 5.7% in 2011. Terengganu, a sub-urban east coast state, has not been immune to this trend — population-based studies among the state’s 62,567 school adolescents found that 15.0% were overweight and 12.0% were obese, representing a substantial proportion of the school-age population.
Beyond the well-documented physical health consequences of childhood obesity — including increased risk of type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease, and orthopaedic complications — growing evidence indicates that obesity significantly impairs children’s psychosocial wellbeing and health-related quality of life (HRQoL). Children with obesity are more likely to experience bullying, social stigmatisation, poor body image, low self-esteem, depression, and anxiety compared to their normal-weight peers. These psychosocial consequences can be as debilitating as the physical health effects and may persist into adulthood.
Health-Related Quality of Life Assessment
HRQoL is a multidimensional construct that encompasses physical, emotional, social, and school-related functioning as perceived by the individual. The Pediatric Quality of Life Inventory (PedsQL 4.0) is one of the most widely validated instruments for measuring HRQoL in children and adolescents. It consists of 23 items across four domains — physical functioning, emotional functioning, social functioning, and school functioning — and provides both child self-report and parent proxy-report versions. The availability of parallel child and parent versions enables comparison of perspectives, which is important because children and their parents may perceive the impact of health conditions differently.
The use of both child self-report and parent proxy-report in this study was methodologically significant. Previous research has demonstrated that parents often underestimate the psychosocial impact of obesity on their children, particularly in domains such as social functioning and emotional wellbeing. This discrepancy has important clinical implications, as parental perception of their child’s quality of life influences health-seeking behaviour, engagement with weight management programmes, and family support for lifestyle changes.
Key Findings
Impact on Physical Functioning
Obese children in Terengganu reported significantly lower physical functioning scores compared to normal-weight children. The physical functioning domain of the PedsQL assesses the child’s ability to engage in physical activities, sports, and daily tasks requiring physical exertion. The reduction in physical functioning scores among obese children reflects the real-world impact of excess weight on physical capacity, including reduced exercise tolerance, joint discomfort, and difficulty participating in physical activities alongside peers. Studies in other Malaysian and international populations have documented similar reductions of approximately 7–10% in physical functioning scores among obese versus normal-weight children.
Social Functioning and Peer Relationships
Social functioning was also significantly impaired among obese children. This domain assesses the child’s ability to get along with other children, make friends, and participate in social activities. The lower scores in this domain likely reflect the social stigmatisation and weight-based teasing that obese children frequently experience. Research has shown that weight-based bullying is one of the most common forms of peer victimisation experienced by school-age children, and its psychological impact can be severe and long-lasting.
Child-Parent Discrepancy
A notable finding was the discrepancy between child-reported and parent-reported HRQoL scores. Parents tended to rate their children’s quality of life higher than the children rated it themselves, particularly in the psychosocial domains. This pattern is consistent with the broader paediatric HRQoL literature, which consistently shows that parents have incomplete insight into their children’s subjective experiences of conditions that affect social and emotional wellbeing. The practical implication is that healthcare providers should not rely solely on parental assessments when evaluating the psychosocial impact of obesity on children — direct assessment of the child’s perspective is essential.
Childhood Obesity in Terengganu and Malaysia
The Terengganu context provides important insights into childhood obesity patterns in sub-urban Malaysian states. A comprehensive population-based study of all school adolescents across all seven districts of Terengganu found significant associations between BMI category and gender, age, school location (urban versus rural), and district. Urban school locations consistently showed higher obesity prevalence than rural areas, reflecting the impact of urbanisation-related lifestyle changes on childhood weight status. The Malaysian NHMS data shows that the prevalence of childhood obesity has been increasing over the past few decades, driven by dietary shifts toward energy-dense processed foods, reduced physical activity, and increased screen time.
Implications
The findings support the need for comprehensive childhood obesity prevention and management programmes that address not only the physical health consequences but also the psychosocial impact of excess weight on children’s quality of life. School-based programmes that combine nutrition education, physical activity promotion, and psychosocial support may be most effective. Anti-bullying initiatives that specifically address weight-based stigmatisation should be integrated into school health programmes. Healthcare providers should routinely assess HRQoL as part of the clinical evaluation of obese children, using validated instruments that capture the child’s own perspective.
Limitations
The study’s cross-sectional design prevents determination of causal relationships between obesity and reduced HRQoL. The PedsQL 4.0, while well-validated, may not capture all culturally specific aspects of quality of life relevant to Malaysian children. The study focused on children aged 9–11 years, and findings may not be generalisable to younger children or adolescents. The specific Terengganu context may limit generalisability to other Malaysian states with different sociodemographic profiles. Additionally, the study did not assess mediating factors such as physical activity levels, dietary patterns, or family dynamics that may influence the relationship between obesity and HRQoL.
Child-Report and Parent-Report of Health-Related Quality of Life Among 9–11 Years Old Obese School Children in Terengganu, Malaysia. Malaysian Journal of Public Health Medicine. 2017;Special Volume (2).
License: Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)