Background: Childhood overweight and obesity pose significant global public health challenges, with Pakistan witnessing a rising prevalence and consequent adverse health impacts. External factors including parental, peer, school, and community influences shape children's health behaviors during their developmental years.

Purpose: This study aimed to assess opportunities for physical activity, safe and supportive environments for physical activity, and their association with overweight and obesity among school-aged children and adolescents aged 9 to 17 years in Pakistan.

Methods: A population-based cross-sectional study was conducted, involving a representative multistage random cluster sample of 3,371 school-aged children and adolescents (9 to 17 years old) and their families from seven randomly selected districts in Punjab, Pakistan. Overweight (> +1 SD) and obesity (> +2 SD) were determined using the World Health Organization reference from 2007. Various statistical analyses including the Chi-square test, Pearson correlation coefficient, Linear regression, and logistic regression were employed.

Results: The study comprised 3,371 Pakistani school children aged 9 to 17 years and 3,371 families from 62 schools. The prevalence of overweight and obesity among Pakistani school-aged children and adolescents was 16.8% and 10.3%, respectively. At the socio-ecological community level, factors such as the availability of physical activity opportunities in the community (OR 1.34, 95% CI 1.03-1.74, p < 0.05), residing in a safe community (OR 0.47, 95% CI 0.37-0.61, p < 0.001), and living in a supportive community (OR 0.49, 95% CI 0.38-0.64, p < 0.001) were associated with a lower risk of obesity among students.

Conclusion: The study highlights the concerning prevalence of overweight and obesity among Pakistani school-aged children and adolescents, emphasizing the significant impact of community-level environmental factors. Disparities in opportunities and safety within supportive community environments were observed concerning physical activity, especially among overweight and obese children residing in rural areas. Recommendations advocate for interventions targeting community-level determinants to effectively address this public health concern, in line with established guidelines. Ongoing monitoring, intervention, and future research are essential to comprehensively combat overweight, obesity, and related behavioral factors.