{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T21:17:34Z","timestamp":1787174254372,"version":"build-2736575974"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec017\">\n<jats:title>Background<\/jats:title>\n<jats:p>Childhood obesity poses a significant public health challenge, yet effective school-based physical activity (PA) interventions remain scarce, especially in Pakistan. There is a lack of data assessing the impact of such interventions on obesity and related health outcomes in Pakistani school children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec018\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This study aimed to design and implement a school-based intervention targeting multiple levels of the socio-ecological model to increase physical activity and reduce the prevalence of overweight and obesity in Pakistani youth. Conducted from October 2022 to January 2023 in Lahore, Pakistan, the 12-week, non-randomized controlled trial involved 1,200 students from eight schools, with four schools (n\u2009=\u2009570) in the intervention group and four (n\u2009=\u2009630) in the control group. Primary outcomes included changes in body mass index (BMI), waist circumference, and the prevalence of overweight\/obesity, measured through anthropometric assessments. Secondary outcomes involved alterations in moderate-to-vigorous physical activity duration. Descriptive statistics, Chi-square tests, general linear mixed models, and repeated measures ANOVA were used for analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec019\">\n<jats:title>Results<\/jats:title>\n<jats:p>The intervention showed significant improvements across various socio-ecological levels. Intrapersonal factors saw a reduction in fast food consumption from 11.9% to 7.9% (F<jats:sub>(1,1198)<\/jats:sub>\u2009=\u200990.39, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; \u03b7\u00b2\u2009=\u20090.074) and an increase in physical activity frequency from 11.9% to 39.6% (F<jats:sub>(1,1198)<\/jats:sub>\u2009=\u2009465.25, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; \u03b7\u00b2\u2009=\u20090.028). Screen time decreased from 27.0% to 7.4% (F<jats:sub>(1,1198)<\/jats:sub>\u2009=\u2009219.83, <jats:italic>p<\/jats:italic>\u2009=\u20090.015; \u03b7\u00b2\u2009=\u20090.15), and normal sleep duration increased from 44.6% to 71.8% (F(<jats:sub>1,1198)<\/jats:sub>\u2009=\u2009242.73, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; \u03b7\u00b2\u2009=\u20090.16). At the interpersonal level, parental involvement in encouraging sports and providing financial support for sports activities significantly increased. School-level factors also showed positive changes, including improved sports facilities and equipment access. Community-level factors revealed increased opportunities for physical activity and a more supportive community environment. The intervention group\u2019s BMI change (\u22120.06\u2009\u00b1\u20090.07 kg\u00b7m\u00b2) significantly differed from the control group\u2019s (0.19\u2009\u00b1\u20090.09 kg\u00b7m\u00b2).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec020\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study demonstrates the effectiveness of a multi-level intervention in boosting physical activity and addressing obesity among Pakistani school-aged children, supporting the implementation of similar school-based interventions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317534","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T18:37:37Z","timestamp":1740422257000},"page":"e0317534","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effectiveness of a school-based physical activity intervention on overweight and obesity among children and adolescents in Pakistan"],"prefix":"10.1371","volume":"20","author":[{"given":"Moazzam","family":"Tanveer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejaz","family":"Asghar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgian","family":"Badicu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0844-1284","authenticated-orcid":true,"given":"Alexios","family":"Batrakoulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umar","family":"Tanveer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2175-2765","authenticated-orcid":true,"given":"Serge","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus Santos","family":"de Sousa Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7677-5070","authenticated-orcid":true,"given":"Luca Paolo","family":"Ardig\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"issue":"1","key":"pone.0317534.ref001","doi-asserted-by":"crossref","first-page":"e12698","DOI":"10.1111\/ijpo.12698","article-title":"Beyond sleep duration: Sleep timing as a risk factor for childhood obesity","volume":"16","author":"HF Skj\u00e5k\u00f8deg\u00e5rd","year":"2021","journal-title":"Pediatric Obesity"},{"issue":"4","key":"pone.0317534.ref002","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.jshs.2017.09.002","article-title":"Overweight, obesity, and screen-time viewing among Chinese school-aged children: National prevalence estimates 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