Objective To analyze the impacts of family-related factors on overweight and obesity among students in the nutrition improvement program for rural compulsory education in Henan province.

Methods From October to November 2023, stratified random cluster sampling was conducted to include 5 835 primary and secondary school students from four key counties of the nutrition improvement program for rural compulsory education in Henan province. The body heights and body weights of the students were measured, and questionnaires were administered to their parents. Chi-square tests and logistic regression were employed to analyze the determinants of overweight and obesity, and a random forest model was constructed.

Results The detection rate of overweight and obesity among primary and secondary school students was 30.76%. Specifically, boys had a higher rate than girls (36.05% vs. 25.29%, χ² = 79.321, P < 0.05); primary school students had a higher rate than secondary school students (34.06% vs. 25.08%, χ² = 51.243, P< 0.05); and students in urban areas had a higher rate than those in rural areas (34.30% vs. 29.60%, χ²=11.303, P < 0.05). Multivariate logistic regression analysis revealed that females (OR = 0.625, 95%CI: 0.556–0.703), secondary school (OR = 0.703, 95%CI: 0.620–0.797), rural areas (OR = 0.849, 95%CI: 0.736–0.980), non-mother primary caregiver (OR = 0.838, 95%CI: 0.739–0.950), maternal educational background (secondary school: OR = 1.240, 95%CI: 1.040–1.479; college or above: OR = 1.490, 95%CI: 1.113–1.995), family after-tax income of last year ≥ ¥100 000 (OR = 1.515, 95%CI: 1.145–2.004), students′ picky or selective eating habits (rarely: OR = 0.826, 95%CI: 0.705–0.967; sometimes: OR = 0.444, 95%CI: 0.378–0.521; often/always: OR = 0.409, 95%CI: 0.322–0.520), parental misperception of students′ body form (OR = 2.283, 95%CI: 2.029–2.568), and parental intervention measures for students′ weight (OR = 1.198, 95%CI: 1.063–1.350) were associated with overweight and obesity (P<0.05). The AUC value of the random forest model was 0.743. Moreover, the Gini index identified the two most influential variables, which were parental intervention measures for students′ weight (187.452) and parental perception of students′ body form (174.191).

Conclusions The prevalence of overweight and obesity is relatively high among students in the nutrition improvement program for rural compulsory education in Henan province. Therefore, implementing prevention and control measures based on the family is of great significance.