Weight Status, Resilience, and Quality of Life in Indian Children

Associations Between Factors Contributing to Obesity (Dietary Behaviour and Physical Activity), Resilience (Dietary and Physical Activity Self-Efficacy, Self- Esteem, General Resilience and Optimism), and HRQoL in Indian Adolescents

A school-based cross-sectional study that aims to generate context-specific evidence on how weight status is related to resilience, health behaviour, and quality of life among Indian adolescents.

Primary Objective

To assess differences in overall resilience (total score of Adolescent Resilience score from ARQ49) between normal-weight and overweight/obese Indian adolescents aged 14-16 years.

Secondary Objectives

1. To compare differences in Adolescent Resilience Questionnaire (ARQ49) subscale scores between normal-weight and overweight/obese adolescents. The internal resilience factors assessed by the ARQ49 include confidence, emotional insight, negative cognition, social skills, empathy, and tolerance, while the external resilience factors include family connectedness, family availability, peer connectedness, peer availability, supportive school environment, school connectedness, and community connectedness.
2. To assess differences in internal resilience factors (diet self-efficacy, physical activity self-efficacy, self-esteem, and optimism) between normal-weight and overweight/obese adolescents and to examine parental nutrition knowledge as an external resilience resource and moderator in association analyses.
3. To compare dietary behaviors, physical activity patterns, and Pediatric Quality of Life Inventory (PedsQL) scores between normal-weight and overweight/obese adolescents.

4. To examine the associations among resilience, dietary and physical activity behaviors, and PedsQL within the overall sample and within different weight groups, and to evaluate parental nutrition knowledge as a moderator of the relationship between weight status and resilience or health outcomes.

   Exploratory Objective

5. To explore differences in resilience, health behaviors, and PedsQL between normal-weight and underweight Indian adolescents.

Study hypotheses

The investigators hypothesized that adolescents with overweight/obesity, compared with their normal-weight peers, would demonstrate lower scores on total resilience (primary outcome), as well as on internal and external resilience indices; report lower diet self-efficacy, physical activity self-efficacy, self-esteem, and optimism; report less frequent health-promoting behaviors (including lower fruit and vegetable intake and fewer days achieving ≥ 60 min/day of moderate-to-vigorous physical activity); and report lower PedsQL scores.

Parental nutrition knowledge will not be treated as a between-group outcome; instead, it will be tested as a moderator in association analyses, examining whether parental nutrition knowledge influences the relationship between weight status and resilience or health outcomes.

Furthermore, the investigators hypothesized that higher resilience scores would be positively associated with healthier dietary behaviors, greater physical activity participation, and higher PedsQL scores across the overall sample, with these associations expected to hold true within both normal-weight and overweight/obese groups. In addition, analyses involving underweight adolescents will be exploratory and descriptive in nature. We will explore whether underweight adolescents show different levels of resilience, health behaviors, and HRQoL compared with adolescents with normal weight.

Study Overview

• Status: Completed
• Conditions: Childhood Obesity; Underweight; Overweight (BMI > 25)
• Intervention / Treatment: Behavioral: Behaviour intervention targeted for Lifestyle modification

Detailed Description

Childhood and adolescent obesity is associated with adverse physical, psychological, and social outcomes, including reduced health-related quality of life (HRQoL). In India, the coexistence of underweight and overweight highlights the need to examine behavioural and psychosocial factors alongside anthropometric measures.

Resilience, defined as the capacity to adapt to stress and challenges, is a multidimensional construct encompassing individual, family, peer, school, and community domains. Internal resilience-related traits such as diet and physical activity self-efficacy, self-esteem, and optimism may influence adolescents' health behaviours and well-being. However, evidence examining these factors together, particularly in relation to weight status among Indian adolescents, remains limited.

This study is a school-based cross-sectional investigation conducted among adolescents aged 14-16 years in Kolkata, India. The primary objective is to assess differences in overall resilience (ARQ49 total score) between normal-weight and overweight/obese adolescents. Secondary objectives include comparing internal resilience-related traits, dietary behaviours, physical activity patterns, and HRQoL (PedsQL), and examining associations among these variables within the overall sample. An exploratory objective assesses similar outcomes among underweight adolescents.

Participants are recruited from public and private secondary schools using non-probability and snowball sampling through existing professional networks. One parent or guardian per adolescent participates to provide data on parental nutrition knowledge and related contextual factors.

Data collection includes validated self-administered questionnaires and anthropometric measurements (height and weight) to calculate BMI-for-age z-scores using international standards. Statistical analyses include group comparisons across weight categories and multivariable models examining associations among resilience, health behaviours, parental factors, and HRQoL, accounting for clustering at the school level.

This study aims to generate context-specific evidence on how psychosocial resilience and behavioural factors relate to weight status and well-being among Indian adolescents.

