Association of lifestyle behaviours and socio-economic disparities with overweight and obesity among school-aged children and adolescents: a population-based cross-sectional study.

This population-based cross-sectional study investigated the associations of sleep, nutrition and physical activity with overweight and obesity among 4108 school-aged children and adolescents (9-17 years) in Punjab, Pakistan, alongside 3371 parental responses. BMI was calculated using anthropometric measurements, and weight status was classified according to the 2007 WHO growth reference. Socio-economic status was determined through parental education, occupation and household income, while lifestyle behaviours were assessed via validated questionnaires. Multivariate logistic regression analyses were conducted, adjusting for sex, grade and socio-economic variables. The prevalence of overweight and obesity was 19·4 % and 10·7 %, respectively. Girls had a higher obesity prevalence than boys (12·3 % v. 8·9 %), whereas boys showed a higher combined prevalence of overweight and obesity. Among boys, obesity was significantly associated with urban residence (adjusted OR (aOR) 1·37; 95 % CI 1·13, 1·83), being an only child (aOR 2·74; 95 % CI 1·92, 3·92), frequent fast-food consumption (≥ 3 times/week; aOR 1·56; 95 % CI 1·23, 1·97) and lower parental education (aOR 1·22; 95 % CI 1·05, 1·41). Among girls, long weekend sleep duration increased obesity risk (aOR 1·38; 95 % CI 1·14, 1·67), while being an only child (aOR 0·36; 95 % CI 0·25, 0·52), frequent fast-food consumption (aOR 0·64; 95 % CI 0·50, 0·80) and lower parental education (aOR 0·81; 95 % CI 0·70, 0·94) were linked to lower odds. Physical activity and soft drink intake were not significant after adjustment. These findings underscore complex, gender-specific relationships between lifestyle and socio-economic factors, highlighting the need for targeted interventions promoting healthy sleep, nutrition and equity-focused strategies.