Abstract
Diet, physical activity (PA) and sedentary behavior are important, yet modifiable, determinants of obesity. Recent research into the clustering of these behaviors suggests that children and adolescents have multiple obesogenic risk factors. This paper reviews studies using empirical, data-driven methodologies, such as cluster analysis (CA) and latent class analysis (LCA), to identify clustering patterns of diet, PA and sedentary behavior among children or adolescents and their associations with socio-demographic indicators, and overweight and obesity. A literature search of electronic databases was undertaken to identify studies which have used data-driven methodologies to investigate the clustering of diet, PA and sedentary behavior among children and adolescents aged 5–18 years old. Eighteen studies (62% of potential studies) were identified that met the inclusion criteria, of which eight examined the clustering of PA and sedentary behavior and eight examined diet, PA and sedentary behavior. Studies were mostly cross-sectional and conducted in older children and adolescents (≥9 years). Findings from the review suggest that obesogenic cluster patterns are complex with a mixed PA/sedentary behavior cluster observed most frequently, but healthy and unhealthy patterning of all three behaviors was also reported. Cluster membership was found to differ according to age, gender and socio-economic status (SES). The tendency for older children/adolescents, particularly females, to comprise clusters defined by low PA was the most robust finding. Findings to support an association between obesogenic cluster patterns and overweight and obesity were inconclusive, with longitudinal research in this area limited. Diet, PA and sedentary behavior cluster together in complex ways that are not well understood. Further research, particularly in younger children, is needed to understand how cluster membership differs according to socio-demographic profile. Longitudinal research is also essential to establish how different cluster patterns track over time and their influence on the development of overweight and obesity.
Highlights
The unacceptably high prevalence of childhood overweight and obesity is a major public health issue in developed countries world-wide [1]
There was some evidence to suggest that boys are more likely to be in clusters characterized by poor diet quality and that children from a low socio-economic status (SES) are more likely to be in clusters defined by high levels of sedentary behavior; it should be noted that these conclusions are based on a small number of studies that were inconsistent in the types of dietary, physical activity (PA) and/or sedentary behaviors examined
Implications for future research This review of studies that have used data-driven methodologies to examine clustering of obesogenic behaviors has shown that diet, PA and sedentary behaviors can cluster in complex ways that are both conducive and deleterious to good health and that these clusters differ across socio-demographic groups and are not consistently associated with overweight/obesity
Summary
The unacceptably high prevalence of childhood overweight and obesity is a major public health issue in developed countries world-wide [1]. Diet, PA and sedentary behavior may combine in complex ways that have a cumulative effect on the development of overweight and obesity [8]. This has important implications for public health because understanding which behaviors need to be targeted simultaneously and in whom obesogenic behaviors cluster together can be used to assist in the development of targeted obesity prevention initiatives. Interventions that are appropriately targeted and effectively bring about multiple behavior change, may be more cost-effective and maximise reach, to those most in need [12,13]
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