Playing Alone: Recess Physical Activity and Social Interactions of Children with and Without Obesity and Severe Obesity.

This study aimed to compare recess physical activity, social behaviors, and social/school perceptions among children with obesity and severe obesity and those without obesity. Recess observations were done using the System of Observing Children's Activity and Relationships during Play. School climate surveys and anthropometric measurements were also completed. A total of 414 observations from 160 (52% female) children were collected at four schools in Little Rock, AR, during three semesters from 2023 to 2024. Children were in kindergarten through 5th grade. Linear mixed-effects models were used to estimate adjusted associations. Thirteen percent of observations reflected children with severe obesity, 21% were from children with obesity, and 66% were from children with a BMI below the 95th percentile on the age- and gender-specific reference growth charts. Overall, children were engaged in moderate-vigorous physical activity 64% of the time and played alone 22% of the time. Positive play was observed 50% of the time. Children with severe obesity played alone 8% ( < 0.05) more than the reference group without obesity. There was no evidence of an inverse association between obesity and physical activity. Surveys from upper elementary children showed no differences in self-reports of being happy, having friends, or enjoying recess by weight status. While we observed more alone play at recess among children with severe obesity, we did not observe less physical activity or more negative play experiences among children with obesity or severe obesity. Recess appears to be beneficial regardless of weight status, both socially and for physical activity.