| Summary: | Summary Background Body mass index (BMI) is often used to diagnose obesity in childhood and adolescence but has limitations as an index of obesity‐related morbidity. The Edmonton Obesity Staging System for Pediatrics (EOSS‐P) is a clinical staging system that uses weight‐related comorbidities to determine health risk in paediatric populations. The purpose of this study was to investigate the associations of EOSS‐P and BMI percentile with quality of life (QOL), cardiorespiratory fitness (CRF) and muscular strength in adolescents with obesity. Methods Participants were enrolled at baseline in the Healthy Eating, Aerobic and Resistance Training in Youth trial (BMI = 34.6 ± 4.5 kg m−2, age = 15.6 ± 1.4 years, N = 299). QOL, CRF (peak oxygen uptake, VO2peak) and muscular strength were assessed by the Pediatric QOL Inventory (PedsQL), indirect calorimetry during a maximal treadmill test and eight‐repetition maximum bench and leg press tests, respectively. Participants were staged from 0 to 3 (absent to severe health risk) according to EOSS‐P. Associations were assessed using age‐adjusted and sex‐adjusted general linear models. Results Quality of life decreased with increasing EOSS‐P stages (p < 0.001). QOL was 75.7 ± 11.4 in stage 0/1, 69.1 ± 13.1 in stage 2 and 55.4 ± 13.0 in stage 3. BMI percentile was associated with VO2peak (β = –0.044 mlO2 kg−1 min−1 per unit increase in BMI percentile, p < 0.001), bench press (β = 0.832 kg per unit increase in BMI percentile, p = 0.029) and leg press (β = 3.992 kg, p = 0.003). There were no significant differences in treadmill time or VO2peak between EOSS‐P stages (p > 0.05). Conclusion As EOSS‐P stages increase, QOL decreases. BMI percentile was negatively associated with CRF and positively associated with muscular strength.
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