AAP Guidelines Address Youth, Obesity, and the Media

From Medscape Medical News

Laurie Barclay, MD

June 29, 2011 — At every well-child visit, pediatricians should ask about daily screen time and whether the child's bedroom has a television (TV) or Internet connection, according to an American Academy of Pediatrics (AAP) policy statement reported online June 27 in Pediatrics.

"Obesity has become a worldwide public health problem," write Victor C. Strasburger, MD, and colleagues from the 2010-2011 AAP Council on Communications and Media. "Considerable research has shown that the media contribute to the development of child and adolescent obesity, although the exact mechanism remains unclear. Screen time may displace more active pursuits, advertising of junk food and fast food increases children's requests for those particular foods and products, snacking increases while watching TV or movies, and late-night screen time may interfere with getting adequate amounts of sleep, which is a known risk factor for obesity."

The effect of TV viewing on children's weight status appears to be intensified by having a TV set in the child's bedroom. In a study of 2343 children aged 9 to 12 years, the presence of a TV set in the child's bedroom was a significant risk factor for obesity, independent of physical activity levels. Another cross-sectional study showed that 1- to 5-year-olds who had a bedroom TV were more likely to be overweight or obese. Compared with teenagers who did not have a bedroom TV, those who did spent more time on TV viewing and less time on physical activity. They also ate fewer family meals and fewer vegetables and drank more sweetened beverages.

Other harmful effects of TV and other media include disruption of sleep patterns. In a longitudinal study of adolescents in New York, those who watched 3 or more hours/day of TV had double the risk for difficulty falling asleep compared with those who watched TV less than 1 hour/day. Sleep displaced by TV or media viewing may also be associated with increased risk for obesity.

Sleep loss may increase snacking and consumption of less healthy foods to maintain energy; it may cause fatigue, and therefore increase sedentary behavior; and it may also have direct metabolic consequences.
 
AAP Recommendations
Specific AAP recommendations regarding dealing with media use as a risk factor for youth obesity include the following:

• As recommended in Bright Futures guidelines, every well-child visit should include asking parents and patients 2 key questions about media use: How much time does the child or teenager spend with screen media per day? Is there a TV set or unrestricted, unmonitored Internet connection in the child's bedroom or throughout the house?
• Pediatricians should encourage parents to monitor their child's TV viewing, to educate their child regarding good nutrition, and to discuss food commercials with their child.
• Pediatricians should advise parents to limit total noneducational screen time to 2 or fewer hours/day, to refrain from placing TV sets and Internet connections in their child's bedroom, to coview with their children, to facilitate good sleep habits by limiting use of screen media at night, and to avoid screen exposure for infants younger than 2 years.
• Pediatricians should collaborate with community groups and schools to conduct media education programs in childcare centers, schools, and community-based institutions such as the YMCA. These programs should teach children how to understand and interpret commercials and should teach parents about limiting overall media use.
• Pediatricians should collaborate with their state chapters, the AAP, parent and public health organizations, and the federal government to petition Congress, the Federal Trade Commission, and the Federal Communications Commission to ban junk food advertising during programming viewed mostly by young children. They should also advocate for bans on interactive advertising involving junk food or fast food to children via digital TV, cellular telephones, and other media, and for bans on payments for product placement in movies.
• Pediatricians should ask Congress to fund media research on the interaction of heavy media use in children with stress in the home or other psychosocial elements of the child's life. Other research topics should include the role of new media technologies in increasing advertising exposure or encouraging more sedentary behavior, the relative effects of these mechanisms on obesity, and how to counteract these effects.
• Pediatricians should advocate for more counteradvertising and more prosocial video games and Web sites encouraging children to choose healthy foods.
• Pediatricians should realize that children with high levels of screen time have increased childhood stress, which increases their risk for stress-associated conditions including mood disorders, substance abuse, diabetes, cardiovascular disease, and asthma. Replacing screen time with more prosocial or resilience-building activities, such as exercise and imaginative or social play, may therefore help prevent or ameliorate a wide range of conditions in addition to obesity.

"Media clearly play an important role in the current epidemic of childhood and adolescent obesity," the authors conclude. "The sheer number of advertisements that children and adolescents see for junk food and fast food have an effect. So, too, does the shift away from good nutritional practices that increased media screen time seems to create. Any success in dealing with the current epidemic will require a major change in society's recognition of media exposure as a major risk factor for obesity and in young people's media habits and the advertisements to which they are exposed."
Pediatrics. Published online June 27, 2011. Full text