• Study Type: Observational
• Enrollment (Actual): 720

Contacts and Locations

Study Locations

• India
  • West Bengal
    • Kolkata, West Bengal, India, 700009
      • Mitra Institution (Main)
    • Kolkata, West Bengal, India, 700009
      • Victoria Institution High School
    • Kolkata, West Bengal, India, 700020
      • Ballygunge Government High School
    • Kolkata, West Bengal, India, 700026
      • Andhra Association High School (AAHS)
    • Kolkata, West Bengal, India, 700029
      • Lycee School
    • Kolkata, West Bengal, India, 700029
      • National High School For Boys
    • Kolkata, West Bengal, India, 700029
      • National High School For Girls
    • Kolkata, West Bengal, India, 700033
      • Tollygunge Adarsh Hindi High School (Girls and Boys)
    • Kolkata, West Bengal, India, 700053
      • New Alipore Multipurpose School
    • Kolkata, West Bengal, India, 700063
      • New Vista Academy
    • Kolkata, West Bengal, India, 700071
      • Sakhawat Memorial Govt. Girls' High School
    • Kolkata, West Bengal, India, 700090
      • Calcutta Public School, Bidhan Park
    • Kolkata, West Bengal, India, 700094
      • Indus Valley World School
    • Kolkata, West Bengal, India, 700099
      • Calcutta Public School, Kalikapur
    • Kolkata, West Bengal, India
      • Holy Mission school
    • Kolkata, West Bengal, India
      • St. Joseph and Mary's school

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 16 years (Child)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

School-going Indian adolescents aged 14 to 16 years, studying in grades 8 to 10 in secondary schools in Kolkata, India. Participants were recruited from public and private schools. One parent or guardian of each participating adolescent was also invited to participate. Weight status categories (underweight, normal weight, and overweight/obese) were defined analytically using BMI-for-age z-scores based on IOTF cut-offs.

Description

Eligibility Criteria

Inclusion Criteria:

• Adolescents aged 14 to 16 years
• Studying in grades 8, 9, or 10
• Enrolled in participating secondary schools in Kolkata, India
• Able to provide assent, with written consent from a parent or legal guardian
• One parent or guardian willing to participate in the parent survey

Exclusion Criteria:

• Age below 14 years or above 16 years
• Not enrolled in grades 8, 9, or 10
• No parental/legal guardian consent or no adolescent assent
• Incomplete eligibility for participation in the survey procedures

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Groups classified based on BMI; Adolescent participants (14-16 years): Participants will be categorized into weight status groups (underweight, normal-weight, overweight/obese) based on BMI-for-age z-scores for analysis. Group 1: Overweight BMI Cut-Off Points (kg/m²) by International Obesity Task Force; IOTF Overweight (including obesity) ≥25.00 Group 2: Obese BMI Cut-Off Points (kg/m²) by International Obesity Task Force; IOTF Obese ≥30.00 Group 3: Normal-weight BMI Cut-Off Points (kg/m²) by International Obesity Task Force; IOTF Normal Weight - 18.5-24.99

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall resilience (ARQ49 total score)	Overall resilience will be assessed using the Adolescent Resilience Questionnaire (ARQ49). The total score will be calculated by summing responses across all items, with higher scores indicating higher levels of psychosocial resilience.	At baseline (single time-point assessment)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health-related quality of life (HRQoL)	HRQoL will be assessed using the Pediatric Quality of Life Inventory (PedsQL). Scores will be transformed to a 0-100 scale, with higher scores indicating better quality of life.	At baseline (single time-point assessment)
Diet and Physical activity self-efficacy	Self-efficacy will be assessed using a validated Diet and Physical Activity Self-Efficacy Scale. The scale includes multiple domains related to confidence in engaging in physical activity and making healthy dietary choices. Subscale scores will be calculated for each domain, with higher scores indicating greater self-efficacy.	At baseline (single time-point assessment)
Optimism	Optimism will be assessed using the Youth Life Orientation Test (Y-LOT). A total score will be calculated, with higher scores indicating a more optimistic outlook.	At baseline (single time-point assessment)
Dietary and PA behaviour	Dietary and physical activity behaviour will be assessed using selected items from the Global School-based Student Health Survey (GSHS), including frequency of consumption of key food groups and hours/days of physical activity (weekly/monthy). Responses will be analysed as categorical or frequency-based variables.	At baseline (single time-point assessment)
Self-esteem	Self-esteem will be measured using the Rosenberg Self-Esteem Scale (RSES). Total scores will be calculated, with higher scores indicating higher self-esteem.	At baseline (single time-point assessment)

Collaborators and Investigators

• Sponsor: Maastricht University Medical Center
• Collaborators: Maastricht University
• Investigators: Principal Investigator: Poulami Dasgupta, Maastricht University/MaastrichtUMC

Study record dates

Study Major Dates

• Study Start (Actual): February 20, 2023
• Primary Completion (Actual): February 28, 2024
• Study Completion (Actual): April 30, 2024

Study Registration Dates

• First Submitted: November 22, 2022
• First Submitted That Met QC Criteria: December 5, 2022
• First Posted (Actual): December 13, 2022

Study Record Updates

• Last Update Posted (Actual): April 29, 2026
• Last Update Submitted That Met QC Criteria: April 23, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: physical activity; self-esteem; health related quality of life; self-efficacy; psychosocial resilience; optimism; dietary behavior
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Obesity; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Overweight; Pediatric Obesity; Thinness; Motor Activity
• Other Study ID Numbers: Resilient Kids

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared publicly because the study involves adolescent participants and linked parent data, and open sharing would raise ethical and privacy concerns. De-identified data may be considered upon reasonable request, subject to review by the research team, applicable ethical approvals, and a data-sharing agreement, in accordance with Maastricht University data governance requirements.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No