Age-specific effects of screen time on overweight/obese: a structural equation model of children and adolescents in Western Maharashtra, India.

Background: The rapid increase in digital technology use has led to unprecedented screen time levels among children and adolescents, raising concerns about overweight/obesity, especially in urban settings. Despite growing global evidence, limited data exists for Indian cities like Pune. Objectives: This cross-sectional study assessed the relationship between screen time duration and overweight/obesity in children's (6-11 years) and adolescents (12-19 years) in Pune, India, accounting for dietary patterns, physical activity, and sociodemographic factors. Methods: A sample of 3,920 students from urban Pune schools was evaluated for screen time, physical activity, diet, BMI, and sociodemographic variables. Multinomial logistic regression and structural equation modeling identified associations between these factors and overweight/obesity, stratified by age groups (6-11 and 12-19 years). Results: Overweight/obesity prevalence was 27.1%. Excessive screen time was strongly associated with higher overweight and obesity risk. Children with 2-4 h daily screen time had 35.69 times higher Adj. OR (p < 0.001), and those exceeding 4 h had 28.80 times higher Adj. OR (p < 0.001). Among children's (6-11 years), 2-4 h increased Adj. OR by 88.58 times (p < 0.001) and over 4 h by 69.45 times (p < 0.001). In adolescents (12-19 years), 2-4 h increased Adj. OR by 11.88 times (p < 0.001) and over 4 h by 9.22 times (p < 0.001). Conclusion: High screen time is a major modifiable risk factor for obesity among urban children and adolescents in Pune. Age-specific and family-centered interventions targeting reduced screen time and improved physical activity are urgently needed for effective obesity prevention and health promotion.