There is a clinical need to consider the physical activity - sedentary pattern in children with obesity. Position paper of the European Childhood Obesity Group.

INTRODUCTION: While international prevention guidelines recently advocated, in addition to moderate and vigorous physical activity (MVPA) guidelines, for a minimization of sedentary time (SED), recommendations remain to be developed for youths with obesity.

METHODS: A literature search was conducted in PubMed, the Cochrane Library plus the reference lists of selected articles for relevant publications in English, including original papers, systematic reviews, and meta-analyses, with search terms "sedentary behaviors" or "sedentary time" or "screen time" AND "children" or "adolescents" AND "obesity" or "adiposity" or "cardiometabolic risk" or "cardiometabolic disease". The results were summarized as a narrative review and presented to the scientific board of the European Childhood Obesity Group (ECOG) who then discussed their implication in clinical practice and proposed the position outlined in this paper.

RESULTS: SED and screen times are associated with adiposity and cardiometabolic risks independently of youths' physical activity level. Besides considering MVPA and SED times as separate variables, comprehensive studies have questioned the impact of different patterns of MVPA and SED levels. Although lower body adiposity and better cardiometabolic health are achieved among those with desirable movement behaviors patterns (i.e., more MVPA/less SED or active/not sedentary), youths with intermediate patterns (i.e., high MVPA/high SED and low MVPA/low SED, or active /sedentary and inactive/not sedentary) have been found to be associated with intermediate risks.

CONCLUSION: There is a need to decrease SED behaviors irrespective of MVPA and to consider PA-SED patterns in youths with obesity. The European Childhood Obesity Group (ECOG) encourages anti-obesity strategies targeting both physical activity (PA) and SED behaviors to support the shift from long periods of SED time, especially screen time, to daily routines incorporating bouts of PA. Stepwise or sequential approaches to movement behavior counseling might start with targeting SED at first to decrease cardiometabolic risks when implementing MVPA is not yet possible.