A Look Back at Healthy Lifestyle Behavioral Patterns among School-Age Children: Are We Neglecting Healthy Weight for Overweight Kids?

Abstract

Objective: To describe prevalence of healthy lifestyle behaviors (HLBs) between two school-age cohorts of racial-ethnically diverse children. Methods: Using two Early Childhood Longitudinal Study cohorts (ECLS-K 1999 and 2010), we compared percentage change in HLBs (sleep, physical activity, screen time, and family meals) by child weight groups and within racial-ethnic groups. Weight groups of interest included healthy weight (HW; BMI 5th-84th percentile), overweight (OW; ≥ 85th-94th), obese (OB; ≥ 95th-99th percentile), and severely obese (SO; ≥ 99th percentile). Results: OW children within the 2010 cohort reported greater percentage change (range: 2.0%-15.1% increase) in HLBs, whereas HW children demonstrated lower percentage change (range: -6.2% to 8.7% increase). OB and SO children showed significant lower percentage change in reducing screen time (range: -11.0% and -12.7%, respectively). HW Latino children demonstrated the least favorable trends with overall declines noted for 4/5 HLBs. Screen time was noted to have the greatest degree of favorable change (2%-14%) across weight groups, whereas adequate sleep duration demonstrated the lowest favorable percentage change (2%-2.8%). Conclusion: Fewer HW and OB children were participating in recommended HLBs compared with OW children in 2010. Recent health campaigns may have helped providers prioritize the identification and counseling of OW children, yet our data suggest that we may be neglecting the role of HLB counseling in OB and HW children. Continued analysis on the social determinants that impact HLBs in school-age and HW/OB minority children should inform how we can best tailor counseling and messages in the coming decades.