BACKGROUND: The main objective of the study is to analyse the changes in the prevalence of obesity among Czech adolescents between 2002 and 2018 with regard to the socioeconomic status (SES) of adolescents' families and to find SES-separated correlates of adolescents' obesity in 2018. METHODS: A nationally representative sample of 29,879 adolescents (49.6% of them boys) aged 10.5-16.5 years was drawn from the Health Behaviour in School-aged Children cross-sectional, self-reported questionnaire surveys conducted in 2002, 2006, 2010, 2014, and 2018 in Czechia. Chi-square (χ2) tests were performed to assess the changes in the prevalence of obesity in both genders and all SES categories of adolescents between 2002 and 2018, and SES category-related differences in the prevalence of obesity in 2018 separately for boys and girls. A series of multiple stepwise logistic regression (backward elimination) analyses were used to reveal obesity correlates separately for SES categories of adolescents. RESULTS: Across the quadrennial surveys from 2002 to 2018, we observed a clear increase in the prevalence of obesity in all SES categories of adolescents, which was most striking (p < 0.05) in adolescents with low SES (boys: + 7.5% points (p.p.); girls + 2.4 p.p.). When all the survey cycles were compared, the highest prevalence of obesity was evident in the low-SES adolescents in 2018, both in girls (5.1%) and boys (12.0%). Regardless of the adolescent SES category, the lower odds of obesity were significantly (p < 0.05) associated with regular vigorous physical activity (PA), participation in organized sport, and daily consumption of sweets. In addition, at least 60 min of moderate-to-vigorous PA significantly reduced the odds of obesity in adolescents of low and high SES categories. CONCLUSIONS: An unreasonable increase in the prevalence of obesity in adolescents with low SES highlights the need to prevent obesity in adolescents with a low-SES background. Additionally, significantly higher odds of obesity in 11- and 13-year-old adolescents from low-SES families, compared with their peers aged 15, indicated an expectable rise in obesity in older low-SES adolescents in the near future.

Faculty of Physical Culture Department of Recreation and Leisure Studies Palacký University Olomouc 771 11 Olomouc Czech Republic

Faculty of Physical Culture Department of Social Sciences in Kinanthropology Palacký University Olomouc 771 11 Olomouc Czech Republic

Faculty of Physical Culture Institute of Active Lifestyle Palacký University Olomouc 771 11 Olomouc Czech Republic

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Ford ND, Patel SA, Narayan KMV. Obesity in low- and middle-income countries: burden, drivers, and emerging challenges. Annu Rev Public Health. 2017;38:145–164. doi: 10.1146/annurev-publhealth-031816-044604. PubMed DOI

Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomic. 2015;33(7):673–689. doi: 10.1007/s40273-014-0243-x. PubMed DOI PMC

Mitchell N, Catenacci V, Wyatt HR, Hill JO. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2011;34(4):717–732. doi: 10.1016/j.psc.2011.08.005. PubMed DOI PMC

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–781. doi: 10.1016/S0140-6736(14)60460-8. PubMed DOI PMC

Seidel JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66(Suppl 2):7–12. doi: 10.1159/000375143. PubMed DOI

Inchley J, Currie D, Jewell J, Breda J, Barnekow V. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002-2014. WHO Reg Off Eur 2017. http://www.euro.who.int/__data/assets/pdf_file/0019/339211/WHO_ObesityReport_2017_v3.pdf?ua=1. Accessed 23 May 2019.

Frederick CB, Snellman K, Putnam RD. Increasing socioeconomic disparities in adolescent obesity. Proc Nation Acad Sci Unit Stat Am. 2014;111(4):1338–1342. doi: 10.1073/pnas.1321355110. PubMed DOI PMC

Hamřík Z, Sigmundová D, Pavelka J, Kalman M, Sigmund E. Trends in overweight and obesity in Czech schoolchildren from 1998 to 2014. Cent Eur J Public Health. 2017;25(Suppl 1):10–14. doi: 10.21101/cejph.a5099. PubMed DOI

