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Objective: To examine associations between health behavior patterns and childhood obesity, and the mediating effect of sleep duration.

Design: Population-based survey.

Participants: Secondary analysis of data from the Infant Feeding Practices Study (age 6 years, n = 1073).

Measurements: Mothers self-reported their child’s health behaviors including physical activity (PA), screen time, sleep duration, and diet. Latent class analysis determined the child’s patterns based on health behaviors. Sleep was examined as a mediator between the class membership variable and %BMIp95.

Results: A 3-class model fit the data best, with classes labeled as “Poorest eaters” (low fruit/vegetable consumption, high fast food), “Healthy” (low screen time, highest fruit/vegetable consumption) and “Active, super-eaters, highest screen time” (highest PA and screen time, ate the most). “Poorest eaters” had an increased %BMIp95 (β = 4.11, P = .006) relative to the “Healthy” class. The “Poorest eaters” and “Active, super-eaters, highest screen time” classes had shorter sleep duration (β = −0.51, P < .001; β = −0.38, P < .001; respectively) relative to the “Healthy” class. Independent of class membership, each additional hour of sleep was associated with a %BMIp95 that was 2.93 U lower (P < .001).

Conclusions: Our results indicate that health behavior patterns mediated by sleep duration may influence a child’s %BMIp95. The bi-directionality of the relationship between health behaviors and sleep remains unclear. Our findings suggest the importance of a constellation of health behaviors on childhood obesity. Interventions should include a multitude of health behaviors and consider the possibility that improving diet and activity behaviors may facilitate improved sleep and lowered obesity risk among children.