Electronic games and childhood obesity

Nutrition Research Newsletter, July, 2004

Childhood obesity is becoming an increasing public health problem in several high-income countries, including the United States, Switzerland, and Britain, and in several low- and intermediate-income countries. Several environmental factors have been associated with obesity among US children: television watching, low physical activity, lower socioeconomic status in white adolescents, consumption of sugar-containing beverages, skipping breakfast, and unstructured meals. US society has sometimes been described as a "toxic environment" for the development of obesity. Although European societies differ in many ways from the US society, the environment is becoming more globally uniform; it is unclear, however, whether the environmental factors identified in US children are also significant for the development of obesity in European children. The aim of this study was to identify environmental and behavioral factors, in particular type and the duration of sedentary activities, associated with obesity in children living in Switzerland.

For this cross-sectional study, a convenience sample of 10 schools was chosen from four communities of the Greater Zurich area in the German-speaking Northeastern Switzerland. All 922 children in grades one to three of primary school in 1999 were eligible for the study. Of the 922 eligible subjects, 872 (94.6%) took part in the study. Weight was measured in light clothing without shoes using a medical scale, height was measured without shoes, and all measurements were performed before noon. Triceps and subscapular skinfold thicknesses were measured. Questionnaires were administered to the children using structured interview by a physician or by a medical assistant to assess age, sex, nationality, number of siblings, smoking status of parents, professional situation of parents, television programs regularly watched, amount of time playing electronic games, breakfast consumption, watching television during meals, and snacking while watching television. To assess the amount of time watching television, the programs regularly watched were recalled by the children as part of the answers to the questionnaire and recorded by the interviewer.

The total duration of all programs regularly watched by the child during weekdays was calculated. Television use during weekends was not assessed. Usual amount of physical activity was estimated by the teacher for each child using a visual analog scale from 0 (lowest) to 10 (highest). The prevalence of obesity was 3.0% for boys and 2.9% for girls. The prevalence of obesity using the combined definition of overweight and overfat was 11.0% for boys and 11.2% for girls.

The present study had several important findings: obesity was independently associated with the time spent playing electronic games and the time spent watching television and was inversely associated with physical activity. The data also suggest that children may be at higher risk for obesity if their father smokes or mother works outside of the home. This study provides the strongest evidence for an independent association between time spent playing electronic games and childhood obesity. The use of computer and video games has previously been positively associated with overweight status in Asian-American girls but negatively in Asian-American boys, whereas in the same study, no significant association was detected in European-American and African-American children. The reasons for these differences are unclear, but these results suggest that the association between use of electronic games and obesity may vary among populations.

In the present study, the association of electronic game use with obesity was significant, with a nearly 2-fold increased risk for obesity by hour per day spent playing electronic games. Therefore, use of electronic games should be considered as another sedentary activity to be targeted for obesity prevention in children. The positive association between time spent watching television and childhood obesity was expected and is significant, with a two- to three-fold increased risk with each additional hour of television per day.

N Stettler, T Signer, Paolo Suter. Electronic games and environmental factors associated with childhood obesity in switzerland Obes Res 12:896-903 (June 2004) [Correspondence: Nicolas Stettler, Division of Gastroenterology and Nutrition, North 1559, The Children's Hospital of Philadelphia, Thirty-Fourth Street and Civic Center Boulevard, Philadelphia, PA 19104-4399. E-mail: nstettle@cceb.med.upenn.edu]