Hardy LL, Mihrshahi S, Gale J, Drayton BA, Bauman A, Mitchell J. 30-year trends in overweight, obesity and waist-to-height ratio by socioeconomic status in Australian children, 1985 to 2015. Int J Obes. 2017;41(1):76–82. doi: 10.1038/ijo.2016.204. PubMed DOI PMC

Kelly A, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128(15):1689–1712. doi: 10.1161/CIR.0b013e3182a5cfb3. PubMed DOI

Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012;31(1):219–230. doi: 10.1016/j.jhealeco.2011.10.003. PubMed DOI

Tremmel M, Gerdthem UG, Nilsson PM, Saha S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14(4):E435. doi: 10.3390/ijerph14040435. PubMed DOI PMC

Dumuid D, Olds T, Lewis LK, Martin-Fernández JA, Barreirea T, Broyles S, et al. The adiposity of children is associated with their lifestyle behaviours: a cluster analysis of school-aged children from 12 nations. Pediatr Obes. 2016;13(2):111–119. doi: 10.1111/ijpo.12196. PubMed DOI

Huang TT, Drewnowski A, Kumanyika SK, Glass TA. A systems-oriented multilevel framework for addressing obesity in the 21st century. Prev Chronic Dis. 2009;6(3):A82. PubMed PMC

Ren H, Zhou Z, Liu W, Wang X, Yin Z. Excessive homework, inadequate sleep, physical inactivity and screen viewing are major contributors to high paediatric obesity. Acta Paediatr. 2016;106(1):120–127. doi: 10.1111/apa.13640. PubMed DOI PMC

Wilkie HJ, Standage M, Gillison FB, Cumming SP, Katzmarzyk PT. Multiple lifestyle behaviours and overweight and obesity among children aged 9-11 years: result from the UK site of the international study of childhood obesity. Lifestyle Environ BMJ Open. 2016;6(2):e010677. doi: 10.1136/bmjopen-2015-010677. PubMed DOI PMC

Bleich SN, Vercammen KA. The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC Obes. 2018;5:6. doi: 10.1186/s40608-017-0178-9. PubMed DOI PMC

Sigmund E, Badura P, Sigmundová D, Voráčová J, Zacpal J, Kalman M, et al. Trends and correlates of overweight/obesity in Czech adolescents in relation to family socioeconomic status over a 12-year study period (2002-2014) BMC Public Health. 2018;18(1):122. doi: 10.1186/s12889-017-5013-1. PubMed DOI PMC

Voráčová J, Sigmund E, Sigmundová D, Kalman M. Family affluence and the eating habits of 11- to 15-year-old Czech adolescents: HBSC 2002 and 2014. Int J Environ Res Public Health. 2016;13(10):E1034. doi: 10.3390/ijerph13101034. PubMed DOI PMC

Nobari TZ, Whaley SE, Prelip ML, Crespi CM, Wang MC. Trends in socioeconomic disparities in obesity prevalence among low-income children aged 2-4 years in Los Angeles county, 2003-2014. Child Obes. 2018;14(4):248–258. doi: 10.1089/chi.2017.0264. PubMed DOI PMC

Bann D, Johnson W, Li L, Kun D, Hardy R. Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies. Lancet Public Health. 2018;3(4):e194–e203. doi: 10.1016/S2468-2667(18)30045-8. PubMed DOI PMC

Newton S, Braithwaite D, Akinyemiju TF. Socio-economic status over the life course and obesity. Systematic review and meta-analysis. PLoS One. 2017;12(5):e0177151. doi: 10.1371/journal.pone.0177151. PubMed DOI PMC

Bucksch J, Sigmundova D, Hamrik Z, Troped PJ, Melkevik O, Ahluwalia N, et al. International trends in adolescent screen-time behaviors from 2002 to 2010. J Adolesc Health. 2016;58(4):417–425. doi: 10.1016/j.jadohealth.2015.11.014. PubMed DOI

Kalman M, Inchley J, Sigmundova D, Iannotti RJ, Tynjälä JA, Hamrik Z, et al. Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: a cross-national perspective. Eur J Pub Health. 2015;25(Suppl 2):37–40. doi: 10.1093/eurpub/ckv024. PubMed DOI

Iannotti RJ, Wang J. Trends in physical activity, sedentary behavior, diet, and BMI among US adolescents, 2001-2009. Pediatrics. 2013;132(4):606–614. doi: 10.1542/peds.2013-1488. PubMed DOI PMC

OECD Data. Czech Republic - Selected indicators for Czech Republic. Available onile: https://data.oecd.org/czech-republic.htm. Accessed 24 May 2019.

