How do multiple energy balance behaviours influence obesity in school-aged children?

July 21, 2021

Currently, a quarter of Australia’s young children are estimated to experience overweight and obesity. This is of concern given childhood obesity, if left untreated, can have .

Whilst there exists an exhaustive list of behaviours that influence obesity genesis in school aged children, our recent study focussed on energy balance behaviours which include diet, physical activity, sedentary behaviour, and sleep.

Most previous evidence has examined these behaviours individually to understand and explore their effects on obesity. However, these health behaviours do not exist in isolation and therefore this approach does not account for the interaction and co-occuring of these behaviours in daily life.

Novel comprehensive approaches that examine multiple behaviours together would be beneficial in understanding the synergistic influence of health behaviours on obesity development in children. Our systematic review explored the combined influence of these behaviours, as lifestyle patterns, in children aged between 5-12 years.

Considering multiple behaviours together rather than examining them individually may help in understanding childhood obesity

We examined evidence on the clustering of these four behaviours using three common data reduction techniques in nutrition and physical activity research In brief, these techniques are able to identify underlying ‘patterns’ across behaviours in a given dataset.

Search strategies were run in six databases and 28 eligible studies were identified. Of these, only six studies examined patterns for all four behaviours, with the remaining studies examining only 2-3 of the four behaviours of interest.

What we found

We found a range of lifestyle patterns displayed by children within this age group. We broadly classified these patterns into either a healthy, unhealthy or a mixed lifestyle pattern based on the behavioural characteristics that comprised the specific pattern.

Healthy patterns comprised behaviours likely to be protective of obesity (e.g. healthy diets, high physical activity, low sedentary behaviour, high sleep duration). Unhealthy patterns contained less desirable behaviours (e.g. unhealthy diets, low physical activity, high sedentary behaviour, low sleep duration). Mixed patterns contained a mixture of healthy and unhealthy behaviours.

The review identified that mixed patterns were most prevalent, and were reported in most studies.

Unhealthy patterns consisting of low physical activity and high sedentary behaviour were also frequently reported by studies. Unhealthy patterns were reported more frequently in children from lower socio-economic backgrounds.  Lastly, we identified that unhealthy lifestyle patterns were more often associated with overweight/obesity risk than healthy or mixed patterns.

Significance of our findings

• The co-occurrence of health behaviours in children as captured by the lifestyle patterns identified in this review provides a more comprehensive picture of the influence of multiple behaviours on obesity compared to previous methods of examining individual behaviours.
• Children with unhealthy patterns were at increased risk of overweight/obesity, suggesting that the cumulative effect of multiple undesirable behaviours are particularly harmful and warrant appropriate intervention strategies to ensure these patterns do not track into adolescence.
• The common co-occurrence of healthy and unhealthy behaviours as identified by mixed patterns highlights the complexity of lifestyle behaviours within individuals, whereby children who appear to be exhibiting healthy levels of one or two behaviours may still be at increased health risk based on levels of other behaviours.
• Findings by sex and socio-economic position highlight the need for future prevention and intervention strategies to also be sex and socio-economic position specific to ensure maximum impact on obesity reduction in children.

Given the limited number of studies identified in this review that investigated all four behaviours, a clear picture of the combined influence of energy balance behaviours on obesity could not be established. Further studies are required that comprehensively assess the patterning of all four of these behaviours. The use of lifestyle patterns rather than considering behaviours individually can be beneficial in understanding and treating complex health outcomes such as obesity in children.

Ninoshka D’Souza is a PhD student at the Institute for Physical Activity and Nutrition, Deakin University. Her PhD thesis explores lifestyle patterns and adiposity in school-aged children. This blog highlights key findings from a published systematic review that forms part of her thesis.