Childhood obesity has emerged as a major public health challenge worldwide. The rapid increase in access to digital technology has significantly altered lifestyle patterns in children, reducing physical activity and increasing sedentary behaviours. WHO reports that childhood overweight and obesity continue to rise globally, correlating strongly with reduced activity and increased screen exposure [1]. In India, changing lifestyle patterns driven by urbanization and digitalization have contributed significantly to rising rates of childhood adiposity [2]. Screen exposure—including smartphones, video games, computers, televisions, and tablets—has become a central part of children’s daily routine. Many children exceed recommended screen-time limits, increasing the risk of sedentary behaviour [3]. Prolonged screen time displaces outdoor play, reduces metabolic activity, and promotes unhealthy snacking habits, leading to positive energy balance and weight gain [4]. Numerous studies have found a strong correlation between screen exposure and obesity. Robinson et al. reported that each additional hour of screen time increased the risk of obesity in school-aged children [5]. Indian evidence also demonstrates that children exposed to ≥2 hours/day of screen time are nearly twice as likely to be overweight or obese [6]. Additional factors such as poor sleep and emotional eating reinforce this behavioural cycle [7,8]. As screen exposure is a modifiable behaviour, understanding its impact on physical activity, dietary habits, sleep, and obesity is essential. The present study assesses these associations among children aged 5–15 years.

This cross-sectional observational study was conducted over six months in the Pediatric Outpatient Department of a tertiary care hospital. Children aged 5–15 years were included, while those with chronic illnesses, endocrine disorders, congenital anomalies, or disabilities affecting activity were excluded. Written informed consent and child assent were obtained. The sample size calculation used a prevalence estimate of 19.3% for childhood obesity from Ranjani et al. [9]. Using the formula for single proportion (Z = 1.96, p = 0.193, d = 0.05), the minimum sample size was 239.3. After adjusting for 10% non-response, the final sample size was 265. Data collection included demographic details, type and duration of screen exposure, sleep duration, snacking behaviour, and physical activity patterns. Screen time was categorized as <2 hours/day and ≥2 hours/day. Physical activity was recorded as ≥60 minutes/day or <60 minutes/day based on WHO recommendations. Anthropometric measurements were taken using standard techniques. BMI was calculated and classified using WHO BMI-for-age percentiles. Overweight was defined as >85th percentile and obesity as >95th percentile. Data analysis used SPSS, with results presented as frequencies and percentages. The Chi-square test assessed associations, with p < 0.05 considered significant. Ethics approval was obtained prior to the study.

A total of 265 children participated. The mean age was 10.2 ± 2.9 years, with almost equal distribution across genders and age groups. Most belonged to the middle socioeconomic class. Table 1: Demographic Characteristics of Participants (n = 265) Variable Category Frequency (n) Percentage (%) Age Group 5–10 years 132 49.8% 11–15 years 133 50.2% Gender Male 134 50.6% Female 131 49.4% Socioeconomic Status Upper 58 21.9% Middle 151 57.0% Lower 56 21.1% More than half the children (61.5%) had screen exposure ≥2 hours/day. Smartphones were the most frequently used devices. Table 2: Type of Screen Devices Used (n = 265) Device Type Frequency (n) Percentage (%) Smartphone 214 80.8% Television 176 66.4% Tablet 92 34.7% Computer/Laptop 58 21.9% Multiple Devices 148 55.8% Children with prolonged screen exposure reported significantly shorter sleep duration and more bedtime screen use. Table 3: Sleep Duration and Bedtime Screen Use Sleep Variable < 2 h/day (n=102) ≥ 2 h/day (n=163) Sleep ≥ 8 hours/day 72 (70.6%) 68 (41.7%) Sleep < 8 hours/day 30 (29.4%) 95 (58.3%) Bedtime Screen Use 18 (17.6%) 93 (57.1%) Table 4: Screen Time Distribution (n = 265) Screen Time Duration Frequency (n) Percentage (%) < 2 hours/day 102 38.5% ≥ 2 hours/day 163 61.5% Table 5: Association Between Screen Time and Physical Activity Physical Activity < 2 h/day (n=102) ≥ 2 h/day (n=163) p-value ≥ 60 minutes/day 68 (66.7%) 38 (23.3%) <0.001 < 60 minutes/day 34 (33.3%) 125 (76.7%) <0.001 Table 6: Association Between Screen Time and BMI BMI Category < 2 h/day ≥ 2 h/day p-value Normal 78 (76.5%) 82 (50.3%) <0.001 Overweight 14 (13.7%) 42 (25.8%) <0.001 Obese 10 (9.8%) 39 (23.9%) <0.001 Children with prolonged screen exposure commonly use multiple digital devices and consume more energy-dense snacks during screen time. High screen-time children had reduced sleep duration, more irregular sleep schedules, and significantly lower physical activity levels. Overweight and obesity were nearly twice as prevalent among prolonged screen-time users. Overall, prolonged screen exposure was associated with unhealthy behavioural patterns and higher adiposity indicators.

The present study shows that prolonged screen exposure significantly reduces physical activity and increases overweight/obesity in children. This aligns with Biddle et al., who found that children exceeding 2 hours/day of screen time had 1.8 times higher odds of overweight [10]. Altenburg et al. reported that reducing screen time lowered BMI by 0.10–0.30 kg/m², confirming a causal link between screen exposure and obesity [11]. Stiglic and Viner’s systematic review showed that >3 hours/day screen time increased childhood obesity risk by 30–60% [12]. Similarly, Rey-López et al. found that TV viewing >3 hours/day increased obesity risk 2.5-fold [13]. The findings of Suchert et al. showed that 72% of adolescents with prolonged screen exposure failed to meet physical activity recommendations, supporting our results [14]. Falbe et al. reported a 40% higher prevalence of obesity among children with high screen exposure [15]. The ISCOLE study demonstrated that every additional hour of sedentary time increased body fat by 1.4% [16]. Haines et al. described that snacking during screen time increased overweight risk by 2.1 times [17]. Long-term effects were highlighted by Davison et al., who found that prolonged screen exposure predicted higher BMI trajectories in girls [18]. Sleep disruption from screen use—shown by Hale and Guan to reduce sleep by 30–60 minutes and increase obesity risk by 89%—was also noted in our study population [19]. Chaput et al. recommended limiting recreational screen time ≤2 hours/day to prevent excess adiposity [20]. Thus, evidence from both the present study and global literature strongly supports that prolonged screen exposure is a major modifiable risk factor for pediatric obesity.

Prolonged screen exposure is significantly associated with reduced physical activity and increased risk of overweight and obesity in children. Children with ≥2 hours/day of screen time exhibit higher sedentary behaviour, lower physical activity, and greater BMI compared to those with limited screen exposure. RECOMMENDATIONS ● Children should limit recreational screen time to ≤2 hours/day, stay physically active for at least 60 minutes, and maintain screen-free meals and bedtime routines. Healthy snacks, good sleep hygiene, and parental role-modelling are essential. ● Schools should promote activity, pediatricians must counsel families, and communities should reduce sedentary habits. Future research should further explore long-term screen-time effects.

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