AAP Guidelines Address Youth, Obesity, and the Media

[Guest guest]

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<http://pediatrics.aappublications.org/content/early/2011/06/23/peds.2011-\

1066.full.pdf>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<http://pediatrics.aappublications.org/content/early/2011/06/23/peds.2011-10\

66.full.pdf>

--

Ortiz, MS, RD

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