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The purpose of the study was two-fold: to describe the self-reported physical and psychosocial quality of life of 37 school-age children (24 girls, 13 boys, grades 1 to 12) living with severe obesity and having difficulty managing their illness; and to examine the descriptive comments of school nurses providing case management to these students. Quality-of-life scores measured by the Pediatric Quality of Life Inventory Version 4.0 SF15 were lower among children with obesity compared to the healthy norm. School nurses' descriptive comments support physical and psychosocial health concerns reflected by quality-of-life scores, and demonstrate the key role of the school nurse in assessing the needs of students living with severe obesity. Comments by school nurses suggest a holistic approach, including environmental and psychosocial interventions might be the most effective strategy for nurses and other professionals working with schoolage children with obesity.