Prospective associations of sleep duration and screen time with transition from overweight/obesity to normal BMI in U.S. adolescents

Background: Shorter sleep duration and longer screen time are established risk factors for adolescent obesity. However, the extent to which these behaviors are prospectively associated with the transition back from overweight/obesity to a healthy status remains unclear. We examined whether sleep duration and screen time among adolescents with overweight/obesity are associated with the likelihood of transitioning to a normal body mass index (BMI). Methods: We used data from 3498 U.S. adolescents aged 9–11 years with overweight/obesity (45.1% female), from the Adolescent Brain Cognitive Development (ABCD) Study. Cox proportional hazards models examined the prospective associations of parent-reported sleep duration (9–11, 8–9, 7–8, and <7 h/day) and screen time (hours/day) with a shift from overweight/obesity (BMI percentile ≥85) to a normal (BMI percentile <85) accounting for key covariates including pubertal status. Results: Over a median 657 days of follow-up, 643 (18.4%) adolescents transitioned from overweight/obesity to a normal BMI percentile. Compared with those sleeping 9–11 h, adolescents sleeping 7–8 h were less likely to transition to a normal BMI percentile (hazard ratio [HR]: 0.60, 95% CI 0.44, 0.82), with significant dose-response trend (p for trend = 0.003). The association remained significant in sex-stratified analyses for both females (HR: 0.55, 95% CI 0.30, 0.98) and males (HR: 0.59, 95% CI 0.41, 0.86), with similar significant trend in both groups (p for trend <0.05). Higher screen time was not associated with transitioning to a normal BMI overall (HR: 0.99, 95% CI 0.96, 1.02) or by sex (females, HR: 1.00, 95% CI 0.95, 1.05; males, HR: 0.99, 95% CI 0.95, 1.02). Conclusion: Short sleep duration was prospectively associated with a lower likelihood of transitioning to a normal BMI among adolescents with overweight/obesity. This association warrants further investigation as a potential intervention target.