Research & Development MSMT. Ministry of Education, Youth and Sports - The Central Administrative Office Responsible for Research and Development. Available online: http://www.msmt.cz/research-and-development-1. Accessed 24 May 2019.

Currie C, Nic Gabhainn S, Godeau E. The health behaviour in school-aged children: WHO collaborative cross-national (HBSC) study: origins, concept, history and development 1982-2008. Int J Public Health. 2009;54(Suppl 2):131–139. doi: 10.1007/s00038-009-5404-x. PubMed DOI

Roberts C, Freeman J, Samdal O, Schnohr CW, Looze M, Nic Gabhainn S, et al. The health behaviour in school-aged children (HBSC) study: methodological developments and current tensions. Int J Public Health. 2009;54(Suppl 2):140–150. doi: 10.1007/s00038-009-5405-9. PubMed DOI PMC

de Onis M, Lobstein, T. Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes 2010;5(6):458–0. PubMed

de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–667. doi: 10.2471/BLT.07.043497. PubMed DOI PMC

Bilík J, editor. Demographic yearbook of districts of the Czech Republic – 2008-2017. 1. Prague: Czech Statistical Office; 2018. pp. 1–145.

HBSC International Research Protocol. Health Behaviour in School-Aged Children - Survey Methods. 2019. http://www.hbsc.org/methods/index.html. Accessed 24 May 2019.

Chan NPT, Choi KC, Nelson EAS, Sung RYT, Chan JCN, Kong APS. Self-reported body weight and height: an assessment tool for identifying children with overweight/obesity status and cardiometabolic risk factors clustering. Matern Child Health J. 2013;17(2):282–291. doi: 10.1007/s10995-012-0972-4. PubMed DOI

Fonseca H, Silva AM, Matos MG, Esteves I, Costa P, Guerra A, et al. Validity of BMI based on self-reported weight and height in adolescents. Acta Paediatr. 2010;99(1):83–88. PubMed

Aasvee K, Rasmussen M, Kelly C, Kurvinen E, Giacchi MV, Ahluwalia N. Validity of self-reported height and weight for estimating prevalence of overweight among Estonian adolescents: the health behaviour in school-aged children study. BMC Res Notes. 2015;8:606. doi: 10.1186/s13104-015-1587-9. PubMed DOI PMC

Ahluwalia N, Dalmasso P, Rasmussen M, Lipsky L, Currie C, Haug E, et al. Trends in overweight prevalence among 11-, 13- and 15-years-olds in 25 countries in Europe, Canada and USA from 2002 to 2010. Eur J Pub Health. 2015;25(Suppl 2):28–32. doi: 10.1093/eurpub/ckv016. PubMed DOI

Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M. Researching health inequalities in adolescents: the development of the health behaviour in school-aged children (hbsc) family affluence scale. Soc Sci Med. 2008;66:1429–1436. doi: 10.1016/j.socscimed.2007.11.024. PubMed DOI

Currie C, Inchley J, Molcho M, Lenzi M, Veselak Z, Wild F. Health Behaviour in School-Aged Children (HBSC) Study Protocol: Background, Methodology and Mandatory Items for the 2013/2014 Survey, 1st ed. CAHRU: St. Andrews, United Kingdom. 2014:1–48.

