AIM: Among children in the US-Affiliated Pacific, we aimed to identify lifestyle clusters and associations with obesity. METHODS: Movement behaviours, diet and anthropometrics were from the Children's Healthy Living Program (n = 1780
2012-2015). Partitioning-around-medoids identified clusters
regression examined differences in anthropometrics. RESULTS: Among 2-5-year-olds, boys' clusters were: (1) high %energy from (E%) fat and sedentary behaviour
(2) high screen time and energy intake and (3) long sleep. Body mass index z-score (zBMI) was lower in Cluster 3 versus 1 (-0.28 [-0.50
-0.07], p = 0.01). Girls' clusters were: (1) high energy intake
(2) low E% fat and (3) high physical activity and sleep. zBMI was lower in Cluster 3 versus 1 (-0.34 [-0.55
-0.13], p = 0.002). Among 6-8-year-olds, boys' clusters were: (1) high screen time
(2) high energy intake
(3) high E% protein
(4) long sleep and (5) high sedentary time and low E% saturated fat. Compared with Cluster 1, zBMI was lower in Clusters 3 (-0.43 [-0.84
-0.02], p = 0.04), 4 (-0.64 [-1.08
-0.20], p = 0.004) and 5 (-0.93 [-1.35
-0.51], p <
0.001). Girls' clusters were: (1) high E% fat and protein
(2) high screen time and energy intake
(3) short sleep and high physical activity (4) long sleep and (5) low sedentary time. Compared with Cluster 1, zBMI was lower in Clusters 2 (-0.57 [-0.98
-0.17], p = 0.006), 3 (-0.48 [-0.81
-0.14], p = 0.005) and 5 (-0.50 [-0.83
-0.18], p = 0.003). CONCLUSION: Various lifestyle patterns support healthy body weight. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01881373.