Add Video Games, Lose the Bedroom TV to Fight Kids' Obesity

Norra MacReady

March 04, 2014

Time in front of a television or video screen can be both a blessing and a curse when it comes to the vexing problem of childhood obesity, 2 new studies suggest. The studies were published online March 3 in JAMA Pediatrics.

In the first study, Stewart G. Trost, PhD, from the Center for Research on Exercise, Physical Activity and Health, School of Human Movement Studies, The University of Queensland, Brisbane, Australia, and colleagues hypothesize that video games might help overweight children achieve a healthy weight. "Given the popularity and pervasiveness of video gaming in youth culture, active video games may be an effective strategy to increase physical activity in overweight and obese children," they write.

From August 2011 through July 2012, the authors recruited study participants from Young Men's Christian Associations across Massachusetts, Rhode Island, and Texas. Eligible children were between 8 and 12 years of age, had a body mass index (BMI) greater than the 85th percentile for their sex and age, and had a parent or guardian willing to participate in the program and attend weekly sessions with them. All of the volunteers were enrolled in JOIN for ME, a family-based pediatric weight management program based on empirically validated principles. In this program, which the investigators modified slightly to fit the needs of the study, the child and his or her parents attended 16 hour-long group sessions that were structured around topics such as nutrition, setting daily calorie and activity goals, and self-monitoring.

The children were then randomly assigned to a program plus active gaming (P+AG) or program only (PO) group. In addition to the weekly meetings, P+AG participants were given a game console, motion capture device, and active sports game, with a second game delivered in the ninth week of the study. They were on their own as far as determining how long and how often to use the games. Children in the PO group had no intervention other than the sessions, but they received the hardware plus 2 active games at the end of the study.

All children underwent height and weight measurement at baseline and at weeks 8 and 16 of the study. In addition, an accelerometer-based motion sensor was used to measure their physical activity.

At baseline, there were 34 children enrolled in the P+AG group and 41 in the PO group. By week 8, this had dropped to 32 (94%) and 40 (98%), respectively, and by week 16, the numbers had dropped to 26 (76%) and 34 (83%), respectively, for an overall retention rate of 80%. Children in the P+AG group spent a mean of 25.3 minutes per day (standard deviation [SD], 2.5) in moderate-to-vigorous physical activity (MVPA), and children in the PO group spent 26.9 minutes (SD, 2.3).

By weeks 8 and 16, MVPA had increased to a mean of 30.1 minutes per day (SD, 2.6) and 32.7 (SD, 2.9) minutes per day among children in the active gaming group (P < .05 between baseline and week 16). Children in the control group, however, showed little change in MVPA, clocking in at 26.0 minutes per day (SD, 2.4) at week 8 and 26.3 minutes per day (SD, 2.7) by week 16 (P < .05 for the 16-week between-group change).

Active gaming also was associated with changes in weight and BMI: at baseline, children in the P+AG group were a mean of 66.9% overweight (SD, 5.0) but dropped to a mean of 59.8% (SD, 5.0) overweight by week 8 and to 56.0% (SD, 5.1) by week 16, a change of 10.9 percentage points (SD, 1.6; P < .05 between baseline and week 16). Weight loss in the PO group also was significant, but more modest: the children went from a mean of 62.3% overweight at baseline (SD, 4.5) to an 8-week mean of 59.5% (SD, 4.5) and a 16-week mean of 56.9% (SD, 4.6), for a decrease of 5.5 percentage points (SD, 1.5) during the life of the study (P < .05 compared with baseline). However, the children in the P+AG group lost 5.4 percentage points more (SD, 2.2; P < .05 for the 16-week change between groups) than the children in the PO group.

Slight as these differences might seem, "even small changes in physical activity such as those observed in the current study, when combined with modest reductions in energy intake, have important implications for long-term energy balance," the researchers point out. They cite evidence suggesting that "the annual weight gain observed in 90% of the US population (0.8-0.9 kg) could be eliminated by some combination of increasing energy expenditure and reducing intake by 100 kcal/[day]. The mean weight reduction observed in the P + AG group (0.85 kg) is consistent with these calculations."

