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Research Article: Nutritional and behavioral determinants of overweight and obesity among school-aged children in Shandong Province, China: evidence from a large-scale cross-sectional study

Date Published: 2026-08-03

Abstract:
Childhood overweight and obesity are pressing global health challenges with rising prevalence in China. Shandong Province, as a populous and economically developed region, provides a critical context for understanding regional patterns and determinants. A cross-sectional survey was conducted among 83,436 children aged 9–12?years from 155 schools in 16 cities (September–November 2025). Anthropometric measurements and validated questionnaires were used to assess weight status, demographics, family environment, and lifestyle factors. Overweight/obesity was classified using International Obesity Task Force (IOTF) cut-offs. Logistic regression identified associated risk and protective factors. The prevalence of overweight/obesity was 19.0%. Rates were higher in boys than girls (19.9% vs. 18.2%, p <?0.001) and increased with age (11-year-olds 20.4% vs. 9-year-olds 18.0%, p <?0.001). Urban children had slightly higher prevalence than rural peers (19.6% vs. 18.7%, p =?0.002). Factors independently associated with overweight/obesity included parental overweight/obesity (OR?=?1.18, 95% CI: 1.10–1.26), maternal gestational diabetes (OR?=?1.53, 95% CI: 1.36–1.71), and high birth weight (OR?=?1.16, 95% CI: 1.09–1.24). Lifestyle behaviors were strongly associated: <1?h/day physical activity increased risk, while >1.5?h/day was protective (OR?=?0.83, 95% CI: 0.79–0.87); >8?h sleep reduced risk (OR?=?0.66, 95% CI: 0.60–0.72); >3?h/day screen time (OR?=?1.10, 95% CI: 1.02–1.20) and >3?h/day homework (OR?=?1.49, 95% CI: 1.38–1.62) elevated risk; frequent fruit/vegetable intake was protective, whereas fast-food consumption >3 times/week increased risk (OR?=?1.12, 95% CI: 1.05–1.20). Childhood overweight/obesity in Shandong Province is influenced by demographic, familial, and lifestyle factors. Findings highlight the importance of multilevel interventions—targeting family health behaviors, maternal metabolic management, school-based physical activity promotion, and community nutrition policies—to curb the rising burden of obesity.

Introduction:
Childhood overweight and obesity are pressing global health challenges with rising prevalence in China. Shandong Province, as a populous and economically developed region, provides a critical context for understanding regional patterns and determinants.

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