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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078026/
Part 1: Scoping Review: Video Games and Obesity in Children Part 1: Scoping Review: Video Games and Obesity in ChildrenMethods A systematic search of PubMed, PsycINFO, and CINAHL databases was conducted for studies published in the English language from December 2013 until November 2018. The search terms included a combination of MeSH Terms or engine specific search terms of video games (video gam*, active video gam*, exergam*) and obesity (obesity, adiposity). Observational studies in a child population (average age 2.0–18.9 years old) that assessed the relationship between obesity and video games (or vice versa) were included. Studies that included video games as a mediator or moderator of an association between a predictor variable (obesity-related behaviors such as sleep or diet) and obesity were also included [,]. Studies were excluded if they were conducted in children with a chronic condition (such as autism) or in adults; used a non-observational study design (such as case study, intervention, qualitative study, or systematic review); involved video game development (such as characters or features of video games); or were specific to video game addiction tendencies.Two authors (CLK and EDJ) independently screened abstracts retrieved from the initial search. Full text articles of selected abstracts were independently assessed for inclusion by the same authors. Any disagreement in eligibility after the abstract or full text process was resolved by the third author (AES). Reference lists of the included articles were scanned for relevance. Data were extracted into a pre-piloted form including type of study; population characteristics (age, race, setting, and country); study methodology; measures of video game play and obesity; and main results.Results The selection of studies is detailed in . Three hundred and twenty articles, including 319 articles from initial search and one article through reference lists of included full text articles, were identified. After removing 84 duplicates, 236 original articles were screened. In abstract screening, 164 abstracts did not pass screening as they included children with chronic conditions (n=17), were in adults (n=7), were interventions or qualitative studies (n=52), were systematic reviews or meta-analyses (n=43), assessed another media device (n=4), were focused on video game addiction (n=3), or were the outside of the scope of the review (n=38). The 38 abstracts that were outside of scope included those with no measure of video game play or assessed general sedentary behaviors (n=19), no measure of obesity (n=7), validation studies (n=4), assessed parental habits on obesity (n=3), were not in English (n=2), assessed only children who had obesity introducing no variability (n=1), were reporting on child-care general screen-time policies (n=1), or were an education guide for parents (n=1). Forty-three systematic reviews or meta-analyses from original screening of 236 articles were assessed for eligibility in Part 2. Thirty-nine articles excluded as they assessed broad energy balance behaviors (n=14), were outside of scope (n=12), addressed only video game play or obesity but not both (n=7), or were overall opinion pieces (n=6). The remaining 4 articles are discussed in Part 2 they pertain to exergames [–] or general video games [], and they present aggregate findings.Flow Chart of Study SelectionSeventy-two articles remained for full-text screening. Forty-six articles did not pass full-text screening as many articles (n=22) assessed aggregate screen time or combined TV/video games without specifically reporting on video game play separate from the other types of screen-time. Twenty-six articles were ultimately selected for data extraction [, , –].Descriptive characteristics of the included articles are reported in . In total, 25 cross-sectional studies and one longitudinal study with follow-up of 2 years were identified. Sample sizes of included studies ranged from 91 to 24,800 (median: 938), and half of studies were conducted in Canada (n=7) or the US (n=6). The youngest age range included was 2–13 years [], as most focused on the 10–12 year old age range [, , , –, ] or included a broad age range of adolescents ages 11–18 years old [, , , , , , ]. The oldest data were collected in 2001 [], and the most recent data collection was 2015 [], with all other studies occurring between these time points.Part 2: Video Games as an Intervention for Healthy Weight (Review of Reviews) Part 2: Video Games as an Intervention for Healthy Weight (Review of Reviews)In recent years, video game play has been a behavioral target for weight reduction and attenuation among children and adolescents – on the one hand, to reduce sedentary video game play and, conversely, to manipulate traditionally sedentary video games into physically active game play. This section summarizes the systematic reviews published from 2013–2018 that utilized video games in weight reduction interventions or weight attenuation, including 4 reviews identified in the literature search and 4 identified by the authors’ files. Descriptive characteristics of the included reviews are shown in .Part 3: Areas for Future Research Part 3: Areas for Future ResearchOverall, there is inconclusive evidence that video games directly influence childhood obesity, from both observational and intervention studies. There are multiple opportunities for future areas of research into video game play and its potential effects on childhood obesity, including better capturing quality or content not just quantity of video game play as related to obesity and related behaviors. Video