Abstract

Background

Obesity is a nutritional diseases, one of the most significant of the 21st century, that has grown to epidemic proportions. Overweight and obesity, once considered a problem in high-income countries, now affect low- and middle-income countries, especially in urban areas. Overweight and obesity rates among children and adolescents are constantly rising. The main cause of obesity and overweight is a lack of energetic balance between consumed and expended calories. Obesity in children is associated with an increased risk of non-communicable diseases, but in addition to somatic problems, it also causes negative psychosocial effects. The aim of the study was to analyse factors leading to overweight and obesity in young people and assess the impact of the health behaviours of parents on their children鈥檚 health.

Methods

A cross-sectional study was conducted per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A convenience sampling method was used, and the study was conducted among adolescents with excess body weight and their parents, as well as adolescents with normal body weight. The study used a questionnaire, body mass index assessment, physical activity assessment, and a health behaviour inventory.

Results

The study included 340 people, 170 with excess body weight, and 170 from the control group. The average age in the study group was 14.58 years, with a standard deviation of 2.72. The age of parents of children with excess body weight was between 20 and 50 years. Among parents of overweight or obese children, more than half were overweight (54%), and another 27% were obese. 41% of respondents with eating disorders assessed their knowledge of the causes, effects, and methods of preventing overweight and obesity as average. In the group of overweight or obese respondents, 84% prefer passive leisure time. People who are not overweight mostly accept their appearance (66%), while people with excess body mass do not accept their appearance (63%). The surveyed parents usually perceived their knowledge of proper nutrition as good (75%).

Conclusions

A relationship exists between normal weight, overweight or obesity, and a sense of happiness. The highest sense of happiness was reported by people who were not overweight.

Introduction

Overweight and obesity are defined by the World Health Organisation as abnormal or excessive accumulation of adipose tissue, which poses a health risk, but also as a chronic metabolic disease resulting from disturbances in energy homeostasis [1]. Obesity is a lifestyle-related condition and one of the most critical public health concerns of the 21st century, having escalated to epidemic proportions. Overweight and obesity rates among children and adolescents are constantly rising, and the problem has grown to epidemic proportions. Between 1975 and 2016, the incidence of overweight or obesity among children and adolescents aged 5鈥�19 years increased more than fourfold worldwide, from 4 to 18%. In 1975, just under 1% of children and adolescents aged 5鈥�19 years were obese; in 2016, obesity affected over 124听million children and adolescents, while over 340听million children and adolescents were overweight or obese. In 2019, an estimated 38.2听million children under the age of 5 were overweight or obese [1,2,3,4]. Currently, overweight and obesity affect almost 60% of adults and nearly every third child, 29% of boys, and 27% of girls in the WHO European region. In Poland, the problem of overweight and obesity affects 10% of children aged 1鈥�3, 30% of children of early school age, and 22% of teenagers up to 15 years of age. Poland is one of the leading countries affected by the obesity epidemic [5, 6]. According to the Association for the Study of Obesity (ASO), nearly 200听million school-age children worldwide are overweight or obese, and 40鈥�50听million are obese. In the European Union, approximately 60% (almost 260听million) of adults and over 20% (nearly 12听million) of school-age children are overweight or obese [7, 8].

The high prevalence of obesity has precipitated a substantial increase in research investigating the etiological underpinnings of childhood obesity. Formal genetic data, derived from twin, adoption, and family studies, indicate that at least 50% of the inter-individual variance in body mass index is attributable to genetic factors. Genome-wide association studies have identified polygenes implicated in the regulation of body weight. A consensus exists that parental obesity constitutes the most potent risk factor for obesity in children and adolescents. The magnitude of parental obesity influences this risk, with a further exacerbation observed when both parents are affected. Furthermore, numerous genes associated with both monogenic and polygenic childhood obesity have been identified; several genes have been demonstrated to elicit early-onset obesity in children when harboring functional defects. These genes account for approximately 5% of cases. However, the majority of childhood obesity cases appear to stem from a polygenic predisposition, arising from the presence of risk alleles within multiple genes, which may operate synergistically in response to obesogenic environmental milieus. The FTO gene serves as a salient example of this phenomenon; while its effect size is comparatively modest, it is compounded by a sedentary lifestyle. Both candidate gene and genome-wide association studies reveal that typical obesity-related genes exhibit small effect sizes, yet obesity risk alleles demonstrate considerable prevalence within populations [9,10,11].

