Aim. To examine the simultaneous influence of physical activity, screen time, and sleep duration recommendations on the odds of childhood obesity (including overweight). Methods. Physical activity was assessed via pedometer and screen time, and sleep duration were assessed via survey in a cross sectional sample of 674 children (aged 7–12 years) from two Midwestern communities in the fall of 2005. Participants were cross tabulated into four groups depending on how many recommendations were being met (0, 1, 2, or all 3). Linear and logistic regression were used to examine the influence of physical activity, screen time and sleep duration on obesity and interactions among the three variables. Results. Children achieving all three recommendations simultaneously (9.2% of total sample) were the least likely to be obese. Approximately 16% of boys and 9% of girls achieving all recommendations were overweight or obese compared to 53% of boys and 42.5% of girls not achieving any. Conclusions. The odds of obesity increased in a graded manner for each recommendation which was not met. Meeting all three recommendations appears to have a protective effect against obesity. Continued efforts are warranted to promote healthy lifestyle behaviors that include meeting physical activity, screen time, and sleep duration recommendations concurrently. 1. Introduction Physical activity (PA), screen time (ST; i.e., television/video games), and sleep (SLP) are modifiable lifestyle risk factors for childhood obesity [1]. Many cross sectional and prospective studies have shown these variables to be independently associated with obesity [2–7]. As such, these variables are frequently studied in childhood obesity and, along with diet, are the specific focus of a recent Institute of Medicine statement on childhood obesity prevention [8]. In an attempt to promote general well-being and prevent or treat obesity, these risk factors are associated with clinical and public health recommendations. These recommendations include limiting ST to ≤2 hours per day, achieving ≥60 minutes of moderate to vigorous PA per day [9] (equivalent to 13,000 and 11,000 steps per day for boys and girls, resp.) [10], and sleeping 10-11 hours per night for children aged 5–12 years [11]. Independently, the effect of PA, ST, or SLP on obesity is well established. However, few studies have focused on these risk factors concurrently. We have previously found that children failing to meet both PA and ST recommendations were 3 to 4 times more likely to be obese than children meeting both [12]. Vioque et al. [13]
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