2.2.1. Psychosocial Factors

Body image dissatisfaction. The body image satisfaction scale consists of the following three questions that ask youth to rate their satisfaction with their weight, body shape, and muscle size [46]: How satisfied are you with your weight?; How satisfied are you with your body shape?; How satisfied are you with your muscle size? A body image dissatisfaction index was created using these questions, which ranges from 1 to 5, with higher values indicating greater dissatisfaction (Cronbach's α = 0.84).

Depression symptoms. The children's depression inventory: short version (CDI-S) was used to assess depressive symptoms [39]. The CDI-S consists of 10 items with a total score that ranges from 0 to 20. Higher scores indicate a greater presence of depressive symptoms [39].

Self-perception regarding weight. This index comprises three items with a total score ranging from 1 to 5 (Cronbach's α = 0.77). A higher score indicates a greater likelihood to regard oneself as overweight or obese. One of the three items is the pictorial body image assessment (PBIA), which asks youth: Which figure in A (female figures) or B (male figures) above is closest to your usual weight? [38] The PBIA silhouettes were modified from Stunkard et al. [47] to include larger body shapes. The silhouettes range from underweight (BMI < 19) to highly severe obesity (BMI > 50) [48]. The two other items ask youth to describe their weight (How do you describe your weight?) [49] and if they ever feel fat (Do you ever feel fat?) [50].

Youth weight-specific quality of life. Weight-specific QOL was evaluated using the YQOL-W, a 21-item instrument with three domain scores: Self, social, and environmental (Cronbach's α for selfitems = 0.90; Cronbach's α for social items = 0.90; Cronbach's α for environmental items = 0.90). The validity and reliability of this instrument has been tested in a multicultural sample of overweight and obese youth in the US and Mexico [19,21]. The YQOL-W has good reliability and validity for assessing weight-specific QOL in children and adolescents, including one-week test–retest intra-class correlation coe fficients that were 0.73 for social, 0.71 for self, and 0.73 for environment [19]. The total score for this survey ranges from 0–100, and 100 indicates the best QOL.