The primary cause of obesity and overweight is a lack of energetic balance between consumed and expended calories. Increased consumption of high-energy products with high fat and sugar content, as well as increased physical inactivity due to sedentary leisure and rising urbanisation, have been noted worldwide. These dietary patterns, combined with lower levels of physical activity, are causing a sharp rise in obesity in children [1]. However, in addition to an improper diet and insufficient amount of physical activity, obesity can be caused by numerous genetic factors (30鈥�40%) and by environmental and behavioural factors that include the improper lifestyle of household members, advertising highly processed products, compensating for emotional losses, and finding solace in food [2,3,4]. One of the main environmental factors causing increased consumption is improper eating habits, which usually result from imitation. A way of eating, i.e., the quality and quantity of consumed food, is passed on to children by parents. Children adapt to the eating habits at home and use them later in life [5, 12]. It should be remembered that parents are responsible for making decisions about food availability and its preparation for consumption. The similarity in behaviours between parents and children is a result of parental supervision regarding the behaviour of their children [13].

Obesity is associated with an increased risk of non-communicable diseases such as cardiovascular diseases, diabetes, musculoskeletal disorders, and cancer, as well as disability in adulthood and premature death. The latest estimates show that overweight and obesity are the fourth most common risk factor for non-communicable diseases and the main risk factor for disability, causing 7% of all years lived with disability. In addition to somatic consequences, there are also negative psychosocial consequences [1, 3]. The most common psychological complications are low self-esteem, feeling physically unattractive, and a lack of acceptance from peers, which causes negative emotions such as sadness, regret, and loneliness, which may develop into depression. Rejection from a peer group is usually caused by social stereotypes about obese people and causes the phenomenon of stigmatization [14, 15]. The complications of stigmatisation related to obesity in young people are common, may cause serious emotional and physical health consequences, and can also have an impact on later life [16]. Scientists claim that humiliation due to excessive body weight negatively impacts the elimination of excess weight, self-esteem, and self-worth [17].

The study attempted to assess the factors leading to overweight and obesity among young people compared to a control group with normal body weight and whether overweight or obesity correlates in any way with the health behaviours of parents, as well as with self-esteem. The study aims to analyse factors leading to overweight and obesity in young people, and assess the impact of the health behaviours of parents on their children鈥檚 health. In conclusion, it should be emphasised that the obtained results of the research may constitute a basis for taking action aimed at the prevention and reduction of overweight and obesity among young people, as well as raising awareness of the impact of a healthy lifestyle on the well-being of children and adolescents. We hope that the study will fill the above gaps in current knowledge, especially in the assessment of the relationship between the health behaviours of adolescents and their parents.

Materials and methods

Study design

The cross-sectional study was conducted in 2023 per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Study participants

A convenience sampling method was used, and the study was conducted among adolescents with excess body weight according to the BMI index WHO classification for children and adolescents, who were hospitalised in paediatric departments at the Medical Centre in 艁a艅cut. Children and adolescents were hospitalized only because of overweight or obesity, without other coexisting diseases. The control group-adolescents with normal body weight in primary and secondary schools. Additionally, the study included parents of both groups. The inclusion criteria for the study were the consent of the parents of the study participants, the consent of the study participants to complete the survey, excessive body mass for the study group, and normal body mass for the control group. The exclusion criteria were the lack of consent of the parents of the study participants and the lack of consent of the study participants to complete the survey. After obtaining consent to participate from the participants, 200 surveys were distributed in each group, and 340 responses were received, which means a return rate of 85%. A total of 340 participants who correctly completed the questionnaire were included in the analysis.

Instruments

The study used a survey questionnaire, an assessment of the body mass index, an assessment of physical activity, and the Health Behaviour Inventory.

