Author(s): ZHANG, Y., CHEN, J., Institution: CHINA INSTITUTE OF SPORT SCIENCE, Country: CHINA, Abstract-ID: 739

INTRODUCTION:
The rising prevalence of overweight and obesity among children and adolescents has become a major public health concern. Urbanization and lifestyle transitions may contribute to unfavorable physical activity and dietary behaviors, increasing obesity risk. However, long-term trend data in rapidly urbanizing regions remain limited. This study aimed to examine temporal trends in overweight and obesity among children and adolescents in Macao from 2005 to 2025 and to identify key behavioral factors associated with excess weight, focusing on physical activity and breakfast consumption.
METHODS:
A repeated cross-sectional design was applied using data from the Macao Citizen Physical Fitness Surveillance System conducted in 2005, 2010, 2015, 2020, and 2025. A total of 25,717 participants aged 6–18 years were included. Overweight and obesity were defined using age- and sex-specific criteria. Descriptive analyses were used to estimate prevalence across survey years. Logistic regression models assessed temporal trends in overweight and obesity. Chi-square tests identified potential associated factors. Variables with statistical significance were entered into multivariable logistic regression models adjusting for age and sex to examine associations between extracurricular physical activity frequency, physical activity intensity, breakfast consumption frequency, and overweight/obesity.
RESULTS:
From 2005 to 2025, the prevalence of overweight and obesity among children and adolescents in Macao increased significantly, with a steady rise in risk over time (OR = 1.022 per year, 95% CI: 1.018–1.027; P for trend < 0.001). The increasing trend was more pronounced among boys than girls. Univariate analyses indicated that age, sex, extracurricular physical activity frequency, physical activity intensity, and breakfast consumption frequency were significantly associated with overweight and obesity (all P < 0.05). In multivariable analyses, girls had lower risks of overweight (OR = 0.55, P < 0.01) and obesity (OR = 0.40, P < 0.01) compared with boys. Insufficient physical activity intensity was associated with increased risks of overweight (OR = 1.56, P < 0.01) and obesity (OR = 2.33, P < 0.01). Participants engaging in extracurricular physical activity ≤2 days per week showed approximately twofold higher risks of overweight and obesity (OR range: 2.01–2.20, P < 0.01). Lower breakfast consumption frequency was independently associated with a higher risk of obesity (OR range: 1.58–1.79, P < 0.01).
CONCLUSION:
Overweight and obesity among children and adolescents in Macao increased substantially from 2005 to 2025, with higher risks in boys. Insufficient extracurricular physical activity, low activity intensity, and irregular breakfast consumption were key modifiable risk factors. These findings highlight the need for targeted school- and community-based interventions to promote regular physical activity and healthy eating behaviors, especially during childhood and adolescence.