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Systematic review of the influence of digital media on the body weight of children and adolescents in connection with their physical activity

Leonie Albrecht BA / Dr. med. Pia Runge

Digital media consumption in western industrialized countries is becoming increasingly widespread. These include the use of computers, online services, smartphones, game consoles and television (Colombani & Videlaine, 2013). All of these digital media make up a large proportion of children and young people's leisure activities (Feierabend, Plankenhorn, Rathgeb & Behrens, 2017a, 2017b). Current study results by Feierabend et al. (2017b) show that 98% of German households are equipped with media devices, usually with a large number of them. At the same time, industrialized countries are increasingly confronted with diseases of affluence such as obesity and overweight, which, in addition to the health impairment, also represent a corresponding financial burden on the health systems (Branca, Nikogosian & Lobstein, 2007; Bader, 2012). Data from the Robert Koch Institute's Child and Adolescent Health Survey (KiGGS) show that in 2008, 15% of 3 to 17-year-old German children and adolescents were overweight. Of these, 6.3% are affected by obesity (Kurth & Schaffrath Rosario, 2010). It is questionable which intervention programs can successfully reduce screen time and whether they actually have an influence on BMI. It is possible that digital media can even be used as an opportunity to exercise and thus have a positive influence on BMI.

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First publication date: 04.04.2019
Leonie Albrecht BALeonie Albrecht BADr. med. Pia RungeDr. med. Pia Runge

DOI

http://doi.org/10.24945/MVF.06.19.1866-0533.2193

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Abstract: Systematisches Review zum Einfluss digitaler Medien auf das Körpergewicht von Kindern und Jugendlichen im Zusammenhang mit deren physischen Aktivität

The aim of this work is to show the current state of research on the topic of “Influence of digital media on the body weight of children and young people in connection with their physical activity” based on studies from the last five years. Six RCTs met the specified inclusion and exclusion criteria and were used for the systematic review. The results show that health-related behavior patterns (such as food intake, physical activity and screen use) were improved to a small extent, but there is no significant effect on BMI and prevention of obesity and overweight. This shows that digital media represent an opportunity to reach children and young people well, to motivate them and to strengthen their interest and self-awareness and to initiate self-control.

Abstract: Impact of digital media on the body weight of children and adolescents in relation to their physical activity - a systematic review

Purpose of this systematic review is to identify the current state of research on the topic “the impact of digital media on the weight of children and adolescents in relation to their physical activity” based on studies of the last five years. Six RCTs met the specified inclusion and exclusion criteria and were used for the systematic review. The results show that health-related behaviors (such as food intake, physical activity and screen usage) have been slightly improved, but there is no significant impact on BMI and the prevention of overweight and obesity. As a result, digital media is a way to reach and motivate children and adolescents. Thus, both interest and self-awareness can be strengthened and self-control initiated.

Keywords (English)

BMI, digital media, obesity, overweight

Literature

References Christison, A., Evans, T., Bleess, B., Wang, H., Aldag, J. & Binns, H. (2016). Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management. Games for Health Journal, 5(6), 382–388.https://doi.org/10.1089/g4h.2015.0097 Colombani, L. & Videlaine, F. (2013). The age of curation: From abundance to discovery. Bain & Company. Retrieved from: http://www.bain.com/publications/articles/theage-of-curation-from-abundance-to-discovery.aspx on June 7, 2018 Feierabend, S., Plankenhorn, T., Rathgeb, T. & Behrens, P. (2017b). KIM Study 2016: Childhood, Internet, Media. Media Education Research Association Southwest, 92. Retrieved from: https://www.mpfs.de/fileadmin/files/Studien/KIM/2016/KIM_2016_Web-PDF.pdf ). Overweight and obesity among children and adolescents in Germany. Federal Health Gazette – Health Research XI Health Protection, 53(7), 643–652. https://doi.org/10.1007/s00103-010-1083-2 Lynch, B.A., Gentile, N., Maxson, J., Quigg, S., Swenson, L. & Kaufman, T. (2016). Elementary school–based obesity intervention using an educational curriculum. Journal of Primary Care and Community Health, 7(4), 265-271. https://doi.org/10.1177/2150131916644888 Maddison, R., Marsh, S., Foley, L., Epstein, LH, Olds, T., Dewes, O. & Mhurchu, CN (2014). Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 1–11. https://doi.org/10.1186/s12966-014-0111-2 Nollen, N., Mayo, M., Calson, S., Rapoff, M., Goggin, KJ & Ellerbeck, EF (2015). Mobile Technology for Obesity Prevention A Randomized Pilot Study in Racial and Ethnic Minority Girls, 46(4), 404–408. https://doi.org/10.1016/j.amepre.2013.12.011.Mobile Robinson, TN, Matheson, D., Desai, M., Wilson, D., Weintraub, D., Haskell, W. & Killen, J (2013). Family, Community and Clinic Collaboration to Treat Overweight and Obese Children: Stanford GOALS -- a Randomized Controlled Trial of a Three-Year, Multi-Component, Multi-Level, Multi-Setting Intervention, 36(2), 389–399. https://doi.org/10.1016/j.cct.2013.09.001. Sandner, B. (2017). Influence of digital media on the health of children and adolescents, 29–32. Smith, JJ, Morgan, PJ, Plotnikoff, RC, Dally, KA, Salmon, J, Okely, AD & Lubans, DR (2014). Smart-Phone Obesity Prevention Trial for Adolescent Boys in Low-Income Communities: The ATLAS RCT. Pediatrics, 134(3), e723–e731. https://doi.org/10.1542/peds.2014-1012 World Health Organization (WHO), Branca, F., Nikogosian, H., & Lobstein, T. (nd). The challenge of obesity and strategies to combat it. World Health Organization (WHO), (n.d.). Body mass index -BMI. Retrieved from http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/ahealthy-lifestyle/body-mass-index-bmi. on June 27, 2018.

