Sedentary Behaviors in Youth and Prevention and Management of Childhood Obesity

Barnett TA, Kelly AS, Young DR, et al.
Sedentary Behaviors in Today’s Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association. Circulation 2018;August 6:[E-pub ahead of print].

This American Heart Association Scientific Statement provides a contemporary overview of research and recommendations regarding youth sedentary behavior and its impact on obesity and cardiometabolic health in the modern digital age. The following are key points to remember:

  1. Sedentary behavior refers to low-energy pursuits such as television viewing, reading, and motorized transport. Increased sedentary behaviors are associated with increased risks of cardiovascular disease in adults but not in pediatric studies.
  2. Screen time in the current era refers to using smart phones, personal computers, tablet devices, and televisions to read online content, play video games, watch programming or DVDs, and stream videos.
  3. Measurement of sedentary behavior can occur by subjective measurement, objective measurement such as motion sensors (accelerometers), or direct observation. Screen time relies on subjective self-reporting, commonly through recalls or diaries.
  4. Prevalence estimates of sedentary behavior in youth, by objective and subjective studies, suggest an average of 6.6-8.6 hours of sedentary behavior and/or recreational screen time daily. Increasing age is associated with more screen time.
  5. Of all measures of sedentary activity, only self-reported screen time has a known positive association with increased adiposity. The National Health and Nutrition Examination Survey showed that adolescents who reported >2 hours of daily screen time were 1.8 times more likely to be obese or overweight.
  6. Other metabolic effects of sedentary behavior in youth (lower insulin sensitivity, clustering of metabolic risk factors, and metabolic syndrome) were identified in some studies, with effects into young adulthood.
  7. Sedentary behavior correlates with increased maternal TV viewing in girls and young children; it decreases with outdoor play in school-aged children. TV viewing time increases with neighborhood crime and distance to parks; it decreases with family TV viewing rules. Screen time increases with the number of TVs, computers, or game consoles in the home or bedroom, fewer family mealtimes, and mealtime television watching.
  8. Sedentary behavior interventions typically show small, significant effects. Interventions in preschool children were more effective in children <3 years old and when conducted in a home, community, or preschool setting. The most successful family-based interventions involved increased parental involvement, structural changes in the home environment such as modifying video game access, and decreased parental sedentary behavior.
  9. Recommendations include the following:
    • Time spent in screen-based activities should be reduced to mitigate risks.
    • Bedrooms and mealtimes should be free of TVs and screen-based devices.
    • Parents should be supported to develop and enforce suitable screen time restrictions.
    • Parents should model healthy screen-based behaviors.
    • Novel approaches promoting more face-to-face interactions and outdoor play should be encouraged.
    • All children should “sit less, play more.”

Keywords: Sedentary Behavior, Child, Preschool, Child, Adolescent, Pediatric Obesity, Adiposity, Metabolic Syndrome, Parents, Computers, Television, Overweight, Reading, Computers, Handheld, Self Report, Risk Factors

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