Andersen A, Krølner R, Currie C, Dallago L, Due P, Richter M, et al. High agreement on family affluence between children's and parents' reports: international study of 11-year-old children. J Epidemiol Community Health. 2008;62:1092–1094. doi: 10.1136/jech.2007.065169. PubMed DOI

Boyce W, Torsheim T, Currie C, Zambon A. The family affluence scale as a measure of national wealth: validation of an adolescent self-reported measure. Soc Indic Res. 2006;78:473–477. doi: 10.1007/s11205-005-1607-6. DOI

Hartley JEK, Levin K, Currie C. A new version of the HBSC family affluence scale – FAS III: Scottish qualitative findings from the international FAS development study. Child Indicat Res. 2015;9:233–245. doi: 10.1007/s12187-015-9325-3. PubMed DOI PMC

Liu Y, Wang M, Villberg J, Torsheim T, Tynjälä J, Lv Y, et al. Reliability and validity of family affluence scale (FAS II) among adolescents in Beijing, China. Child Indicat Res. 2012;5:235–251. doi: 10.1007/s12187-011-9131-5. DOI

Molcho M, Gabhainn SN, Kelleher CC. Assessing the use of the family affluence scale (fas) among Irish schoolchildren. Ir Med J. 2007;100(Suppl 8):37–39. PubMed

Hobza V, Hamrik Z, Bucksch J, De Clerq B. The family affluence scale as an indicator for socioeconomic status: validation on regional income differences in the Czech Republic. Int J Environ Res Public Health. 2017;14(12):E1540. doi: 10.3390/ijerph14121540. PubMed DOI PMC

Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;12:10. PubMed PMC

Inchley J, Currie D, Young T, Samdal O, Torsheim T, Augustson L, et al. Growing up unequal: gender and socioeconomic differences in young people's health and well-being. Health Behaviour in School-Aged children (HBSC) Study: International report from the 2013/2014 survey. Health Policy for children and adolescents, No. 7. Copenhagen: WHO Regional Office for Europe 2016. http://www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf Accessed on 24 May 2019.

Prochaska JJ, Sallis JF, Long B. A physical activity screening measure for use with adolescents in primary care. Arch Pediatr Adolesc Med. 2001;155(5):554–559. doi: 10.1001/archpedi.155.5.554. PubMed DOI

Ridgers ND, Timperio A, Crawford D, Salmon J. Validity of a brief self-report instrument for assessing compliance with physical activity guidelines amongst adolescents. J Sci Med Sport. 2012;15(2):136–141. doi: 10.1016/j.jsams.2011.09.003. PubMed DOI

Bobakova D, Hamrik Z, Badura P, Sigmundova D, Nalecz H, Kalman M. Test-retest reliability of selected physical activity and sedentary behavior HBSC items in the Czech Republic, Slovakia and Poland. Int J Public Health. 2015;60(1):59–67. doi: 10.1007/s00038-014-0628-9. PubMed DOI

Liu Y, Wang M, Tynjälä J, Lv Y, Villberg J, Zhang Z, et al. Test–retest reliability of selected items of health behaviour in school-aged children (HBSC) survey questionnaire in Beijing, China. BMC Med Res Methodol. 2010;10:73. doi: 10.1186/1471-2288-10-73. PubMed DOI PMC

Badura P, Sigmund E, Geckova AM, Sigmundova D, Sirucek J, van Dijk JP, et al. Is participation in organized leisure-time activity associated with school performance in adolescence? PLoS One. 2016;11(4):e0153276. doi: 10.1371/journal.pone.0153276. PubMed DOI PMC

Bosakova L, Kolarcik P, Bobakova D, Sulcova M, Van Dijk JP, Reijneveld SA, et al. Test-retest reliability of the scale of participation in organized activities among adolescents in the Czech Republic and Slovakia. Int J Public Health. 2016;61(3):329–336. doi: 10.1007/s00038-015-0749-9. PubMed DOI

Sigmundová D, Sigmund E, Bucksch J, Baďura P, Kalman M, Hamřík Z. Trends in screen time behaviours in Czech schoolchildren between 2002 and 2014: HBSC study. Cent Eur J Public Health. 2017;25(Suppl 1):15–20. doi: 10.21101/cejph.a4822. PubMed DOI

Schmitz KH, Harnack L, Fulton JE, DRJr J, Gao S, Lytle AL, et al. Reliability and validity of a brief questionnaire to assess television viewing and computer use by middle school children. J Sch Health. 2004;74(9):370–377. doi: 10.1111/j.1746-1561.2004.tb06632.x. PubMed DOI

