Physical Activity and Pediatric Obesity: A Quantile Regression Analysis.

Purpose: We aimed to determine whether moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) were independently associated with body mass index (BMI) and waist circumference (WC) in children and adolescents.

Methods: Data from the International Children's Accelerometry Database were used to address our objectives (N = 11,115; 6-18 yr; 51% female). We calculated age- and gender-specific BMI and WC z-scores and used accelerometry to estimate MVPA and total SB. Self-reported television viewing was used as a measure of leisure time SB. Quantile regression was used to analyze the data.

Results: MVPA and total SB were associated with lower and higher BMI and WC z-scores, respectively. These associations were strongest at the higher percentiles of the z-score distributions. After including MVPA and total SB in the same model, the MVPA associations remained, but the SB associations were no longer present. For example, each additional hour per day of MVPA was not associated with BMI z-score at the 10th percentile (b = -0.02, P = 0.170) but was associated with lower BMI z-score at the 50th (b = -0.19, P < 0.001) and 90th percentiles (b = -0.41, P < 0.001). More television viewing was associated with higher BMI and WC, and the associations were strongest at the higher percentiles of the z-score distributions, with adjustment for MVPA and total SB.

Conclusions: Our observation of stronger associations at the higher percentiles indicates that increasing MVPA and decreasing television viewing at the population-level could shift the upper tails of the BMI and WC frequency distributions to lower values, thereby lowering the number of children and adolescents classified as obese.