Objective To explore relationship between attainment of the 24 hour movement guidelines and longitudinal changes in generalized and central obesity in primary school students.

Methods A two-year longitudinal survey was conducted on 318 third-grade primary school students in Shanghai; physical activity, screen time, and sleep duration were measured by accelerometry and questionnaires. Children's height, weight, and waist circumference were based on standard measurements. Paired-samples t-tests were used to compare differences in the growth rates of generalized and central obesity in third-grade students over two consecutive years. Beside, multiple linear regressions estimated the longitudinal relationship between attainment of the 24 h movement guidelines and the progression of obesity over two consecutive years.

Results ①Among the 24 h movement, the screen time compliance rate (79.9%) was the highest, the moderate-to-vigorous physical activity (MVPA) compliance rate (42.5%) was the lowest, and the compliance rate of the three activities accounted for 22.6%. ②The data showed that the rates of generalized and central obesity increased with age, and the rate of progression of generalized obesity was higher than that of central obesity. ③Hierarchical regression analysis depicted that independent achievement of MVPA was effective in controlling the progression of generalized and central obesity in pupils, while screen time and sleep achievement were not significantly associated with each other. The combination of physical activity and screen time and the combination of sleep and screen time were negatively associated with the progression of generalized obesity, meanwhile the combination of physical activity and sleep was negatively associated with the progression of central obesity.

Conclusion MVPA was an independent factor in the progression of obesity in pupils in Shanghai, and achieving different behavioral combinations of 24 h activity slowed the progression of obesity in children. In the future, the epidemic of obesity should be prevented and controlled through a combination of interventions that increase the amount of time children spend physically and the corresponding behavioral mix.