games may positively influence snacking and unhealthy energy intake, which can lead to positive energy balance and excess weight gain [, ]. Similar mechanisms have been proposed for TV viewing, which may evoke similar sedentary behavior as traditional console-based sedentary video game play but differ from mobile-based gaming [, , ]. There is a growing interest in video game play before bedtime due to delaying sleep onset and shortening sleep duration, as youth with shorter sleep duration have been shown to consume more calories [, ] and have higher prevalence of obesity [].Co-participation and within game socialization are areas to be investigated as social interaction is a main feature of many video games and may differentially impact obesity-related behaviors []. Two-thirds of parents play video games with their child at least once a week, thus reducing parental screen-time may influence child video game play []. This area warrants additional research.Understanding the extent to which exergames may be integrated into comprehensive behavioral change programs is warranted, as coupling exergames with nutrition education and psychosocial counseling has produced reduction in children’s weight status []. The assessment of video game play needs to extend into other popular modalities such as esport leagues, which are competitive video game leagues including both individual and team options []. Esports are quickly growing popularity and projected to reach a $23.5 billion industry itself by 2020 []. The mass use and social acceptability of video gaming may have downstream influences on energy-related behaviors on children [].While this review did not specifically examine video game addiction, further investigations are needed into pathways of video game addiction and potential links to obesity []. Video game addiction has been associated other negative outcomes, including lower school performance and higher substance use in adolescence [] and problematic gaming behaviors later in life [].Strengths of the current body of literature include that there are several reports of video game play and obesity specifically in children and adolescents. The relationship of video game play with other obesity metrics (such as body fat percentage) are also beginning to be reported in the scientific literature to add precision beyond anthropometry [, , ]. Further, more investigation of potential mediation and moderation models [, ] will help to advance the understanding of the complex relationship between video game play and obesity via behavioral mechanisms.There are still many limitations and areas of improvement in this field. A chief limitation is the lack of prospective trials. In the 12 of 26 articles that did report significant associations between video game play and obesity, it is not possible to identify causal relationships. Is video game play causing childhood obesity, or are children with obesity more likely to play video games, or does video game play cluster with other obesogenic behaviors like higher dietary intake and poor sleep and these behaviors may independently explain observed associations? Another limitation of the literature is that video games advance at a much faster speed than study protocols. This lag limits the potential for long-term studies and creates a constantly evolving definition of video games. These challenges may be surmountable with nimble protocol designs and industry-research partnerships []. Finally, the objective measurement of video game play has not yet advanced, and research has continually relied on self-report data. Objective measures of television use are possible [], but video game consoles can also be used for many other purposes (streaming services), video games can be played on multiple platforms (cell phone, console, or computer), and modern video game play varies widely in terms of content (e.g. from first person shooter to dance and sports games to augmented reality in a fantasy world). Therefore, it is increasingly difficult to unobtrusively and objectively quantify children’s video game play.CONCLUSIONSOverall, there is inconclusive evidence that video games are associated with obesity and, due to the lack of longitudinal studies, virtually no evidence to evaluate if video game play directly contributes to obesity or weight gain in children. On the other hand, there is some (limited) evidence that video game play that involves physical activity can be integrated within behavioral programs to help children to lose weight and attenuate weight gain. Future research should delve into the co-occurrence of video game play with obesogenic behaviors and continue to keep pace with the constantly growing and evolving video game industry to understand the impact of this popular pastime on children’s health.Acknowledgements:We would like to acknowledge Lori Steib and Stacie Davis for their assistance in retrieving journal articles for the review.Funding: CLK was supported by T32DK064584from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. AES was supported in part by 1 U54 from the National Institute of General Medical Sciences of the NIH, which funds the Louisiana Clinical and Translational Science Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.FootnotesConflict of Interest: Kracht, Joseph, and Staiano declare that they have no conflict of interest.Human and Animal Rights and Informed Consent: This article does not contain any studies with human subjects performed by any of the authors.REFERENCES1. Entertainment Software Association. Essential facts about the computer and video game industry [press release] (2018.
Author: Chelsea L. Kracht, Elizabeth D. Joseph, Amanda E. Staiano
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