Review
Sedentary behaviour and obesity development in children and adolescents

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Abstract

Sedentary lifestyle patterns in children and adolescents, i.e. playing digital games, using computers and especially watching television, have been associated with obesity. However, not all sedentary behaviour has shown the same relevance to, and relationship with, obesity. Therefore, we conducted a review including published studies found in PubMed and other medical journals, dated between January 1990 and April 2007. The ages of the children and adolescents who were the object of the study ranged between 2 and 18 years. For the purpose of this paper, we selected cross-sectional, longitudinal and intervention studies. Sufficient evidence exists to recommend setting a limit to the time spent watching TV, especially for younger children. However, video games and computers do not represent such a high risk compared to watching TV, when they do not replace physical activity too much. In fact, there is no evidence to suggest that sedentary behaviour displaces physical activity levels. Mechanisms that explain the link between sedentariness and obesity are also discussed. Finally, future studies should take into account important mediators such as socioeconomic status and family structure.

Introduction

There are several critical periods in the development of obesity during childhood and adolescence [1]; childhood obesity is known to track into adolescence [2] and adulthood [3], [4], and is associated with several health problems [5], [6]. Adolescent body mass index (BMI) remained predictive of premature death after adjustment for adult BMI in two cohorts (Nurses Health Study II and the Harvard Growth Study) [7], [8]. The Nurses Health Study II, which included 102,400 women, among them girls who had never smoked, revealed that mortality rates had already increased among women with a BMI of 22.0 to 24.9 kg/m2[8].

The origin of obesity is complex and is influenced by genetic and environmental factors [9]; nevertheless, the recent increase in adiposity which has now reached epidemic proportions [10], suggests that environmental factors play a more significant role [11]. However, the lack of accurate and robust measures of energy intake and expenditure may explain why reviews concerning energy intake and energy expenditure show different results supporting both positions [12].

Sedentary lifestyle patterns in children and adolescents have been associated with obesity [13], which is also becoming an increasing concern in European countries [13], [14], [15], [16]. It is suggested that the increased use of information and communication technology, particularly watching television, playing digital games and using computers are critical sedentary factors affecting obesity prevalence [17]. For example, nearly two thirds of Spanish teenagers (71.5%), especially boys (87% of boys versus 57.2% of girls), have a video games console, 57.8% had a computer in their rooms and all the teenagers had a television set at home (24% of families had four or more television sets) [18]. In this regard, several cross-sectional studies carried out on children and adults suggested a strong relationship between high amounts of hours of television viewing and increased obesity [17], [19], [20], [21]. A meta-analysis found that time spent watching television was related to overweight, but the association was weak and, most likely, not clinically relevant [22]. However, most studies in this meta-analysis had a cross-sectional design and did not control for confounding factors; therefore they are unable to prove a relationship of cause and effect. Recent findings from a birth cohort [23] reinforce the fact that watching television in childhood is associated with an increased BMI, adding evidence for an association of cause and effect between television viewing and overweight.

Nevertheless, not all sedentary behaviour showed the same relevance to and relationship with obesity. For example, time spent playing digital games has not been associated with overweight [17], perhaps because it may elicit a lower sedentary effect [24] or because it could be related to a different lifestyle, i.e. boys are usually more active than girls and even spend more time on electronic games [25]. In addition, the effect of sedentary lifestyle on obesity risk may depend on the genotype of the subject. A higher risk of obesity was found among girls carrying the 27Glu allele of the ADRB2 gene, even when they spent less than 12.5 h/week watching TV [26].

Despite the fact that sedentariness and obesity seem to be linked, there is no great body of knowledge in this regard. Most studies are not comparative and results fail to be conclusive.

Hence, the purpose of this article is to review published studies about sedentary behaviour among children and adolescents and analyse its specific influences on body composition in order to state present knowledge on this topic and serve as a starting point for future investigations into the relationship between sedentary behaviour and obesity.

Section snippets

Methods

The research strategy for reviewing the studies about the relationship between sedentary behaviour and obesity development was based on the following single terms or combinations of them: obesity, adiposity, child, adolescent, sedentary behaviour, television viewing, video games, internet use and sitting time. The databases used were Medline and PubMed and the selection process was conducted by two independent researchers. The inclusion criteria were studies involving healthy children and/or

Cross-sectional studies

Table 1 (see Supplementary data) summarises 46 cross-sectional studies about the effect of sedentary behaviour on the development of overweight and/or obesity. Fig. 1 illustrates the cross-sectional studies showing a significant relationship between overweight and the individual sedentary behaviours.

Discussion

Obesity appears to have spread more dramatically in industrialised countries over the past twenty to thirty years than in underdeveloped countries. From the 1970s until the end of the 1990s, the prevalence of overweight or obesity in school-age children doubled or tripled worldwide [10].

Many people believe that overeating is the sole cause of obesity, but the time that children devote to sedentary activities has increased drastically in the past few decades. This increase in sedentary patterns,

Conclusions

The causes of excessive weight gain in children are multi-factorial [13]. With regard to environmental factors, sufficient evidence exists to recommend setting a limit to the time spent watching TV, especially by young children. In comparison to TV viewing, the results of the studies reviewed indicate that playing video games and using computers do not represent such a high risk if these do not replace too much physical activity. Although controversial results are presented in the majority of

Acknowledgements

This study was supported by Fundación Cuenca Villoro.

References (101)

  • J. Utter et al.

    Couch potatoes or French fries: are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents?

    J Am Diet Assoc

    (2003)
  • E.A. Vandewater et al.

