Objective This study aimed to investigate the prevalence and determinants of overweight and obesity among students aged 6–18 years in Heilongjiang province, providing an evidence base for the development of region-specific body weight management strategies.
Methods Between October 2024 and April 2025, a total of 50 734 students were recruited from six prefecture-level cities and their subordinate counties/districts via a multistage stratified random sampling design. Anthropometric measurements and structured questionnaires were administered. Overweight and obesity were classified according to the standard Screening for Overweight and Obesity among School-Age Children and Adolescents (WS/T 586—2018). Chi-square tests and multivariable logistic regression were employed for data analysis.
Results The overall prevalence of overweight and obesity was 17.45% and 23.46%, respectively. Boys (20.78% and 28.41%) had higher rates than girls (14.01% and 18.35%) (χ2 = 1 486.520, P < 0.01). Across school stages, the prevalence rates of overweight/obesity were 17.30%/30.10% in primary school students, 17.22%/21.10% in junior high school students, and 18.45%/18.16% in senior high school students, with significant differences observed (χ2 = 640.236, P < 0.01). Overweight and obesity rates varied by gender across age groups: Male overweight rate showed a "rise-decline-rise" bimodal pattern, while female overweight rate presented a "decline-rise" unimodal one. Both genders′ obesity rates exhibited a steady downward trend with age. Multivariate analysis indicated that shorter mealtime duration, frequent late-night snacking, being a non-only child, lower exercise frequency, shorter exercise duration, incomplete family structure, and frequent conflicts with caregivers were associated with higher odds of overweight and obesity (all P < 0.05). Stratified analysis further revealed that among primary school students, short mealtime duration and low exercise frequency increased the risk (both P < 0.05), whereas among secondary school students, short mealtime duration, frequent late-night snacking, short exercise duration, conflicts with caregivers, and incomplete family structure were predictors (all P < 0.05).
Conclusions The prevalence of overweight and obesity among students aged 6–18 years in Heilongjiang remains high, underscoring the need for tailored interventions that integrate local dietary and lifestyle characteristics with gender- and school stage-specific management, strengthened family involvement, and school-based health education.
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