Thursday, July 11, 2013

Childhood Obesity and Active Video Games- part of the problem or the solution?

This post is in response to an excellent round table discussion put together by the journal Games for Health, entitled: "Gaming, Adiposity, and Obesogenic Behaviors Among Children".

The experts at the round table did an excellent job discussing the relevant literature surrounding active video games (AVGs). I had a few concerns while reading the article that centre around the idea that we should use AVGs to reduce the prevalence of childhood obesity.

Some concerns/points of discussion:

1) There is much talk about getting children to play AVGs, although as Kristi Adamo points out, we don't understand why children play these games, let alone why they would replace other sedentary behaviors with them. The premise that the reasons for playing non-AVGs are the same as those for playing AVGs is flawed- I suspect that research will soon show that children play non-AVGs and AVGs for different reasons, and that it may be unreasonable to expect a direct replacement of non-AVGs for AVGs. Also, children who play non-AVGs may not be interested in playing AVGs - again, if they're playing them for different reasons. Monique Simons says this very well “To be effective at preventing overweight, children must enjoy playing active games and be willing to replace the non-active games with active ones.” Ralph Maddison suggests that non-AVGs could mistakenly be replaced with other sedentary behaviors (such as TV watching). While this is possible, it is also likely that children will simply add this type of video gaming to their repertoire of sedentary behaviors- leading to an additive effect, and thus more screen time.

2) The idea of inducing automatic shut-offs or other time-based controls on AVGs is interesting- for example, a child can only play the game for one hour at a time before the game shuts off for 12 hours, or a child must maintain a pre-determined activity level (assessed by heart rate or accelerometry) or the game will shut off. If we program AVGs with an automatic shut-off, or limited amount of time that the game can be played, there is the possibility that children will then turn to the seated video games. Further, if a child doesn't meet the activity intensity threshold required to keep an AVG running, this could have negative consequences. Such negative reinforcement may frustrate children and they may stop playing. Why not switch to the seated video game, where you can play for hours without being interrupted or by having to move around at a given intensity. After all, I'm playing video games, not exercising :) (my own personal jab at the AVG people - not reflective of the article)

3) By enhancing AVGs through deeper narratives and character development we would be encouraging children to spend more time indoors (active or otherwise). I suspect that games meant to simulate authentic activities will not lead to the same energy expenditure as the authentic activity itself - although I'm not aware of any study comparing energy expenditure between these two. Further, with deeper narratives and character development, as well as more detailed story line and plot, there may be less of a social aspect to these games. If the goal is to capitalize on what makes seated games so appealing (again, detailed story lines, narratives and character development) I think we can expect these games to become less, not more, social in nature. The benefit of this is that children are likely to play them longer by themselves (assuming point #2 is not an issue) and each individual child playing may achieve higher energy expenditure alone than in a group – each child would be playing instead of one playing and 3 sitting watching on the couch, as is the current model. The drawback of this is obviously the lack of social interaction with peers – video games can be a dangerous path to social isolation, and I for one don’t think that children need any more enticing to go down this path than they currently have.

4) The round table experts begin talking about the 'energy in' component of video games – in fact, some suggest that the link between video games and childhood obesity may have more to do with energy in (eating food) than energy out (exercise/activity). However, the majority of the solutions or areas for future direction for AVGs revolve around energy expenditure, save for a few examples of what might work for reducing food intake. If, as Amanda Staiano suggests, the driving factor for the link between video games and childhood obesity is increased caloric intake instead of the displacement of physical activity, why is there so much emphasis on making games more active? To the outsider, it would make more sense to do one of two things: the first would be to design games that promote less food intake (ie/ with less food advertisements)- however, there are still factors such as distraction mechanisms, habituation to food cues through non-food stimuli, associated learning to eat when gaming, increased stress response which may lead to over consumption and caloric compensation throughout the rest of the day. Suffice it say, this option doesn't seem realistic. In my opinion the best option to minimize the effect of screen time on childhood obesity is to reduce the amount of time kids spend in front of screens – period. TV, video games, computers, smart phones, tablets, etc. Kristi Adamo states an excellent point in her premise “if video games are a non-negotiable priority for children, [then] the ‘active’ gaming direction is logical”. Video games are not non-negotiable – like any behavior, moderation is key, and parents have a major role in demonstrating (through word and action) to their children that alternatives to screen time are feasible, enjoyable and salubrious.

So what then of AVGs? By using AVGs to reduce the prevalence of childhood obesity we may be missing the forest for the trees - video games, and screen-based sedentary behaviors in general, primarily through their associations with increased caloric intake, are a part of the obesogenic environment and thus play a role in the development of obesity. Using screens to reduce the prevalence of childhood obesity from a population perspective is not a viable or sustainable approach, no matter how "active" these screens are.

1 comment:

  1. In my opinion the best option to minimize the effect of screen time on childhood obesity is to reduce the amount of time kids spend in front of screens – period. TV, video games, computers, smart phones, tablets, etc.