The survey questionnaire includes detailed and extensive instructions on how the survey should be completed. It includes open-ended, single- and multiple-choice questions that allow obtaining cadastral, epidemiological, and qualitative information. The survey consists of a general and a detailed part. The general part concerns demographic data such as gender, age, education of the parents, and place of residence. The detailed part contains questions about lifestyle, factors increasing the risk of excess body weight, and the aspect of body-shaming.

Anthropometric measurements

The assessment was made by physical examination including anthropometric measurements of height, body mass, body mass index BMI. The measurements were carried out in the morning hours prior to emptying the bladder. The children were only dressed in personal underwear, without footwear.

The body weight measurement was carried using an electronic scale with an accuracy of measurement of 100听g, with the results being related to the values of percentile norms for gender and age, where a value of <鈥�3 percentile meaning significant lack of body mass, <鈥�10鈥夆垝鈥�3 percentile-lack of body mass, <鈥�25鈥夆垝鈥�10 percentile - slimness, 25鈥�75 percentile-correct body mass, >鈥�75鈥�90 percentile-tendency to be overweight, >鈥�90鈥�97 percentile-being overweight, >鈥�97 percentile - obesity.

The height measurement was carried out using a stadiometer with accuracy of up to 0.5听cm. The results were compared to values of percentile norms for gender and age, where a value of <鈥�3 percentile meaning significant lack of body height, <鈥�10鈥夆垝鈥�3 percentile - low stature, <鈥�25鈥夆垝鈥�10 percentile鈥� stature below the established norm, 25鈥�75 percentile - correct body height, >鈥�75鈥�90 percentile鈥� stature above the established norm, >鈥�90鈥�97 percentile- high stature, >鈥�97 percentile-extremely high stature.

Based on measurements of height and body mass, the indicator of relative body mass (BMI - body mass index) was calculated, and results were compared to percentile norms developed by WHO for age and sex, where a value of <鈥�3 percentile meaning significant lack of body mass, 3鈥�15 percentile - lack of body mass, 15鈥�85 percentile鈥� standard body mass, 85鈥�97 percentile- being overweight, >鈥�97 percentile- obesity.

Physical activity was assessed using the WHO recommendations: at least moderate activity for about 30听min five times a week; moderate or intense physical effort performed for at least 45听min at least five times a week; and 18鈥�27听h of the metabolic equivalent of MET effort per week (an hour of jogging, cycling, playing tennis, swimming-7 MET; an hour of aerobics; mowing the lawn-6 MET; walking for an hour six days a week-18 MET).

The health behaviour inventory (HBI) questionnaire

was used to examine pro-health behaviors through 24 statements that reflect health-related activities. By analyzing the frequency of these behaviors, an overall index of an individual鈥檚 health behavior can be determined.

The HBI consists of four subscales:

• 1. Proper Eating Habits (PEH): This subscale evaluates dietary choices, particularly the consumption of specific types of food, such as bread, fruits, and vegetables.

• 2. Preventive Behaviors (PB): This subscale assesses adherence to health recommendations and the acquisition of information regarding health and disease prevention.

• 3. Health Practices (HP): This section addresses daily lifestyle habits, including sleep, physical activity, and recreation.

• 4. Positive Mental Attitude (PMA): This subscale focuses on psychological well-being, including behaviors aimed at managing stress, emotions, and other potentially detrimental psychological conditions.

Respondents report the frequency of specific health behaviors on a five-point Likert scale, where 1 corresponds to 鈥渁lmost never,鈥� 2 to 鈥渞arely,鈥� 3 to 鈥渙ccasionally,鈥� 4 to 鈥渙ften,鈥� and 5 to 鈥渁lmost always.鈥� The questionnaire examines behaviors over the past year, with an average completion time of less than five minutes. To compute an overall index of health behavior intensity, responses are summed, yielding a score range between 24 and 120. Higher scores indicate a greater prevalence of health-promoting behaviors. Interpretation of the results is based on a sten scale, where scores of 1鈥�4 are classified as low, 5鈥�6 as average, and 7鈥�10 as high. The sten scores differ according to normative data provided for men and women. Each subscale鈥檚 result is the mean of the responses to its respective items. The interpretation of these means is as follows: a mean of 1 signifies 鈥渁lmost never,鈥� 2 signifies 鈥渞arely,鈥� 3 signifies 鈥渙ccasionally,鈥� 4 signifies 鈥渙ften,鈥� and 5 signifies 鈥渁lmost always鈥� [15,16,17].

