Lifestyle correlates of overweight in adults: a hierarchical approach (the SPOTLIGHT project).
Obesity-related lifestyle behaviors usually co-exist but few studies have examined their simultaneous relation with body weight. This study aimed to identify the hierarchy of lifestyle-related behaviors associated with being overweight in adults, and to examine subgroups so identified.



Data were obtained from a cross-sectional survey conducted across 60 urban neighborhoods in 5 European urban regions between February and September 2014. Data on socio-demographics, physical activity, sedentary behaviors, eating habits, smoking, alcohol consumption, and sleep duration were collected by questionnaire. Participants also reported their weight and height. A recursive partitioning tree approach (CART) was applied to identify both main correlates of overweight and lifestyle subgroups.



In 5295 adults, mean (SD) body mass index (BMI) was 25.2 (4.5) kg/m2, and 46.0 % were overweight (BMI ≥25 kg/m2). CART analysis showed that among all lifestyle-related behaviors examined, the first identified correlate was sitting time while watching television, followed by smoking status. Different combinations of lifestyle-related behaviors (prolonged daily television viewing, former smoking, short sleep, lower vegetable consumption, and lower physical activity) were associated with a higher likelihood of being overweight, revealing 10 subgroups. Members of four subgroups with overweight prevalence >50 % were mainly males, older adults, with lower education, and living in greener neighborhoods with low residential density.



Sedentary behavior while watching television was identified as the most important correlate of being overweight. Delineating the hierarchy of correlates provides a better understanding of lifestyle-related behavior combinations which may assist in targeting preventative strategies aimed at tackling obesity.
Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017, France.
Célina
C
Roda
Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017, France.|Université Paris-Est, Lab-Urba, Créteil, France.
Hélène
H
Charreire
Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017, France.
Thierry
T
Feuillet
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Joreintje D
JD
Mackenbach
Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Sofie
S
Compernolle
ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK.
Ketevan
K
Glonti
Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
Helga
H
Bárdos
ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK.
Harry
H
Rutter
ECOHOST - The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK.
Martin
M
McKee
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Johannes
J
Brug
Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Ilse
I
De Bourdeaudhuij
Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Jeroen
J
Lakerveld
Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017, France. jean-michel.oppert@aphp.fr.|Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 06, Institute of Cardiometabolism and Nutrition, Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. jean-michel.oppert@aphp.fr.
Jean-Michel
0000-0003-0324-4820
JM
Oppert
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D057185:Sedentary Behavior; D012890:Sleep; D012907:Smoking; D012959:Socioeconomic Factors; D013690:Television; D014505:Urban Population; D055815:Young Adult
CART; Eating habits; Lifestyle-related behaviors; Obesity; Physical activity; Sedentary behavior; Sleep; Smoking status; Television viewing