Screen time is associated with metabolic complications in children with obesity independently of adiposity and sleep

<title>Abstract</title> <p>Recreational screen time is linked to childhood obesity and cardiometabolic risk, but whether its association with metabolic complications operates through adiposity or sleep is unclear. In a single-visit cross-sectional study of 131 children (3–18 years) with overweight or obesity at a Gansu maternal and child-care hospital, obesity-related metabolic complications (ORMC) increased monotonically with screen time (25.3% at &lt; = 1 h/day, 56.3% at &gt; = 2 h/day), with an adjusted odds ratio of 3.87 (95% CI 1.17–12.82) for &gt; = 2 versus &lt; 2 h/day. The association persisted after adjustment for age, sex and sleep insufficiency and strengthened after adjusting for body fat percentage, and bootstrap mediation analysis excluded indirect effects through sleep or adiposity. Screen time is independently associated with metabolic complications in children with obesity, supporting screen-time limits in paediatric clinics irrespective of weight trajectory.</p>