Data collection

The prepared research tool was subjected to verification, i.e., checking how well it measures the matter we want to understand. A pilot study to verify and standardise the survey questionnaire was conducted on a small group of 30 people, checking if all questions were clear and understandable to the respondents, whether they were understood as per the researcher鈥檚 intention, and whether they provided the information the researcher wanted to obtain. At the beginning of the study, the researcher explained the purpose and significance of the study to each respondent and informed them that participation in it was completely voluntary. All respondents received envelopes with information about the study, the informed consent form, and the questionnaire and were asked to return them to the researcher upon completion. The respondents did not raise any objections when answering the questions. When planning the sample size, a ratio of 1:10 (one item per 10 study participants) was taken into account, which in our case means a minimum of 250 respondents. Taking into account the cases of refusal and withdrawal from participation in the study, 400 surveys were distributed in the test phase, and 340 responses were received, which means a return rate of 85%. 340 forms (100%) were considered for statistical analysis.

Sample

The study included 340 people, 170 with excess body weight, and 170 from the control group. The average age in the study group was 14.58 years with a standard deviation of 2.72, and in the control group, 14.87 years with a standard deviation of 2.48.

The age of children with excess body weight was between 20 and 50 years. Over half of them were overweight, and another 4% were obese. 32% of the parents had a normal body weight.

Ethical considerations

The study was approved by the Team for Scientific Research Ethics at the Bioethics Committee at Collegium Masoviense University of Health Sciences in Zyrardow no. 63/2022 and 112/2022. Participation in the study was voluntary, anonymous and respondents were informed of their right to refuse or withdraw from the study at any time. Each participant was informed about the purpose of the study and the time of completion of the study. The study also concerned minors under 16 years of age, therefore informed consent to participate in the study was obtained from their parents or legal guardians.

Statistical analysis

To conduct statistical analyses, the R programming language version 4.2.2 and the RStudio environment version 2022.12.0 were used. A level of 伪鈥�<鈥�0.05 was considered statistically significant. The choice of R programming language and RStudio environment allows for robust and reproducible statistical analyses, which is especially important for handling complex data structures and ensuring transparency in the analysis process.

The mean, standard deviation, median, mean rank, skewness, and kurtosis coefficients were used in the statistical description of the obtained BMI results and age. These descriptive statistics provide a comprehensive understanding of the distribution and central tendency of the data. The mean and standard deviation offer insights into the average and spread of values, while the median provides a measure of central tendency that is less sensitive to outliers. The skewness and kurtosis coefficients are used to assess the shape of the data distribution, identifying whether the data is normally distributed or if it has significant asymmetry or outliers.

The distribution of numbers and percentage distribution were used in the statistical description of the results obtained for selected sociodemographic variables. These measures were chosen to provide a clear understanding of the frequency and proportion of participants in different sociodemographic categories, facilitating the interpretation of the sample composition.

The Mann-Whitney U test was used to assess the relationship between a healthy lifestyle, a sense of joy in life, self-assessment of physical activity and healthy nutritional habits, and being overweight or obese. The Mann-Whitney U test is a non-parametric test that compares differences between two independent groups when the assumption of normality is not met. It is appropriate for examining relationships between variables with ordinal or continuous data that may not follow a normal distribution. Chi-square tests were used to verify the relationship between being overweight or obese and the motivations for undertaking physical activity, nutrition characteristics, dieting, and appearance acceptance. The Chi-square test is suitable for categorical variables and helps determine whether there is an association between two or more categorical variables, in this case, relating lifestyle factors to overweight and obesity. It tests the hypothesis that the distribution of observed frequencies across categories is consistent with the expected distribution.

