Abstract
PURPOSE: Childhood obesity is a growing public health crisis with significant cardiometabolic and mental health implications throughout life. Socioeconomic adversity, family discord, and childhood stress are strongly associated with a higher prevalence of obesity, disproportionately affecting adolescents from under-resourced families. This study aims to assess the metabolic health and lifestyle behaviors of adolescents in these vulnerable populations and their potential implications for long-term health. METHODS: Baseline metabolic characteristics and lifestyle behaviors of 138 adolescents (aged 12-19 years) enrolled in the E-DUCASS program (NCT05379842), a 24-month randomized intervention for food-insecure families, were analyzed. Anthropometric and clinical variables, adherence to the Mediterranean diet, physical activity, and screen time were assessed using WHO-aligned, validated methods. Parental health literacy was evaluated for its influence on adolescent behaviors. RESULTS: Among participants, 43 % were classified as having overweight or obesity, with metabolic syndrome (MetS) prevalence at 31.9 % (NCEP-ATPIII criteria) and 11 % (IDF definition). Mediterranean diet adherence was poor in 44.2 %, moderate in 53.6 %, and high in only 2.2 %. Physical activity guidelines were met by 8 % of adolescents, while compliance with screen time recommendations was low (14.5 % on weekdays and 7.2 % on weekends). Adolescents whose parents exhibited higher health literacy showed better dietary adherence but no significant differences in other outcomes. CONCLUSIONS: Adolescents from under-resourced families demonstrate poor adherence to healthy behaviors and high rates of obesity and MetS, exceeding levels reported in general European and Spanish cohorts. These findings highlight the urgent need for targeted interventions, such as the E-DUCASS program, to address these disparities.