Abstract
Objectives: To assess the relationship between modifiable lifestyle factors and risk of overweight/obesity in Chinese students, and to evaluate the predicting prevalence of overweight if the lifestyle risk factors were removed.Methods: A cross-sectional survey was conducted among 40,141 students in grade three and above (8–24yrs) in 2019 in Zhejiang Province, China. Physical examination was performed, and a self-administered questionnaire was used to collect lifestyle information, including dietary behavior, physical activity, TV watching, sleeping, smoking, drinking, and tooth-brushing habits. Logistic regression models were performed to assess the relationship between overweight/obesity and a series of lifestyle factors. Population attributable fractions (PAFs) were used to calculate the predicting prevalence of overweight/obesity if lifestyle risk factors were removed.Results: The prevalence of overweight/obesity of participants was 25.5% (male 32.3%, female 18.1%). Overweight/obesity were associated with adverse lifestyle factors, such as watch TV ≥1 h/day (OR = 1.14, 95% CI: 1.11–1.22), insufficient sleep (OR = 1.14, 95% CI: 1.11–1.22), and irregular toothbrushing habits (OR = 1.19, 95% CI: 1.01–1.39). Based on the calculated PAFs, the predicted prevalence of overweight/obesity would decline moderately if lifestyle factors were modified, with the magnitudes of decrease vary by sex, age and residence. Generally, a larger reduction was estimated if the sleeping time was increased and TV time was reduced, with the prevalence of overweight/obesity decreased by 1.1% (95% CI: 0.7, 1.5%) and 0.9% (95% CI: 0.6, 1.2%), respectively.Conclusions: Predicted prevalence of overweight/ obesity in Chinese students may decrease if modifiable lifestyle risk factors were removed. The attributable risk for obesity of lifestyle behaviors varied in age, sex and residence groups. The findings of this study may provide insights for planning and optimizing future obesity intervention endeavors.
Highlights
The worldwide prevalence of childhood obesity has increased dramatically during the past decades [1]
This study quantified the contribution of preventable lifestyle factors for obesity intervention in Chinese students aged 9–24
Our study found that 37.3% of obesity could be prevented if insufficient sleep, prolonged TV time and alcohol use, which showed the top three largest population attributable fraction (PAF), were eliminated
Summary
The worldwide prevalence of childhood obesity has increased dramatically during the past decades [1]. Among children and adolescents aged 5–19, the prevalence of overweight and obesity rose from 4% in 1975 to over 18% in 2016 [2]. Studies suggested that around three-quarters of children with overweight or obesity could track into adulthood [8]. Understanding lifestyle factors for obesity intervention in children and adolescences are necessary. The attribution of these factors, such as dietary behavior, physical activity, screen time and sleeping, could vary in different populations [10,11,12,13]. The cumulative population attributable fraction (PAF) for childhood obesity was 42.9% in a cohort study in New Zealand, as if the excessive screen time and several other related factors were eliminated [15]. A study found that not participating in sports’ teams (PAF, 16.57%; 95% CI, 15.30–17.84%) had the biggest influence on the rate of obesity in American high school students, followed by watching TV and playing computer games [16]
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