Results

Demographic data of the study groups

The study group included 340 adolescents with a mean age of 14.58 years (SD鈥�=鈥�2.7) and a median age of 14 years. In comparison, the control group had a mean age of 14.87 years (SD鈥�=鈥�2.48). The age range in both groups spanned from 11 to 19 years. Skewness and kurtosis coefficients indicated that the age distribution in the study group was approximately symmetrical and platykurtic indicating a slight clustering around the mean (SKEW鈥�=鈥�0.364; KURT=-1.171). The Shapiro-Wilk test revealed statistically significant differences between the age distribution in the study group and a normal distribution (W鈥�=鈥�0.901, p鈥�=鈥�0.000).

Characteristics of the study group鈥檚 families

Among the parents of overweight children surveyed, the majority (44%) were aged between 41 and 50 years (44%), with women representing 54%. Most parents lived in rural areas (66%), were married (64%), and had attained secondary education (56%). Over half of the parents were themselves overweight (54%), while 27% were classified as obese. Only 17% of parents had a normal body weight, and 2% were underweight. In most families (69%), obesity affected only one child, but in 24% of cases, it impacts two children. The duration since the diagnosis of overweight/obesity in the child was 1鈥�2 years in 40% of cases, 3鈥�4 years in 39%, 5鈥�6 years in 15%, and 7鈥�8 years in 6%.

Nutritional status according to BMI

In the study group, the average BMI was 21.15 (SD鈥�=鈥�21.15) with a median of 20.45. The BMI values ranged from 16.49 to 35.92. The Shapiro-Wilk test revealed significant deviations from a normal distribution. No significant relationships were found between BMI and gender, age, or place of residence. The chi-square test assessed the relationship between overweight/obesity among the participants and the family history of overweight/obesity. In the overweight or obese group, 81% reported a family history of overweight or obesity, compared to 58% in the control group (蠂虏 = 6.45, p鈥�=鈥�0.04, V鈥�=鈥�0.185), indicating a statistically significant association. Additional descriptive statistics for both groups are presented in Table听1.

Table 1 Descriptive statistics of the examined group of adolescents and their parents

Self-assessment of knowledge of a healthy lifestyle among the surveyed youth

The self-assessed knowledge of obesity and its causes was compared between cases and controls. Among the cases, 3% rated their knowledge as 鈥渧ery bad,鈥� 3% as 鈥渂ad,鈥� 41% as 鈥渁verage,鈥� 44% as 鈥渁ll right,鈥� and 9% as 鈥渧ery good.鈥� In contrast, controls had 0% 鈥渧ery bad,鈥� 1% 鈥渂ad,鈥� 32% 鈥渁verage,鈥� 15% 鈥渁ll right,鈥� and 52% 鈥渧ery good.鈥� The Mann-Whitney U test showed a U value of 2949.00, p鈥�=鈥�0.090, and effect size 蔚虏 = 0.015, indicating no significant difference in the self-assessment of obesity knowledge between cases and controls. While the distribution of knowledge ratings differed, the difference was not statistically significant (Fig.听1).

Fig. 1

Knowledge of the surveyed adolescents about a healthy lifestyle

The results indicated no significant differences between cases and controls for factors such as lack of vegetables and fruits, irregular eating, eating before bed, stress, and side effects of drugs. However, significant differences were observed for genetic factors (28% of cases vs. 52% of controls, p鈥�=鈥�0.15), diseases and health problems (31% vs. 59%, p鈥�=鈥�0.04), and problems at school or home (47% vs. 21%, p鈥�=鈥�0.02). These findings highlight differences in awareness of genetic and health-related causes of obesity (Table听2).

Table 2 Knowledge of the surveyed adolescents about the causes of obesity

Frequency of practising sports by the surveyed youth

The analysis showed no significant difference in physical activity between cases and controls (U鈥�=鈥�2918.00, p鈥�=鈥�0.137). Among cases, 34% reported no activity, 25% exercised once a week, 28% 2鈥�3 times per week, and 13% daily. For controls, 22% reported no activity, 28% exercised once a week, 29% 2鈥�3 times per week, and 21% daily (Fig.听2).

