비만이 소아의 삶의 질에 미치는 영향
Impact of Obesity on Health-Related Quality of Life among Children
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비만은 유년기의 가장 흔한 만성질환으로 전 세계적으로유병률의 급속한 증가를 보이고 있다.1) Ogden 등2)3)에 의하면 1999~2009년 사이 미국 소아, 청소년의 비만율이 남학생에서 30% 증가한 것으로 나타났다. 우리나라도 10~18세 남학생의 비만율은 1998~2008년 사이 4.6%에서 8.2%로 증가하였고4) 서구와 마찬가지로 비만이 소아, 청소년들의 중요한문제가 되었다. 비만은 심혈관계 질환,5) 암6) 등 신체 여러 기관의 질병을 유발한다. 비만이 신체적 건강에 여러 영향을 미친다는 사실은그 동안 많이 연구되어 왔고 비교적 일관성 있는 결론들이도출되었다.7) 하지만 소아 비만의 가장 큰 문제 중의 하나는심리, 사회적인 문제로, 소아는 6~10세 무렵 즈음이 되면 이미 비만을 게으름이나 둔함과 같은 부정적인 특성과 연관시키기 시작하고 비만인 소아는 놀림과 차별의 대상이 되기도한다.8)9) 어린 시기의 이러한 부정적인 경험은 또래 관계에서의 불안정한 애착을 야기하고 신체와 관련된 죄책감과 수치심을 유발하여 신체이미지를 저하시킨다.10) 신체이미지란 자신의 외형과 기능에 대해 개인이 느끼는 주관적인 느낌이나경험11)을 일컫는 것으로, Agrawal 등12)에 의하면 비만인 사람들은 자신의 신체이미지를 낮게 보고하는 경우가 많고 낮은 신체이미지는 우울증이나 불안, 식이장애 등 여러 비만 관련 문제들의 원인이 되기도 한다.13) 또한 비만은 자아존중감에도 영향을 미쳐 비만인 소아들은 또래에 비해 사회적으로자신감이 떨어지고 사회에 적응하는 데 어려움을 보이기도한다.14) 이 밖에도 소아 비만은 성인기 비만으로 이어져 성인기의 삶의 질을 저하시키기도 한다.15)16) 본 연구에서는 비만이 우리나라 소아의 전반적 건강과 행복에 미치는 영향을 알아보고자 신체적, 정신적, 사회적 기능 상태와 전반적인 안녕의 정도를 포괄적으로 반영하는 건강관련 삶의 질17)18)과 비만도의 상관관계를 알아보았다. 더나아가 경로분석을 통해 신체이미지, 자아존중감, 우울/불안과 같은 심리사회적인 요인이 비만과 삶의 질 사이에 어떠한매개효과를 나타내는지 살펴보았다. 본 연구의 가설은 비만도가 증가할수록 신체이미지와 자아존중감이 감소하고 우울/불안이 증가하여 삶의 질이 감소한다는 것이다.
Abstract
Objectives : To examine the relationship between health-related quality of life (HRQoL) and body mass index (BMI) of obese children. MethodsZZThis cross-sectional study included 387 children. HRQoL was measured with the PedsQLTM 4.0 Generic Core Scale. BMI was classified according to the World Health Organization Asia-Pacific obesity guidelines. Psychosocial factors (body image, self-esteem, and depression/anxiety) were also measured. Data were analyzed using one-way analysis of variance, Pearson’s correlation and Path analysis. Results : Obese participants reported lower score for physical evaluation, self-esteem, appearance evaluation component of body image, total HRQoL score, and physical/emotional/social function components of HRQoL ; they reported higher score for depression/anxiety. In addition, results indicated that as BMI increased, appearance evaluation, total HRQoL score, and social function component of HRQoL dropped. Path analysis revealed that BMI did not directly affect HRQoL ; however, BMI directly affects body image and self-esteem, indirectly mediates depression/anxiety, and thereby impacts on an individual’s HRQoL. Conclusions : Body image and self-esteem, rather than BMI itself, have more influence on HRQoL. This reinforces the importance of therapeutic intervention to enhance body image and self-esteem among obese children.
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