Multidimensional factors associated with childhood obesity severity in southern China: a cross-sectional study

Childhood obesity poses a major public health challenge, yet evidence on its graded associations with modifiable factors across dietary, behavioral, familial, and socioeconomic dimensions remains limited, particularly in Southeast China. This study aimed to comprehensively examine the multidimensional factors associated with childhood obesity.

This cross-sectional study included 680 school-aged children from Fujian Province, China. Data on perinatal factors, family weight status, parental education, dietary intake, physical activity, and sleep behaviors were collected. Obesity severity was classified into four ordinal groups based on Chinese national standards. Ordinal logistic regression models were used to estimate associations. Group differences for categorical variables were assessed using the chi-square test.

Birth weight and infant feeding mode showed no significant association with obesity severity. Maternal care was associated with lower obesity risk in girls. Significant familial clustering was observed for paternal obesity (OR = 1.93, 95% CI: 1.20-3.06) and sibling obesity (OR = 2.26, 95% CI: 1.16-4.29). Lower parental education correlated with greater obesity severity. Breakfast frequency declined progressively with increasing obesity severity. At lunch and dinner, intakes of poultry, seafood, vegetables, fruits, and legumes decreased significantly across groups. Poultry intake at lunch was significantly associated with lower obesity risk (OR = 0.558, 95% CI: 0.354-0.878). Barbecue, cold drinks, and puffed foods were associated with increased obesity risk (OR = 1.763, 95% CI: 1.096-2.836). In contrast, nuts (OR = 0.477, 95% CI: 0.282-0.807) and biscuits (OR = 0.483, 95% CI: 0.322-0.723) showed significant were associated with lower risk. Regarding physical activity, ball sports (OR = 0.457, 95% CI: 0.227-0.918) and walking (OR = 0.368, 95% CI: 0.180-0.751) were significantly associated with lower obesity risk. Later bedtime and shorter sleep duration exhibited associations with obesity severity.

Childhood obesity severity is associated with multiple factors, including familial weight status, parental education, meal diversity, snacking patterns, physical activity, and sleep behaviors. These findings may inform multifaceted, family centered approaches that could be considered for the prevention of childhood obesity.