From leadership research to district action: Associations of School-Level Factors and School Sport Facility Parameters with Overweight and Obesity among Children and Adolescents in Pakistan: An Empirical Cross-Sectional Study

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Childhood overweight and obesity are increasingly prevalent in Pakistan, posing significant public health challenges. This study explores the associations of school-level factors and school sports facility parameters with overweight and obesity among children and adolescents in Pakistan. A cross-sectional study across seven random districts in Punjab province, Pakistan, was conducted using a representative multistage random cluster sample. Underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria. Statistical analyses including the Chi-square test, Pearson correlation coefficient, and linear regression were performed to investigate predictive characteristics. Logistic regression analysis assessed the simultaneous impact of several covariates on dichotomous outcomes, with 95% confidence intervals (CIs) computed and a significance level set at p < 0.05. The study included 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. The prevalence of overweight and obesity was 19.4% and 10.7%, respectively. Findings revealed a concerning lack of physical education activities (60% reported 0 sessions per week), morning exercise (60%), and classroom exercises (66%) among school-aged children. Leadership attitudes toward physical education (β = 0.04, p = 0.006) and students’ satisfaction with the playground (β = 0.05, p = 0.015) showed significant associations with body weight status. Conversely, provision of physical education facilities, effective fund utilization for physical education, meeting school sports facility requirements, and weekend opening of school sports grounds did not significantly impact weight status. Satisfaction with the playground was significantly associated with a lower risk of overweight (OR 0.81, 95% CI 0.69–0.95, p < 0.05), indicating reduced overweight likelihood among students satisfied with school playgrounds. The study underscores significant gaps in promoting physical activity within school environments and highlights the urgent need for interventions to enhance physical education resources and sports facilities, aiming to create healthier school environments and reduce overweight and obesity prevalence among students. Further research and interventions are crucial for promoting lifelong physical activity habits and improving student health and well-being. Keywords: overweight and obesity, classroom exercise, sport facility, physical activity support, physical education activities, cross-sectional study

Study methods

In the summer of 2023, a population-based cross-sectional study was conducted among school-going children and adolescents aged 9 to 17 years in seven randomly selected districts of the Punjab region, Pakistan. A stratified multistage random cluster sampling method was employed to enroll a total of 4200 school-aged children and adolescents from 62 schools located in Lahore, Gujranwala, Gujrat, Sheikhupura, Narowal, Hafizabad, and Sialkot. Among the invited students, 4108 students (97.80%) completed useful questionnaires, while 92 students (2.2%) were disqualified due to insufficient information. Children aged 9–11 years old and adolescents aged 12–17 years old were sampled from grades 4 to 12, excluding grades 1 to 3 due to their inability to complete the study questionnaire [13]. Public schools were selected following approval from the Punjab School Education Department, which issued permission letters. Private school administrations independently granted permission upon visitation. The Punjab School Education Department (https://sis.punjab.gov.pk/, accessed on 23 December 2022) provided a list of schools from both urban and rural areas. A nominal fee of PKR 20 was charged in public schools, while private schools were charged PKR 10,000.00 to account for potential socioeconomic disparities. In instances where a school declined to participate, another institution was randomly selected [15]. The survey also involved collaboration from the Education and Rescue 1122 Departments, which volunteered to participate.

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Moazzam Tanveer; Ejaz Asghar; Georgian Badicu; Umar Tanveer; Nadeem Roy; Asifa Zeba; Sameer Badri Al-Mhanna; Alexios Batrakoulis. Associations of School-Level Factors and School Sport Facility Parameters with Overweight and Obesity among Children and Adolescents in Pakistan: An Empirical Cross-Sectional Study. Sports (2024-08-28). https://doi.org/10.3390/sports12090235

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.