Association of Physical Activity and Physical Education With Overweight and Obesity Among School-Aged Children and Adolescents in Pakistan: An Empirical Cross-Sectional Study

Background: Overweight and obesity in children and adolescents are pressing global public health concerns, including in Pakistan, where prevalence rates are rising. The long-term health implications of these conditions underscore the need for targeted interventions during childhood and adolescence and periods when health behaviors are strongly influenced by external factors such as school, neighborhood, peers, and family. Purpose: This study aimed to evaluate the relationship between physical activity (PA), physical education (PE), and overweight/obesity in school-aged children and adolescents (ages 9-17) in Pakistan and to investigate their impact on obesity within this population. Methods: A population-based cross-sectional study was conducted with a multistage random cluster sample of 4108 school-aged children and adolescents from seven districts in Punjab, Pakistan. Overweight and obesity were assessed using World Health Organization (WHO) guidelines. Statistical analyses, including chi 2 tests, Pearson correlation, linear regression, and logistic regression, were performed to examine the predictive characteristics and the impact of covariates on dichotomous outcomes. Statistical significance was set at p<0.05, with 95% confidence intervals (CIs). Results: The study included 4108 students (mean age = 13.92 years, 59.3% boys). The prevalence of obesity was 10.7% and overweight was 19.4%. A significant portion of students-83.8% of girls and 70.0% of boys-did not engage in at least 60 min of moderate to vigorous physical activity (MVPA) on more than 2 days per week. Urban students (79.2%) and those in private schools (79.3%) were particularly inactive. PA two times a week or less was strongly associated with higher obesity risk (OR: 3.47, 95% CI: 2.28-5.30, p<0.001). Conclusion: This study underscores the critical need to enhance PA opportunities in schools and communities in Pakistan, particularly for girls, to address the rising rates of overweight and obesity.