Vereecken CA, Todd J, Roberts C, Mulvihill C, Maes L. Television viewing behaviour and associations with food habits in different countries. Public Health Nutr. 2006;9(2):244–250. doi: 10.1079/PHN2005847. PubMed DOI

Rey-López JP, Vicente-Rodriguez G, Ortega FB, Ruiz JR, Martinez-Gómez D, De Henauw S, et al. Sedentary patterns and media availability in European adolescents: the HELENA study. Prev Med. 2010;51(1):50–55. doi: 10.1016/j.ypmed.2010.03.013. PubMed DOI

Salmon J, Campbell KJ, Crawford DA. Television viewing habits associated with obesity risk factors: a survey of Melbourne schoolchildren. Med J Aust. 2006;184(2):64–67. doi: 10.5694/j.1326-5377.2006.tb00117.x. PubMed DOI

Tremblay MS, LeBlanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behavior guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36(1):59–64. doi: 10.1139/H11-012. PubMed DOI

Vereecken C, Pedersen TP, Ojala K, Krølner R, Dzielska A, Ahluwalia N, et al. Fruit and vegetable consumption trends among adolescents from 2002 to 2010 in 33 countries. Eur J Pub Health. 2015;25(Suppl 2):16–19. doi: 10.1093/eurpub/ckv012. PubMed DOI

Leger D, Beck F, Richard JB, Godeau E. Total sleep time severely drops during adolescence. PLoS One. 2012;7(10):e45204. doi: 10.1371/journal.pone.0045204. PubMed DOI PMC

Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of sleep medicine. J Clin Sleep Med. 2016;12(6):785–786. doi: 10.5664/jcsm.5866. PubMed DOI PMC

Wabitsch M, Moss A, Kromeyer-Hauschild K. Unexpected plateauing of childhood obesity rates in developed countries. BMC Med. 2014;12:17. doi: 10.1186/1741-7015-12-17. PubMed DOI PMC

Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchel EA, et al. Fast-food consumption and body mass index in children and adolescents: an international cross-sectional study. BMJ Open. 2014;4(12):e005813. doi: 10.1136/bmjopen-2014-005813. PubMed DOI PMC

Hamano T, Li X, Sundquist J, Sundquist K. Association between childhood obesity and neighbourhood accessibility to fast-food outlets: a nationwide 6-year follow-up study of 944,487 children. Obes Facts. 2017;10(6):559–568. doi: 10.1159/000481352. PubMed DOI PMC

Marlatt KL, Farbakhsh K, Dengel DR, Lytle LA. Breakfast and fast food consumption are associated with selected biomarkers in adolescents. Prev Med Rep. 2015;3:49–52. doi: 10.1016/j.pmedr.2015.11.014. PubMed DOI PMC

Voráčová J, Badura P, Hamrik Z, Holubčíková J, Sigmund E. Unhealthy eating habits and participation in organized leisure-time activities in Czech adolescents. Eur J Pediatr. 2018;177(10):1505–1513. doi: 10.1007/s00431-018-3206-y. PubMed DOI

Emmett PM, Jones LR. Diet, growth, and obesity development throughout childhood in the Avon longitudinal study of parents and children. Nutr Rev. 2015;73(Suppl 3):175–206. doi: 10.1093/nutrit/nuv054. PubMed DOI PMC

León-Muñoz LM, García-Esquinas E, Soler-Vila H, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Unhealthy eating behaviors and weight gain: a prospective study in young and middle-age adults. Obesity (Silver Spring) 2016;24(5):1178–1184. doi: 10.1002/oby.21477. PubMed DOI

Mikkilä V, Räsänen L, Raitakari OT, Pietinen P, Viikari J. Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases. The cardiovascular risk in young Finns study. Eur J Clin Nutr. 2004;58(7):1038–1045. doi: 10.1038/sj.ejcn.1601929. PubMed DOI

Chzhen Y, Moor I, Pickett W, Toczydlowska E, Stevens G. Family affluence and inequality in adolescent health and life satisfaction: Evidence from the HBSC study 2002–2014. Innocenti Working Pap. 2016;2016–10:1–26.

