ReviewSedentary behaviour and obesity development in children and adolescents
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.
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