Fig. 2

Frequency of practising sports by the surveyed youth

The analysis found no significant difference in leisure time activity between cases (84% passive, 16% active) and controls (39% passive, 61% active) (蠂虏=1.53, p鈥�=鈥�0.46). Most cases (80%) reported a weekly energy expenditure below 10 METs, compared to 57% of controls. However, significant differences were found in reasons for not engaging in physical activity: lack of time was more common among controls (64% vs. 34%, 蠂虏=9.88, p鈥�=鈥�0.02), lack of support was more frequent in cases (38% vs. 20%, 蠂虏=4.36, p鈥�=鈥�0.037), and being ridiculed by peers was reported more by cases (38% vs. 15%, 蠂虏=9.20, p鈥�=鈥�0.02), (Table听3).

Table 3 Patterns of leisure and physical activity among surveyed youth

The data on breakfast consumption revealed that sandwiches were the most common food item, eaten by 73% of cases and 79% of controls. A significant difference was observed in the consumption of fruits and vegetables, with 17% of cases and 38% of controls eating them (蠂虏=5.16, p鈥�=鈥�0.02). Other items, such as cereals, oatmeal, and yoghurts, showed no significant differences. For beverages, tea consumption was significantly higher among controls (71%) compared to cases (53%) (蠂虏=4.07, p鈥�=鈥�0.04). There were no significant differences in the consumption of mineral water, fruit juices, or carbonated drinks. (Table听4).

Table 4 Selected products and beverages consumed by studied adolescents

Sself-acceptance of appearance and experiences of stigmatization among surveyed youth

The results show a significant difference in self-acceptance of appearance between cases and controls. Among the cases, 38% (95% CI: 33鈥�39) reported self-acceptance compared to 66% (95% CI: 63鈥�70) of the controls (蠂虏=8.81, p鈥�=鈥�0.003, V鈥�=鈥�0.216), indicating a moderate effect size. The results show a significant difference in the experience of stigmatization between cases and controls. Among the cases, 19% (95% CI: 18鈥�21) reported never experiencing stigmatization, 31% (95% CI: 31鈥�34) rarely, and 50% (95% CI: 48鈥�55) very often. In contrast, 42% (95% CI: 39鈥�44) of the controls never experienced stigmatization, 39% (95% CI: 38鈥�40) rarely, and only 19% (95% CI: 18鈥�21) very often. The Mann-Whitney U test revealed a significant difference (U鈥�=鈥�1576.00, p鈥�=鈥�0.000, 蔚虏=0.067), indicating that cases experienced stigmatization more frequently than controls (Fig.听3).

Fig. 3

Experience of stigmatization by the surveyed youth

Self-assessment of parents鈥� knowledge about proper nutrition and their health behaviors according HBI scale

The majority of the respondents had an average level of health behaviours (44%). A low level of health behaviours was reported in 26%, and a high level in 30%. The nutrition knowledge of parents depended on their age (p鈥�=鈥�0.049). It was shown that people aged 31鈥�40 had the highest level of knowledge, and those aged 20鈥�30 had those aged 20鈥�30 had the lowest. The health behaviours of parents did not differ depending on their age (p鈥�=鈥�0.189). 61% of respondents tried to pass on their knowledge about proper nutrition to their children. It was shown that nutrition knowledge was more often passed on by parents who themselves had greater knowledge in this area (p鈥�=鈥�0.002), while this knowledge was rarely shared by parents with insufficient knowledge of their own.

n the study group, most parents rated their knowledge of proper nutrition as good (75%) or very good (12%), while 13% rated it as average. Nutrition knowledge was classified as low (1鈥�2 correct answers), average (3鈥�4), or high (5鈥�6) based on a six-question test. The majority of parents had average knowledge (55%), 34% had low knowledge, and 12% demonstrated high knowledge. Health-related behaviors scored an average of 82.62 points, with most parents showing preventive behaviors (21.46 points), while adherence to proper eating habits was slightly lower (20.76 points), (Table听5).

Table 5 The level of health behaviors of the parents of the study group based on the Health Behavior Inventory scale

Discussion

Obesity in childhood is a pressing public health issue worldwide, both in developed and developing countries. Understanding its causes is essential for prevention and treatment. Factors contributing to obesity include genetic, environmental influences, sociodemographic factors, media exposure, poor eating habits, and reduced physical activity [18,19,20].

