Screen-based sedentary behavior and BMI among Chinese adolescents: weight concern as a mediator moderated by body image perception

Abstract Objective Screen-based sedentary behavior (SB) is associated with elevated BMI; however, the underlying mechanisms remain poorly understood. This study investigates the mediating role of weight concern in the SB-BMI relationship and examines how body image perception and gender moderate thi...

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Main Authors: Shuoyuan Tan, Libo Zhou, Gulqihra Abdukerima, Wei Yin, Ning Chen, Ling Yuan, Ya Gao, Pauline Sung-Chan Po Lin, Zhaoxin Wang, Jianwei Shi
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-22367-2
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Summary:Abstract Objective Screen-based sedentary behavior (SB) is associated with elevated BMI; however, the underlying mechanisms remain poorly understood. This study investigates the mediating role of weight concern in the SB-BMI relationship and examines how body image perception and gender moderate this mediation. By focusing on body image as a critical contextual factor, the study aims to inform targeted interventions for adolescent obesity and overweight. Methods In 2016, self-report questionnaires assessing screen-based SB, weight concern, and body image perception were collected from 508 Chinese adolescents (grades 7–9), yielding 438 valid responses (response rate: 86.22%). Path analysis and bootstrap procedures with bias-corrected 95% confidence intervals were used for data analysis. Results Screen-based SB was positively associated with weight concern (b = 1.115, p = 0.009) and BMI (b = 0.183, p < 0.001). The mediation analysis showed that weight concern partially mediated this relationship, with an indirect effect of 0.056 (95% CI = [0.006, 0.114]). This mediation was moderated by body image perception and gender. Specifically, the interaction between BMI overestimation and weight concern was negatively associated with BMI (b=-0.157, p = 0.011), whereas the three-way interaction of gender, weight concern, and overestimated body image perception showed a positive association with BMI (b = 0.080, p = 0.025). Conclusions Screen-based SB influences BMI, with weight concern as a mediator and body image perception and gender as moderators. These findings highlight the importance of targeting sedentary behavior and body image concerns in gender-sensitive interventions for adolescents.
ISSN:1471-2458