Sigmundová D, Sigmund E, Hamrik Z, Kalman M. Trends of overweight and obesity, physical activity and sedentary behaviour in Czech schoolchildren: HBSC study. Eur J Pub Health. 2014;24(2):210–215. doi: 10.1093/eurpub/ckt085. PubMed DOI PMC

Bel-Serrat S, Julian-Almarcegui C, Gonzalez-Gross M, Mouratidou T, Bornhorst C, Grammatikaki E, et al. Correlates of dietary energy misreporting among European adolescents: the healthy lifestyle in Europe by nutrition in adolescence (HELENA) study. Br J Nutr. 2016;115(8):1439–1452. doi: 10.1017/S0007114516000283. PubMed DOI

Hebert JR, Hurley TG, Peterson KE, Resnicow K, Thompson FE, Yaroch AL, et al. Social desirability trait influences on self-reported dietary measures among diverse participants in a multicenter multiple risk factor trial. J Nutr. 2008;138(1):226–234. doi: 10.1093/jn/138.1.226S. PubMed DOI

Ojala K, Vereecken C, Välimaa R, Currie C, Vilberg J, Tynjälä J, et al. Attemps to lose weight among overweight and non-overweight adolescents: a cross-national survey. Int J Behav Nutr Phys Act. 2007;4:50. doi: 10.1186/1479-5868-4-50. PubMed DOI PMC

Kjelgaard HH, Holstein BE, Due P, Brixval CS, Rasmussen M. Adolescent weight status: association with structural and functional dimensions of social relations. J Adolesc Health. 2017;60(4):460–468. doi: 10.1016/j.jadohealth.2016.11.016. PubMed DOI

Lal A, Moodie M, Abbott G, Carver A, Salmon J, Giles-Corti B, et al. The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study. Int J Behav Nutr Phys Act. 2019;16:26. doi: 10.1186/s12966-019-0786-5. PubMed DOI PMC

Sigmund E, Sigmundová D, Šnoblová D, Gecková AM. Actitrainer-determined segmented moderate-to-vigorous physical activity patterns among normal-weight and overweight-to-obese Czech schoolchildren. Eur J Pediatr. 2014;173(3):321–329. doi: 10.1007/s00431-013-2158-5. PubMed DOI PMC

Sigmund E, Sigmundová D, Hamrik Z, Gecková AM. Does participation in physical education reduce sedentary behaviour in school and throughout the day among normal-weight and overweight-to-obese Czech children aged 9–11 years? Int J Environ Res Public Health. 2014;11(1):1076–1093. doi: 10.3390/ijerph110101076. PubMed DOI PMC

Sigmund E, El Ansari W, Sigmundová D. Does school-based physical activity decrease overweight and obesity in children 6-9 years? A two-year non-randomized longitudinal intervention study in the Czech Republic. BMC Public Health. 2012;12:570. doi: 10.1186/1471-2458-12-570. PubMed DOI PMC

Sigmund E, Sigmundová D. Longitudinal 2-year follow-up on the effect of a non-randomised school-based physical activity intervention on reducing overweight and obesity of Czech children aged 10–12 years. Int J Environ Res Public Health. 2013;10(8):3667–3683. doi: 10.3390/ijerph10083667. PubMed DOI PMC

Garaulet M, Ortega FB, Ruiz JR, Rey-López JP, Béghin L, Manios Y, et al. Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes (Lond) 2017;35(10):1308–1317. doi: 10.1038/ijo.2011.149. PubMed DOI

Miller MA, Kruisbrink M, Wallace J, Ji C, Cappuccio FP. Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep. 2018;41(4):1–19. doi: 10.1093/sleep/zsy018. PubMed DOI

Sluggett L, Wagner SL, Harris RL. Sleep duration and obesity in children and adolescents. Can J Diabetes. 2019;43(2):146–152. doi: 10.1016/j.jcjd.2018.06.006. PubMed DOI

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