    Linking obesity and activity level with children's television and video game use

    J Adolesc

    (2004)
  • O.K. Horn et al.

    Correlates and predictors of adiposity among Mohawk children

    Prev Med

    (2001)
  • H. Kaur et al.

    Duration of television watching is associated with increased body mass index

    J Pediatr

    (2003)
  • F.J. Elgar et al.

    Sedentary behaviour, physical activity and weight problems in adolescents in Wales

    Public Health

    (2005)
  • R.M. Viner et al.

    Television viewing in early childhood predicts adult body mass index

    J Pediatr

    (2005)
  • K.F. Janz et al.

    Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study

    Am J Prev Med

    (2005)
  • K.K. Davison et al.

    Cross-sectional and longitudinal associations between TV viewing and girls’ body mass index, overweight status, and percentage of body fat

    J Pediatr

    (2006)
  • L.H. Epstein et al.

    Influence of changes in sedentary behavior on energy and macronutrient intake in youth

    Am J Clin Nutr

    (2005)
  • E.M. Blass et al.

    On the road to obesity: Television viewing increases intake of high-density foods

    Physiol Behav

    (2006)
  • J.J. Reilly et al.

    Health consequences of obesity

    Arch Dis Child

    (2003)
  • A. Must et al.

    Effects of obesity on morbidity in children and adolescents

    Nutr Clin Care

    (2003)
  • A. Must et al.

    Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935

    N Engl J Med

    (1992)
  • R.M. van Dam et al.

    The relationship between overweight in adolescence and premature death in women

    Ann Intern Med

    (2006)
  • M. Rosenbaum et al.

    Obesity

    N Engl J Med

    (1997)
  • Y. Wang et al.

    Worldwide trends in childhood overweight and obesity

    Int J Pediatr Obes

    (2006)
  • J.O. Hill et al.

    Overview of the determinants of overweight and obesity: current evidence and research issues

    Med Sci Sports Exerc

    (1999)
  • P.A. Spanier et al.

    Tackling the obesity pandemic: a call for sedentary behaviour research

    Can J Public Health

    (2006)
  • M.B. Zimmermann et al.

    A national study of the prevalence of overweight and obesity in 6-12 y-old Swiss children: body mass index, body-weight perceptions and goals

    Eur J Clin Nutr

    (2000)
  • P. Bundred et al.

    Prevalence of overweight and obese children between 1989 and 1998: population based series of cross sectional studies

    BMJ

    (2001)
  • L.A. Moreno et al.

    Overweight, obesity and body fat composition in Spanish adolescents. The AVENA Study

    Ann Nutr Metab

    (2005)
  • S. Kautiainen et al.

    Use of information and communication technology and prevalence of overweight and obesity among adolescents

    Int J Obes (Lond)

    (2005)
  • R.E. Andersen et al.

    Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey

    JAMA

    (1998)
  • S.L. Gortmaker et al.

    Television viewing as a cause of increasing obesity among children in the United States, 1986-1990

    Arch Pediatr Adolesc Med

    (1996)
  • S.J. Marshall et al.

    Relationships between media use, body fatness and physical activity in children and youth: a meta-analysis

    Int J Obes Relat Metab Disord

    (2004)
  • R.J. Hancox et al.

    Watching television is associated with childhood obesity: but is it clinically important?

    Int J Obes (Lond)

    (2006)
  • X. Wang et al.

    Metabolic and physiologic responses to video game play in 7- to 10-year-old boys

    Arch Pediatr Adolesc Med

    (2006)
  • M.C. Ochoa et al.

    TV watching modifies obesity risk linked to the 27Glu polymorphism of the ADRB2 gene in girls

    Int J Pediatr Obes

    (2006)
  • A. Must et al.

    Physical activity and sedentary behavior: a review of longitudinal studies of weight and adiposity in youth

    Int J Obes (Lond)

    (2005)
  • J. Wardle et al.

    Food and activity preferences in children of lean and obese parents

    Int J Obes Relat Metab Disord

    (2001)
  • A. Grund et al.

    Is TV viewing an index of physical activity and fitness in overweight and normal weight children?

    Public Health Nutr

    (2001)
  • B.A. Dennison et al.

    Television viewing and television in bedroom associated with overweight risk among low-income preschool children

    Pediatrics

    (2002)
  • R. von Kries et al.

    Maternal smoking during pregnancy and childhood obesity

    Am J Epidemiol

    (2002)
  • M.S. Tremblay et al.

    Is the Canadian childhood obesity epidemic related to physical inactivity?

    Int J Obes Relat Metab Disord

    (2003)
  • N. Stettler et al.

    Electronic games and environmental factors associated with childhood obesity in Switzerland

    Obes Res

    (2004)
  • J.P. Chaput et al.

    Relationship between short sleeping hours and childhood overweight/obesity: results from the ‘Quebec en Forme’ Project

    Int J Obes (Lond)

    (2006)
  • J. Jiang et al.

    Risk factors for overweight in 2-to 6-year-old children in Beijing, China

    Int J Pediatr Obes

    (2006)
  • S.A. Moraes et al.

    Prevalence of overweight and obesity, and associated factors in school children from urban area in Chilpancingo, Guerrero, Mexico, 2004

    Cad Saude Publica

    (2006)
  • J. Salmon et al.

    Television viewing habits associated with obesity risk factors: a survey of Melbourne schoolchildren

    Med J Aust

    (2006)
  • L. Serra-Majen et al.

    Prevalence and determinants of obesity in Spanish children and young people

    Br J Nutr

    (2006)
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