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Sizing the association between lifestyle behaviours and fatness in a large, heterogeneous sample of youth of multiple ethnicities from 4 countries

John D Sluyter1, Robert KR Scragg2*, Lindsay D Plank3, Gade D Waqa4, Kalesita F Fotu5 and Boyd A Swinburn26

Author Affiliations

1 Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand

2 Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand

3 Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand

4 Fiji School of Medicine, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji

5 Tonga Health Systems Support Program, Ministry of Health, Nuku’alofa, Tonga

6 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia

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International Journal of Behavioral Nutrition and Physical Activity 2013, 10:115  doi:10.1186/1479-5868-10-115

Published: 12 October 2013



The magnitude of the relationship between lifestyle risk factors for obesity and adiposity is not clear. The aim of this study was to clarify this in order to determine the level of importance of lifestyle factors in obesity aetiology.


A cross-sectional analysis was carried out on data on youth who were not trying to change weight (n = 5714), aged 12 to 22 years and from 8 ethnic groups living in New Zealand, Australia, Fiji and Tonga. Demographic and lifestyle data were measured by questionnaires. Fatness was measured by body mass index (BMI), BMI z-score and bioimpedance analysis, which was used to estimate percent body fat and total fat mass (TFM). Associations between lifestyle and body composition variables were examined using linear regression and forest plots.


TV watching was positively related to fatness in a dose-dependent manner. Strong, dose-dependent associations were observed between fatness and soft drink consumption (positive relationship), breakfast consumption (inverse relationship) and after-school physical activity (inverse relationship). Breakfast consumption-fatness associations varied in size across ethnic groups. Lifestyle risk factors for obesity were associated with percentage differences in body composition variables that were greatest for TFM and smallest for BMI.


Lifestyle factors were most strongly related to TFM, which suggests that studies that use BMI alone to quantify fatness underestimate the full effect of lifestyle on adiposity. This study clarifies the size of lifestyle-fatness relationships observed in previous studies.

Television; Soft drink; Breakfast; Physical activity; Obesity; Meta-analysis