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Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Overweight in Adolescence
Kevin Patrick, MD, MS;
Gregory J. Norman, PhD;
Karen J. Calfas, PhD;
James F. Sallis, PhD;
Marion F. Zabinski, PhD, MPH;
Joan Rupp, MS;
John Cella, MD
Arch Pediatr Adolesc Med. 2004;158:385-390.
Background The proportion of overweight adolescents has increased, but the behavioral risk factors for overweight youth are not well understood.
Objective To examine how diet, physical activity, and sedentary behaviors relate to overweight status in adolescents.
Design and Setting Baseline data from the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition Project, a randomized controlled trial of adolescents to determine the effects of a clinic-based intervention on physical activity and dietary behaviors.
Participants A total of 878 adolescents aged 11 to 15 years, 42% of whom were from minority backgrounds.
Main Outcome Measure Centers for Disease Control and Prevention body mass index–for-age percentiles divided into 2 categories: normal weight (<85th percentile) and at risk for overweight plus overweight (AR + O) ( 85th percentile).
Results Overall, 45.7% of the sample was classified as AR + O with a body mass index for age at the 85th percentile or higher. More girls from minority backgrounds (54.8%) were AR + O compared with non-Hispanic white girls (42%) ( 21 = 7.6; P = .006). Bivariate analyses indicated that girls and boys in the AR + O group did fewer minutes per day of vigorous physical activity, consumed fewer total kilojoules per day, and had fewer total grams of fiber per day than those in the normal-weight group. Boys in the AR + O group also did fewer minutes per day of moderate physical activity and watched more minutes per day of television on nonschool days than normal-weight boys. Final multivariate models indicated that independent of socioeconomic status (as assessed by household education level), girls had a greater risk of being AR + O if they were Hispanic or from another minority background (odds ratio [OR] = 1.65; 95% confidence interval [CI], 1.09-2.49) and a reduced risk of being AR + O as minutes per day of vigorous physical activity increased (OR = 0.93; 95% CI, 0.89-0.97). A low level of vigorous physical activity was the only significant risk factor for boys being AR + O (OR = 0.92; 95% CI, 0.89-0.95). Analyses based on meeting behavioral guidelines supported these findings and showed that failing to meet the 60 min/d moderate to vigorous physical activity guideline was associated with overweight status for both girls and boys. In addition, boys who failed to meet sedentary behavior and dietary fiber guidelines were more likely to be overweight.
Conclusions Of the 7 dietary and physical activity variables examined in this cross-sectional study, insufficient vigorous physical activity was the only risk factor for higher body mass index for adolescent boys and girls. Prospective studies are needed to clarify the relative importance of dietary and physical activity behaviors on overweight in adolescence.
From the University of California, San Diego (Drs Patrick, Norman, and Zabinski), San Diego State University (Drs Calfas and Sallis and Ms Rupp), and Kaiser Permanente Medical Group, San Diego (Dr Cella).
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