Associations of 24-hour movement guideline adherence and parental perceptions of children's health behaviors with overweight and obesity among school-aged children and adolescents in Pakistan

A population-based cross-sectional study was conducted among school-aged children and adolescents aged 9–17 years in 62 schools using multistage random cluster sampling, involving 4108 students and 3371 parents. Overweight and obesity were assessed according to WHO standards. The prevalence of overweight and obesity was 19.4% and 10.7%, respectively. Only 24.8% of urban children achieved the recommended ≥ 60 minutes of daily moderate-to-vigorous physical activity. More favorable parental perceptions of children's dietary practices were significantly associated with lower child weight status (p = 0.003), while adequate physical activity was linked to a reduced risk of obesity (p = 0.001). Sufficient sleep also significantly decreased the likelihood of overweight (OR = 0.67, p < 0.001). The findings emphasize the potential importance of parental perceptions of children's health behaviors, healthy lifestyle practices, regular physical activity, and adequate sleep in preventing overweight and obesity among Pakistani children and adolescents.