This study "presents a very compelling way to increase physical activity and increase weight loss in children participating in a weight loss program," Diane Gilbert-Diamond, ScD, told Medscape Medical News. However, she warned, "it is important to note that this study is on active video gaming as part of a weight loss intervention. The authors are not proposing that parents go out and purchase active video gaming systems for their children and try this intervention on their own."

Television in the Bedroom: An Unwelcome Guest?

Dr. Gilbert-Diamond, assistant professor of community and family health, Geisel School of Medicine at Dartmouth University, New Hampshire, was the lead author of the second study, which showed an association between the presence of a television in a child's bedroom and higher BMI.

The data come from children participating in the Dartmouth Media Study, an ongoing longitudinal study of 10-to-14-year-olds recruited via random-digit dialing. Of the 6522 children enrolled at baseline, 4575 were available for follow-up 2 years out, and 3055 were available 4 years out. The baseline examination included questions about a bedroom television, as well as questions about television viewing time, not including video games. Data also were collected on each child's sociodemographic status and participation in team sports or other types of physical activity.

The participants' mean age was 12.0 years (SD, 0.0) at baseline, 14.0 years (SD, 0.0) at the 2-year follow-up, and 15.8 years (0.0) at the 4-year follow-up. Boys comprised 51.5% of the baseline sample. Bedroom televisions were reported for 59.1% of the children. Boys were 8% more likely than girls to have a bedroom television (P < .001). Televisions in the bedroom also were more prevalent among children from black or Hispanic families than for children of other races (P < .001), as well as among children from families of lower income or educational status (P < .001 for both).

The association between a television in the bedroom and BMI was determined through a weighted linear regression analysis adjusted for daily hours of television viewing and video game playing; movies viewed per week; parental responsiveness, demandingness, and education; and age, sex, race, ethnicity, and household income. The weighted height distribution of the sample was also used to convert the authors' estimates of excess gain in BMI associated with a bedroom television into an estimate of excess weight gain.

Compared with children whose bedrooms were television-free, a television in the bedroom was associated with a mean BMI increase of 1.16 kg/m2 (95% confidence interval [CI], 0.88 - 1.44 kg/m2) at year 2 and 1.31 kg/m2 (95% CI, 0.93 - 1.70 kg/m2) at year 4. After adjusting for television and movie viewing times, video game playing, parental demandingness and responsiveness, and sociodemographic factors, the differences were 0.57 kg/m2 (95% CI, 0.31 - 0.82 kg/m2) and 0.75 kg/m2 (95% CI, 0.38 - 1.12 kg/m2) at years 2 and 4, respectively. "Each hour per day of television viewing time at baseline also independently predicted a mean excess BMI gain of 0.14 (95% CI, 0.02-0.25) from years 2 to 4," the authors write. "These associations were not altered by additional adjustment for sports participation."

"We were surprised by the large size of the association — children and adolescents with a [television] in their bedroom gained about 1 extra pound a year, even after adjusting for total television viewing time," Dr. Gilbert-Diamond noted to Medscape Medical News. "This can accumulate into very large weight gains over the course of childhood and adolescence."

"With televisions in the bedrooms of 59.1% of the 42.3 million US youth aged 10 to 19 years, this excess weight translates into approximately 8.7 million (95% CI, 0.9 million to 16.4 million) kg/[year] attributable to the presence of bedroom televisions," Dr. Gilbert-Diamond and colleagues write.

These findings, as well as the findings of the active-gaming study, point to the complex nature of childhood obesity and the creativity that parents, clinicians, and researchers will need to fight it, Dr. Gilbert-Diamond said. "One third of children and adolescents in our country are still overweight or obese. We hope that our research will help to reduce this high prevalence. Unlike other parenting strategies that require persistent monitoring, removing a [television] from a child's bedroom, as is strongly recommended by the American Academy of Pediatrics, is a single concrete action that a parent can take to help reduce their child's risk of excessive weight gain."

Dr. Trost is a member of the ActiGraph Scientific Advisory Board. Another author of the active-gaming study serves as a consultant to the UnitedHealth Group, and other authors are employees of UnitedHealth Group, which supported the study. Dr. Gilbert-Diamond and the other authors of the Dartmouth study have disclosed no relevant financial relationships.

JAMA Pediatrics. Published online March 3, 2014. Trost full text, Gilbert-Diamond abstract

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