Adherence With Multiple National Healthy Lifestyle Recommendations in a Large Pediatric Center Electronic Health Record and Reduced Risk of Obesity

Mayo Clin Proc. 2018 Sep;93(9):1247-1255. doi: 10.1016/j.mayocp.2018.04.020. Epub 2018 Jul 27.


Objective: To evaluate the utility of a routine assessment of lifestyle behaviors incorporated into the electronic health record (EHR) to quantify lifestyle practices and obesity risk at a pediatric primary care center.

Patients and methods: Participants included 24,255 patients aged 2 to 18 years whose parent/caregiver completed a self-report lifestyle assessment during a well-child examination (January 1, 2013, through June 30, 2016). Cross-sectional analyses of age, race/ethnicity, body mass index, and lifestyle assessment responses were performed. Outcome measures included prevalence of patients meeting consensus recommendations for physical activity; screen time; and dairy, water, and fruit/vegetable consumption and the odds of obesity based on reported lifestyle behaviors.

Results: Prevalence of meeting recommendations for lifestyle behaviors was highest for physical activity (84%), followed by screen time (61%) and consumption of water (51%), dairy (27%), and fruits/vegetables (10%). Insufficient physical activity was the strongest predictor of obesity (odds ratio [OR], 1.65; 95% CI, 1.51-1.79), followed by excess screen time (OR, 1.36; 95% CI, 1.27-1.45). Disparities existed across ages, races/ethnicities, and sexes for multiple lifestyle habits. Youth who met 0 or 1 lifestyle recommendation were 1.45 to 1.71 times more likely to have obesity than those meeting all 5 recommendations.

Conclusion: Healthy behaviors vary in prevalence, as does their association with obesity. This variation is partially explained by age, sex, and race/ethnicity. Meeting national recommendations for specific behaviors is negatively associated with obesity in a dose-dependent manner. These findings support the assessment of lifestyle behaviors in primary care as one component of multilevel initiatives to prevent childhood obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Electronic Health Records
  • Female
  • Health Behavior*
  • Healthy Lifestyle*
  • Humans
  • Male
  • Patient Compliance / statistics & numerical data*
  • Pediatric Obesity / etiology
  • Pediatric Obesity / prevention & control*
  • Pediatric Obesity / psychology
  • Primary Health Care
  • Protective Factors
  • Risk Factors
  • Self Report