Our study aimed to identify the factors leading to overweight and obesity among young people, while also assessing the influence of parental health behaviors on children鈥檚 health.

Family background plays a critical role in the development of obesity in children and adolescents. Research suggests that obesity often runs in families, with many overweight children being raised by obese parents or in environments where siblings also struggle with obesity [21]. A broad consensus exists that parental obesity represents the most potent risk factor for obesity in children and adolescents. The magnitude of parental adiposity directly influences this risk, with a further significant elevation observed when both parents are affected. Several studies indicate a slightly stronger correlation between offspring BMI and maternal BMI than paternal BMI, suggesting potential influences of intrauterine environments, imprinting effects, the influence of mitochondrial genes, or nurture effects [10]. Global reports corroborate that parental obesity is a robust predictor of excessive body weight in children. The familial risk ratio for childhood obesity, when a parent is obese, exceeds 2.5. Birth weight exhibits a heritable genetic component of approximately 30%, with significant maternal and paternal effects in addition to the neonate鈥檚 own genes. Approximately 5% of childhood obesity cases are attributable to defects that impair gene function, with 鈮モ��5 such genes identified. However, the prevailing forms of childhood obesity appear to arise from a predisposition that primarily fosters obesogenic behaviors within an obesogenic environment [11]. Similar to the findings Rogalska-Nied藕wied藕 et al., we observed that children living in rural areas and whose parents are overweight or obese are at a higher risk of developing obesity themselves [22]. This aligns with previous research emphasizing the family鈥檚 role as the primary environment where children develop their understanding of nutrition and healthy behaviors [23, 24]. Weker also emphasises the significance of the connection between family factors, i.e., obesity in parents and eating habits that children initially imitate and then continue in adulthood. Moreover, overweight or obesity was more common in parents of children with diagnosed metabolic syndrome than in other groups [25]. Our results confirm these findings, as 59% of respondents with overweight or obesity live in rural areas, 81% have overweight or obese parents, and 39% have one sibling. However, the association between family traits and obesity needs to be considered within the broader context of lifestyle behaviors, as familial obesity could result from shared unhealthy habits rather than genetics alone.

High-quality international research indicates that the increasing prevalence of obesity is substantially influenced by environmental and behavioral factors, including dietary patterns. Breakfast skipping has been associated with an elevated risk of obesity in children, while consuming more than three meals per day has been correlated with a reduced risk. This latter finding may be explained by the theory that consuming several smaller meals throughout the day is metabolically more advantageous than consuming three larger meals [26]. Dietary patterns are a well-established risk factor for overweight and obesity. Adolescents with obesity are more likely to follow unhealthy eating behaviors, including consuming excessive amounts of high-calorie, low-nutrient foods such as fast food and sweets [18]. Proper nutrition is crucial during adolescence. The appropriate hours for consuming meals and their quantity are important, as is the way the meals are prepared. It is recommended to eat large amounts of fruit and vegetables rich in fibre and products containing fatty acids, thus eliminating simple sugars and table salt in food [27,28,29]. This has been documented in various studies, including those by Zi臋ba-Ko艂odziej, Matecka, and Orkusz and Babiarz, which highlight the low intake of fruits and vegetables and the frequent consumption of fast food among adolescents [23, 30,31,32,33]. In line with these studies, our findings show that 78% of overweight or obese adolescents consume fast food regularly, and they are also more likely to eat irregularly (56%). These patterns suggest the need for targeted nutritional interventions that promote balanced eating habits from an early age.

