International Journal of Environmental Research and Public Health Article Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy Stefania Paduano 1,* , Antonella Greco 2, Lucia Borsari 2, Chiara Salvia 3, Stefano Tancredi 1, Jenny Pinca 4, Simona Midili 4, Alberto Tripodi 4, Paola Borella 1 and Isabella Marchesi 1 1 Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy; [email protected] (S.T.); [email protected] (P.B.); [email protected] (I.M.) 2 Department of Public Health, AUSL Modena, 41126 Modena, Italy; [email protected] (A.G.); [email protected] (L.B.) 3 Primary Care Health Authority and Services, AUSL Modena, 41124 Modena, Italy; [email protected] 4 Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, 41126 Modena, Italy; [email protected] (J.P.); [email protected] (S.M.); [email protected] (A.T.) * Correspondence: [email protected]; Tel.: +39-059-205-5472 Abstract: Children obesity is a serious public health issue. This study aimed to investigate physi- Citation: Paduano, S.; Greco, A.; cal/sedentary activities of first-year primary schools children in Modena, and their association with Borsari, L.; Salvia, C.; Tancredi, S.; overweight/obesity and dietary habits of children and family characteristics to identify the risk Pinca, J.; Midili, S.; Tripodi, A.; factors for unhealthy lifestyles. Child physical/sedentary activities were gathered through an anony- Borella, P.; Marchesi, I. Physical and mous questionnaire administered to parents, as well as family characteristics and weight/height of Sedentary Activities and Childhood child and parents. Logistic regression models, eventually adjusted for parents’ sociodemographic Overweight/Obesity: A Cross- characteristics, were used to analyze data. Questionnaires were delivered by 660 families (74.2%), of Sectional Study among First-Year which 72 without anthropometric data were excluded. Three out of four children spent in physical Children of Primary Schools in Modena, Italy. Int. J. Environ. Res. activities less than 7 h/week, while 63.9% dedicated to sedentary activities two or more hours/day. Public Health 2021, 18, 3221. https:// From multivariate analysis, the habit significantly affecting children’s overweight/obesity was spend- doi.org/10.3390/ijerph18063221 ing time on tablets/Personal Computers/mobile phones/videogames. Higher parental education level resulted in a protective factor for implementing unhealthy lifestyles in terms of time dedicated Academic Editors: Hanna Nał˛ecz, to physical/sedentary activities. Our results suggest the need of interventions to increase time for Talita Honorato-Rzeszewicz and physical activity and to promote a responsible use of digital media involving the entire families Ida Lauda´nska-Krzemi´nska to reach all parents regardless of their education and nationality with a possible relapse on other family members. Received: 8 February 2021 Accepted: 18 March 2021 Keywords: physical activity; sedentary behaviours; childhood overweight/obesity; parental educa- Published: 20 March 2021 tion; lifestyle Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- 1. Introduction iations. Worldwide, childhood obesity has increased 10 times in the last 40 years, and it is considered a serious public health issue [1–3]. In the 19 countries that participated in the European Childhood Obesity Surveillance Initiative (COSI), the prevalence of overweight children among 6–9-year-old age group ranged 18–52% in boys and 13–43% in girls and that Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. of obesity ranged 6–28% among boys and 4–20% among girls [4]; in many countries 1 out This article is an open access article of 4 obese children are severely obese [5]. Some physical and psychosocial complications distributed under the terms and are already present in obese children and tend to worsen in adulthood. Indeed, obese conditions of the Creative Commons children are likely to become obese adult and are at risk of various chronic diseases [1,6,7]. Attribution (CC BY) license (https:// Therefore, childhood obesity prevention is a priority for public health policies. creativecommons.org/licenses/by/ In Italy, a surveillance system named “Okkio alla Salute” was created in 2007 with the 4.0/). aim to evaluate childhood overweight/obesity trend among 8–9-year-old children and the Int. J. Environ. Res. Public Health 2021, 18, 3221. https://doi.org/10.3390/ijerph18063221 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 3221 2 of 13 associated modifiable behaviors [8]. The 2019 data show that the prevalence of overweight children in primary school is still 20.4% and obese is 9.4% [8]. Being overweight in school-age children is a condition associated to several determi- nants. Living in an obesogenic environment promotes high caloric consumption, such as increasing use of sugar-sweetened beverages and sweet snacks, poor physical activity and excessive use of screens [9–11]. Aside from eating habits, total screen time, e.g., television or computer time, is related to childhood overweight and obesity, some studies demon- strated that time dedicated to physical activity does not compensate the adverse effects of screen time [12–14]. The TV in children’s bedrooms has been related to overweight risk [9]. In addition, several studies have shown that excessive screen time negatively affects children’s dietary habits, leading mostly to poor nutrition food choices and a lower consumption of fibre and fruit [15]. Moreover, TV advertisement can favorite an increase in food intake [14–16]. Therefore, it is fundamental that children achieve a balance between calories intake and energy expenditure by appropriate dietary intake, physical activity and reduced total screen time. These changes should affect not only the child, but also the whole family. For 6 year-old children, WHO suggests at least 60 min of moderate-to-vigorous physical activity per day including strengthen muscle and bone exercises three times per week [17,18]. The Italian Society of Pediatrics and Italian Society of Pediatric Endocrinology and Diabetology recommend to limit screen time to 2 h a day or less [19]. A systematic literature review shows that in Europe less than 50% of children and adolescents comply with physical activity recommendations, regardless of methods of measurement, with great variability among countries [20]. Italy is among the nations with less adherence to these guidelines, with only 13% of 11 years-old children adhering to such guidelines [20]. An increase of sedentary behaviors and a decline of physical activity is recorded between 6 and 11 years of age [21]. The HBSC (Health Behavior in School-aged Children) study demonstrated that this trend continues also during adolescence: a decline of moderate-to-vigorous physical activity was observed with an increase of screen activities such as watching television and using other devices [22]. For a long time in Modena, Northern Italy, a community-based health initiative has been active in promoting healthy lifestyles amongst children attending primary schools [23–25]. Within this project, we conducted a study through an anonymous ad hoc questionnaire administered to the parents to investigate the lifestyles among children attending the first year of primary school. The main aims of this study were to inves- tigate time dedicated to physical and sedentary activities and its association with over- weight/obesity and dietary habits of children and to identify the family characteristics influencing children lifestyles. 2. Materials and Methods 2.1. Study Design In 2018, a cross sectional study was conducted among first-year children (aged 6–7 years) attending the state primary schools in Modena Municipality. The schools’ participation in the initiative was on voluntary basis. Fifteen out of 27 primary schools, for a total of 890 children attending 38 first-year classes participated to the study without any exclusion criteria. 2.2. Data Collection Parents were required to fill out a self-administered questionnaire, accompanied by a participant information sheet and a consent form. The participation was on voluntary basis and data were collected anonymously. The Emilia Ethics Committee (called “Area vasta Emilia Nord”), our reference for on field studies, was consulted for the approval of the study. It allowed the start-up, since the returned questionnaires anonymous, and delivered in a sealed envelope, without any reference to the school and the compiler as well. Int. J. Environ. Res. Public Health 2021, 18, 3221 3 of 13 The questionnaire consisted of three parts. The first part was about the socio- demographic characteristics of each child (sex, month and year of birth,) and their par- ents (year/place of birth, education level, nationality), the anthropometric measurements (weight and height) of both children and parents. The second section collected the chil- dren’s eating habits, such as daily consumption of breakfast and mid-morning snack, fruits and vegetables, carbonated or sugary drinks. The third part gathered data on the children’s lifestyles: days per week (at least one hour/day) spent in organized or non-organized physical activities, hours per week spent in all physical activities (sports + games) and hours per day spent in sedentary activities (watching TV, gaming on tablets, PCs (Personal Computers) and mobile phones) and if there is a TV in the child’s bedroom. In addition, information was collected about how children go to school (walk, bicycle, car or bus). From 2020 WHO guideline, sports cover a range of activities performed within a set of rules and undertaken as part of leisure or competition [18]. Sporting activities involve physical activity carried out by teams or individuals and may be supported by an institu- tional framework, such as a sporting agency.