From Overweight to Severe Obesity: Physical Activity and Behavioural Profiles in a Large Clinical Cohort

Background: Behavioural heterogeneity in obesity is increasingly recognised, but how specific dietary patterns, food preferences and physical activity vary between obesity classes remains poorly characterised. Methods: We analysed behavioural, dietary, and lifestyle data from 1366 adults attending a tertiary obesity clinic in Italy. Participants were stratified into five obesity classes defined by BMI. Age-adjusted regression models and chi-square tests with Bonferroni correction were used to examine associations between obesity severity and key behavioural outcomes, including food preferences, eating behaviours, physical activity, and self-reported sleep quality. Results: The prevalence of uncontrolled eating, skipping meals, and fast eating significantly increased with obesity severity after adjusting for age (all p < 0.05). Preference for yoghurt and legumes declined with increasing BMI, whereas preferences for meat and dairy remained stable. Age-adjusted sport participation decreased progressively, with significantly lower odds in Obesity I, II, and IIIA compared to the Overweight group. Sleep quality was highest among overweight participants and declined with obesity severity; night-time awakenings were most frequent in Obesity IIIB. Conclusions: Distinct behavioural and lifestyle traits, including lower sport participation, reduced preference for fibre-rich foods, and greater frequency of uncontrolled, fast, and irregular eating, showed overall trends across obesity classes. While these findings suggest the presence of behavioural phenotypes, their interpretation is limited by the cross-sectional design and the use of self-reported, non-validated measures. Future studies should incorporate objective assessments to inform targeted obesity interventions.