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However, interventions designed to reduce sedentary behavior, to increase PA, or both may not be efficient if they focus on inappropriate subcomponents of PA predicted from observational studies.

Unfortunately, measuring the subcomponents of PA in epidemiologic studies is difficult because of the complex and latent nature of the exposure (10).

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Thus, the children represented diverse cultural, socioeconomic, and geographic environments.

Selection criteria and sample size were reported elsewhere (15).

The study procedures were explained verbally to all children.

The local research ethics committee of the 4 study regions approved the study protocol, which was uniform across study locations.

Childhood obesity is multifactorial, involving genetic (6), social, cultural, and environmental components (5, 7).

However, the rise in the prevalence of excess body fat is most likely due to environmental changes, such as easy access to large portion sizes of energy-dense foods and a reduced physical activity (PA) level (5, 7, 8).

Weight was measured to the nearest 0.1 kg with a calibrated beam balance scale while the children were wearing light clothing.

Height was measured to the nearest 0.5 cm with a transportable Harpenden stadiometer while the children were shoeless.

Briefly, at each study location, a defined population of children was identified, and from this population a 2-stage cluster sample of children was randomly selected.

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