This exploratory study was conducted to provide an update on the behavioral factors associated with childhood obesity in the USA. The results of this study showed that several sociodemographic and behavioral factors were associated with the prevalence of obesity among the study participants. Specifically, adverse childhood experiences (bullying), depression, smoking, use of marijuana, soft drinks consumption, physical activity, screen time, oral health, mental health, and sleeping time were associated with obesity.

Blasingame et al. [14] analyzed a larger dataset from the 2016–2020 National Survey of Children's Health, emphasizing the cumulative impact of multiple social determinants of health (SDOH) domains, finding that high-risk SDOH profiles significantly increase obesity risk. In contrast, this study focused on specific sociodemographic factors, identifying that being 14 or 15 years old, male, non-White, having a history of substance use, and lack of physical activity were major contributors to overweight and obesity among 12,836 respondents aged 12–17 years. Both studies found similar prevalence rates of overweight and obesity and called for multilevel intervention strategies, with Blasingame et al. advocating for comprehensive approaches addressing health equity across multiple SDOH domains, and this study recommending targeted behavioral change strategies at individual, community, and policy levels.

The authors in [15] in 2018 said that stress, anxiety, and depression may lead to calorie-dense junk food consumption to alleviate uncomfortable psychological and emotional states, which play a critical role in weight gain and obesity. Our study also found that depression (P < 0.01), anxiety, and stress (P < 0.01) were significantly associated with childhood obesity.

Ortega et al. [16] reported that the lack of physical activity was associated with obesity. It is associated with increased abdominal adiposity. This finding is in line with our finding which shows a significant association between lack of physical activity and obesity (P < 0.01).

Unexpectedly, our study revealed that children who consumed vegetables had a higher chance of being obese than those who did not. It is probable that children who ate a lot of vegetables also consumed higher-calorie foods such as soft drinks and were less physically active. There is another study carried out by Ledoux et al. [17], which found consuming more fruits and vegetables (FV) together with other behaviors appears to be associated with decreased obesity in adults. On the other hand, children do not exhibit this relationship. In 2018, the authors in [18], in their systematic review, found moderate quality evidence for an inverse association between vegetable intake and weight-related outcomes in adults. It is still unclear if increased FV intake on its own, in the absence of calorie intake or physical exercise, causes decreases in adiposity or slower growth. In our study, we also wanted to determine the association between vegetable consumption and obesity, but it might also have to do with the fruits and vegetables type, quantity, and calories, as well as the physical activity of children and their genetics who consume vegetables, which are not given any thought. The p value associated with the factor association would have been different if those behavioral factors had been taken into account.

Childhood obesity is influenced by a complex interplay of factors, including genetics, parental influences, and lifestyle choices. Genetics is an important factor that can influence body weight significantly. A recent study carried out by Wen Dai et al. [19] found that reducing calcium/calmodulin-dependent protein kinase-2 (CAMK2) activity in fat cells might help improve blood sugar control in obesity without needing to lose weight. This study suggests that targeting CAMK2 could be a new way to treat metabolic problems associated with obesity. Within the suggested Ang et al. [12] framework, contextual factors such as cultural norms, community environments, and healthcare access play pivotal roles. Cultural norms shape dietary preferences and body image perceptions, while community environments impact physical activity options and food availability. Access to healthcare influences preventive measures and management strategies. Understanding how these contextual factors intersect with established variables is crucial for designing effective interventions. It allows for tailored approaches that consider cultural diversity, community dynamics, and healthcare accessibility in combating childhood obesity.

In the pursuit of combating childhood obesity, a series of evidence-based interventions unfolded, each building upon the last. In 2007, the authors in [20] laid the groundwork with a focus on community-based interventions. Their study illuminated the effectiveness of collaborative efforts involving diverse stakeholders such as communities, healthcare providers, and policymakers. This underscored the need for a comprehensive strategy, recognizing that lasting changes in environments require multifaceted involvement. Expanding on this community-centric approach in the same year, the authors in [21] shifted the spotlight to school-based interventions. Their work showcased the effectiveness of nutrition education and physical activity programs, positioning schools as pivotal environments shaping children's behaviors and paving the way for healthier lifestyles. In 2011, the authors in [22] broadened the perspective by emphasizing the role of policy interventions. Their systematic review highlighted the impact of measures such as sugar-sweetened beverage taxes and front-of-package labeling in reducing childhood obesity rates. This emphasized the potency of policy advocacy in reshaping obesogenic environments and fostering population-wide change. Moving to 2015, the authors in [23] contributed a practical school-based intervention, encouraging water consumption during school lunch. This not only demonstrated the feasibility of implementing changes within school settings but also addressed the critical aspect of beverage choices. In 2016, the authors in [24] delved into community-level factors, offering insights into influences on dietary habits in low-income urban youth. This knowledge contributed to the development of community-based interventions tailored to address specific contextual factors. Considering socioeconomic factors in the same year, the authors in [25] assessed the impact of a sugar tax on beverages, providing a nuanced perspective. The study underscored the importance of tailoring policy design to consider economic disparities, ensuring interventions are equitable and inclusive. Advocating for family-based interventions in 2017, the authors in [26] emphasized positive outcomes when involving the child in the process. This approach recognized the family unit as a fundamental influencer of a child's behaviors, acknowledging the need for interventions addressing the dynamics within households. In 2020, the authors in [27] recognized the digital era, exploring the potential of technology-driven interventions. Their examination of mobile health applications for pediatric obesity signaled the need for innovative approaches leveraging technology to engage and educate children in the battle against obesity. Further highlighting the impact of policy in the same year, the authors in [28] evaluated Chile's food labeling and advertising law, underscoring the effectiveness of regulatory changes and reinforcing the importance of targeted policy measures in shaping dietary patterns among children. The most recent addition to this evolving narrative in 2023 was the study by authors in [29], who delved into family-based interventions within routine pediatric care. Their study not only reaffirmed the effectiveness of such interventions but also provided valuable insights into different treatment groups, paving the way for nuanced and personalized approaches. This chronological sequence paints a comprehensive picture of interconnected interventions over the years in the fight against childhood obesity.

Keeping back all these findings in mind, we suggest some potential avenues for future research related to childhood obesity. Firstly, investigating the effectiveness of digital health interventions, such as mobile apps and wearable devices, in promoting physical activity and healthy eating habits among children offers promise. Secondly, understanding the impact of interventions during prenatal and early childhood periods on long-term obesity outcomes is crucial for developing targeted prevention strategies. Thirdly, delving into the role of genetic and epigenetic factors in childhood obesity, with a focus on personalized interventions, is an emerging area. In addition, examining the influence of community engagement and the built environment on children's habits can inform the development of effective community-based interventions. Lastly, targeted interventions should be developed to address the varying behavioral risk factors among different sociodemographic groups. For instance, programs that focus on reducing obesity among older adolescents and males may be particularly beneficial along with considering the influence of dietary preferences, substance use, and physical activity on obesity, health education, and interventions should promote both healthy behaviors and weight perception. Conducting long-term follow-up studies on existing childhood obesity interventions is imperative to assess sustained impacts into adolescence and adulthood.