Send to

Choose Destination
See comment in PubMed Commons below
J Pediatr. 2017 Oct 4. pii: S0022-3476(17)31071-5. doi: 10.1016/j.jpeds.2017.08.017. [Epub ahead of print]

Childhood Obesity and Physical Activity-Friendly School Environments.

Author information

Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong. Electronic address:
Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.
Department of Physical Education, Hong Kong Baptist University, Hong Kong.
Student Health Service, Department of Health, Hong Kong SAR Government, Hong Kong.
Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR.
Faculty of Education, University of Macau, Macau SAR.
School of Public Health, The University of Hong Kong, Hong Kong SAR.
Shanghai Children's Medical Center, Shanghai, China.



Childhood obesity may be related to school environment, but previous studies often focused on food environment only. This study aimed to examine the relationship between school physical activity environment and childhood obesity.


This is a cross-sectional study with multilevel data collected on school physical activity environment using teacher questionnaires, students' growth, and obesity status from electronic health records, and neighborhood socioeconomic status from census data.


This study included 208 280 students (6-18 years of age) from 438 schools (45% of Hong Kong). Prevalence of obesity was 5.0%. After controlling for socioeconomic status and intraschool correlation, robust Poisson regression revealed a reduced obesity risk associated with higher teachers' perceived physical activity benefits (risk ratio 0.96, 95% CI 0.94-0.99, P = .02), physical activity teaching experience (0.93, 0.91-0.96, P < .001), school campus size (0.93, 0.87-0.99, P = .02), physical activity ethos (0.91, 0.88-0.94, P < .001), number of physical activity programs (0.93, 0.90-0.96, P < .001), and physical activity facilities (0.87, 0.84-0.90, P < .001). Students in schools with at least 3 physical activity-friendly environmental factors (11.7%) had a much lower risk of obesity (0.68, 0.62-0.75, P < .001) than those without (23.7%).


A physical activity-friendly school environment is associated with lower risk of obesity. School physical activity environment should be considered in future epidemiologic and intervention studies.


Chinese; childhood obesity; physical activity; school environment

PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center