Association of screen-based sedentary behavior with overweight and obesity among school-aged children and adolescents in Pakistan: an empirical cross-sectional study

Abstract Background Childhood overweight and obesity are significant global public health concerns, with Pakistan experiencing a growing prevalence, leading to adverse long-term health effects. The external factors such as parental, peer, school, and community influences play pivotal roles in shaping children’s health behaviors during their developmental years. Purpose This study aimed to assess the association of screen-based sedentary behavior with overweight and obesity among school-aged children and adolescents aged 9 to 17 years. Additionally, it sought to examine their influence on overweight and obesity within this population. Methods A population-based cross-sectional study was conducted, involving a representative multistage random cluster sample of 4108 school-aged children and adolescents (9 to 17 years old) from seven randomly selected districts in Punjab, Pakistan. The participants were enrolled from various school grade cohorts, including primary, middle, secondary, and higher secondary schools. Overweight (> + 1 SD) and obesity (> + 2 SD) were determined using the World Health Organization’s 2007 reference. Screen-time viewing was classified as “not meeting” recommendations if participants engaged in more than 2 h per day of screen-based activities after school. The chi-square test, Pearson correlation coefficient, linear regression, and logistic regression were employed. Results The study included 4108 Pakistani school children aged 9–17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. The prevalence of overweight and obesity among Pakistani school-aged children and adolescents was 19.4% and 10.7%, respectively. Sedentary behaviors such as spending three or more hours watching TV on weekdays (OR = 2.50, 95% CI 1.97–3.15, p  < 0.001), using a mobile device for three or more hours (OR = 3.66, 95% CI 2.87–4.67, p  < 0.001), using a computer for three or more hours (OR = 2.25, 95% CI 1.61–3.16, p  < 0.001), and having three or more hours of homework (OR = 1.64, 95% CI 1.31–2.07, p  < 0.001) were associated with a higher risk of obesity. Conclusion The study highlights the concerning rise in overweight and obesity prevalence among Pakistani school-aged children and adolescents, particularly associated with prolonged sedentary activities. These findings underscore the urgency of implementing comprehensive, multisectoral interventions targeting children, adolescents, parents, teachers, and healthcare professionals across various settings to address this pressing public health concern.