Physical inactivity is another major factor contributing to obesity, exacerbated by the increasing use of computers, the internet, and other screen-based entertainment [34]. Previous studies indicate a growing trend of sedentary behaviors among children and adolescents, as reflected in research by the Central Statistical Office and others, showing a significant portion of adolescents spending hours in front of screens [18, 33, 35, 36]. Corroborating evidence from other studies indicates that children with obesity tend to exhibit lower levels of physical activity compared to their non-obese counterparts. Declining exercise levels and increasingly sedentary lifestyles are recognized contributors to the development of obesity. Furthermore, it has been observed that engaging in computer gaming for more than two hours daily is associated with an elevated risk of overweight, with time spent watching television also demonstrating a positive correlation. Screen exposure may augment the risk of obesity due to increased exposure to food marketing, a greater incidence of mindless eating during viewing, the displacement of time allocated to physical activity, the reinforcement of sedentary behavior, and the curtailment of sleep duration [26]. This is consistent with our research, which shows that adolescents with excess body weight tend to avoid physical activity, with 59% citing lack of motivation as the main reason for inactivity. Additionally, societal pressures and negative body image, as highlighted by Rynkowska and Kolarczyk, can further reduce the inclination of obese adolescents to participate in physical activities [37,38,39].

The psychosocial consequences of obesity in children and adolescents are severe, often leading to issues such as low self-esteem, social isolation, and increased risk of mental health problems. Research by Jo艣ko-Ochojska and others points to the discrimination, ridicule, and bullying faced by obese children, which contributes to withdrawal and a diminished sense of self-worth [18, 40, 41]. In our study, we observed that non-overweight adolescents were more likely to report feeling happy (63%) and accepting their appearance (66%), whereas overweight or obese adolescents were less likely to be happy (41%) and struggled with self-acceptance (38%).

The role of parents is critical in shaping the health behaviors of their children, as children often model their behavior on what they observe at home. Numerous studies emphasize the importance of parents in providing both the example and environment for healthy living. Parents who lead a healthy lifestyle and educate their children on proper nutrition and physical activity are more likely to raise children with healthy habits [33, 42,43,44]. Conversely, poor parental eating habits, such as providing unhealthy, high-calorie foods, can contribute to the development of obesity in children. Our findings support these conclusions, reinforcing the need for family-centered interventions to prevent childhood obesity.

Given the multifactorial nature of obesity, a comprehensive approach to prevention is essential. This should include education for both children and parents, promoting a healthy lifestyle that combines balanced nutrition with regular physical activity. Screening programs for unhealthy dietary patterns and excessive weight gain should be implemented early to ensure timely intervention. Moreover, advanced cases of obesity may require multidisciplinary care, including medical, nutritional, psychological, and physiotherapeutic support.

Conclusion: Efforts to combat childhood obesity should focus not only on the individual but also on the family unit and broader social influences. Preventive measures that promote healthy behaviors, both in terms of nutrition and physical activity, should be reinforced at every stage of child development, with special attention given to the home environment where lifestyle habits are formed.

Strengths and limitations of the study

The main limitation of this study is the small sample size, which consisted of volunteers and may not have been representative of the general population. Although a larger sample would have been more representative, the number of participants included in the study was adequate to detect even relatively small effects. The use of convenience sampling, although practical, limits the ability to generalize the findings. A significant limitation of this study was the non-random sampling method employed. That approach facilitated a relatively rapid selection of a highly representative sample, particularly given the small target population of our study and the inclusion of a control group, and conferred cost-effectiveness by obviating the need for a random selection process, it introduced certain caveats. Specifically, it resulted in a limited sample size, which consequently compromises the statistical power of the study and may impede the detection of statistically significant differences or associations. Furthermore, the findings of this study lack generalizability to broader populations.

In addition, multiple determinants were tested, but no correction for multiple testing was made. This is an important limitation of the study, and future studies should consider applying corrections for multiple comparisons to reduce the risk of Type I errors. The study also has strengths, including the comparison with a control group and the assessment of the healthy behaviours of the children鈥檚 parents.

Conclusions

• 1. The growing problem of childhood and adolescent obesity can be slowed if society focuses on the causes. Obesity is influenced by many factors, some of which are more significant than others. A combined diet and physical activity intervention for children and adolescents may be more effective in preventing overweight and obesity.

• 2. The level of knowledge and attitude of parents is crucial for shaping eating habits and a healthy lifestyle in children. Parents who promote healthy eating habits and physical activity can significantly reduce the risk of overweight and obesity in their children, contributing to their healthy development. Mutual motivation and education can be key factors in the success of the whole family in changing their lifestyle.