Adolescents with At‐Risk Eating and Lifestyle Behaviors are Impacted by After‐school Schedules across the Clinical Weight Spectrum
Authors: Perez Leanna , Miller Carla K. , Groner Judith A. 
Published: November 2023

Effective interventions for pediatric obesity begin with knowledge of adolescent behavioral patterns. The objective of this study was to gain a comprehensive understanding of the lifestyle choices of adolescents to develop more effective healthcare guidance and identify windows of opportunity to intervene. The Meal Pattern Timeline (MPT), an innovative dietary assessment tool, was used to measure adolescent eating and lifestyle habits.

Forty‐four adolescents aged 13–18 years were recruited from employees and patients at outpatient pediatric clinics, including a clinic for obesity treatment. Purposive sampling was used to recruit adolescents at both ends of the weight spectrum to better ensure variation in lifestyle and dietary patterns were captured. Pediatric clinical weight categories are based on a body mass index (BMI) percentile, with the 95th to 99th percentiles considered “clinically obese”, and the 5th to 85thpercentiles considered “clinically normal/healthy weight.”

Participants completed an interview using the MPT and responses were recorded on a horizontal timeline labeled with a 24‐hour cycle. The interview included questions about habitual diet, sleep patterns, school schedule, extra‐curricular activities, and family dining patterns. Times, frequency, locations and sources of meals and snacks, food preparation, and dining patterns were recorded. The Block Kids 2004 Food Frequency Questionnaire (FFQ) was also administered to quantify dietary intake.

Qualitative data were analyzed using standardized codes generated from the interviews. Variables were created and used to discern differences in after‐school lifestyle patterns, resulting in four groups: “Idle, Engaged, Balanced, and Working” adolescents. Matrices were constructed to determine common meal patterns for each group.

The “Engaged” adolescents participated in several physical or extra‐curricular activities for the majority of their after‐school hours. “Balanced” adolescents participated in a single physical or extra‐curricular activity followed by sedentary time in the evening. “Balanced” adolescents consumed meals on a consistent basis and often snacked after dinner. “Idle” adolescents had the highest sedentary time, sometimes napping, and often snacked after dinner. “Working” adolescents had the lowest amount of sedentary time and sleep, and were the least consistent with eating meals. “Working” adolescents often substituted a meal with a snack.

BMI percentile was not a driving variable in categorizing subgroups. No differences were found among groups for total energy intake or nutrient composition. However, sugar sweetened beverage intake was significantly different among groups, with the “Working” group reporting the highest intake of sugar sweetened beverages (median intake 830.25g/day; p=0.03).

Each group demonstrated at‐risk behaviors for obesity (e.g., prolonged sedentary time, high sugar/fat snack consumption, and limited meal frequency). Future interventions for pediatric obesity should use lifestyle and meal pattern assessments to identify those at risk for obesity, not simply weight status, to create tailored interventions based on differing patterns.