Adherence to 24-hour movement guidelines and its association with the risk of overweight and obesity in Chinese adolescents: 2007 to 2022

The 24-h movement guidelines (24HGs) were developed to promote healthy lifestyles to improve the overall health status in children and youth. The aims of this study were to evaluate the prevalence of adherence to the 24HGs among Chinese adolescents from 2007 to 2022 and to investigate the associations of both overall adherence and the combinations of guideline components with the risk of overweight (OW) and obesity (OB). A multistage sampling procedure was used to draw samples aged 12 to 19 years participating in each survey wave (2007, 2012, 2017, 2022). Repeated cross-sectional data on lifestyles and anthropometry were collected through self-administered questionnaires. Participants with ≥ 60 min/day of moderate-to-vigorous physical activity (MVPA), < 2 h/day of leisure screen time (ST), and 8–11 h/day of sleep duration (SLD) were classified as adhering to all the 24HGs. Body weight status was classified based on Chinese guidelines. The sample sizes for each survey wave were 861, 853, 1465 and 2599. Adherence to all the 24HGs and MVPA recommendations was consistently low across survey waves. Between 2007 and 2022, the prevalence of meeting all the 24HGs decreased from 7.20% to 3.77%, whereas the prevalence of meeting none increased from 8.94% to 11.58%. Compared to adolescents who met all the 24HGs, those meeting only one component of the 24HGs (AOR = 1.62, 95% CI: 1.05, 2.51), or ST (AOR = 1.68, 95% CI: 1.08, 2.62), or MVPA + SLD (AOR = 2.41, 95% CI: 1.30, 4.46) or none of the 24HGs (AOR = 1.87, 95% CI: 1.15, 3.04) had significantly higher risks of OW and OB. Across all survey waves, a small proportion of Chinese adolescents met all the 24HGs. Adolescents meeting all the 24HGs had the lowest risk of developing OW/OB among Chinese adolescents. Our findings highlight the importance of restricting leisure ST in adolescents. Future family- and school-based health education programs are needed to promote healthy lifestyles for childhood OB prevention.