Additional Information

Citation: Albrecht, L., Runge, P.: “Systematic review of the influence of digital media on the body weight of children and young people in connection with their physical activity”, in: “Monitor Healthcare Research” (06/19), pp. 61-64, doi: 10.24945/MVF.06.19.1866-0533.2193

Plain Text

Influence of digital media on the body weight of children and adolescents in connection with their physical activity - a systematic review

Digital media consumption in western industrialized countries is becoming increasingly widespread. These include the use of computers, online services, smartphones, game consoles and television (Colombani & Videlaine, 2013). All of these digital media make up a large proportion of children and young people's leisure activities (Feierabend, Plankenhorn, Rathgeb & Behrens, 2017a, 2017b). Current study results by Feierabend et al. (2017b) show that 98% of German households are equipped with media devices, usually with a large number of them. At the same time, industrialized countries are increasingly confronted with diseases of affluence such as obesity and overweight, which, in addition to the health impairment, also represent a corresponding financial burden on the health systems (Branca, Nikogosian & Lobstein, 2007; Bader, 2012). Data from the Robert Koch Institute's Child and Adolescent Health Survey (KiGGS) show that in 2008, 15% of 3 to 17-year-old German children and adolescents were overweight. Of these, 6.3% are affected by obesity (Kurth & Schaffrath Rosario, 2010). It is questionable which intervention programs can successfully reduce screen time and whether they actually have an influence on BMI. It is possible that digital media can even be used as an opportunity to exercise and thus have a positive influence on BMI.

>> The three medical databases Pubmed, Cochrane Library and Livivo were searched using the following search word combinations:
1. “overweight” AND “screen time”
a. “overweight” AND “screen time” NOT “food” (Pubmed)
b. “overweight” AND “screen time” AND “children” (Livivo)

Studies depicted in this way were minimized using defined inclusion and exclusion criteria and filtered through a subsequent manual search or an assessment of the relevance of the studies found based on the headings and abstract. The predetermined exclusion criteria are as follows:
A1: Study is not published in English or German,
A2: Study addresses a different question and/or a different topic,
A3: publication date before 2008,
A4: Case studies, reviews, meta-analyses, books, cross-sectional studies,
A5: Studies use measurement methods other than BMI,
A6: Study participants are competitive or top athletes,
A7: only study participants who have another diagnosed illness (in addition to obesity) or disability,
A8: Study from a non-industrial country,
A9: Study participants under 4 and over 18 years old,
A10: Double publications. The recording of the relevant studies is shown below as a flow chart (Fig. 1).

Results

Through the literature search, six out of a total of 1,150 publications were identified that met the previously defined inclusion and exclusion criteria. All studies are based on randomized controlled trials (RCTs) and record both BMI and screen time. For an overview, the included publications including methods, interventions, control groups (CG) and results are shown in Tables 1 to 3. The validity of the individual studies is then assessed using the Physiotherapy Evidence Database scale (PEDro scale).
discussion
All six studies are based on randomized controlled studies that score between five and seven points on the PEDro scale. They vary in terms of the number of test subjects from 51 to 361 participants per study and cover an age range from 7 to 14 years. Four studies refer exclusively to children up to 12 years old (Christison et al., 2016; Lynch et al., 2016; Maddison et al., 2014; Robinson et al., 2013), one study includes 9 to 14 year olds (Nollen et al., 2015) and one publication only examines adolescents between 12 and 14 years old (Smith et al., 2014). Additionally, the study by Smith et al. (2014) only used male subjects, while those of Nollen et al. (2015) only included females. The differences in group size, age and gender make a direct comparison difficult. The number of participants in three studies is limited to small sample sizes of 51 to 80 subjects (Christison et al., 2016; Lynch et al., 2016; Nollen et al., 2015). All three demonstrate that the intervention has no significant effect on BMI or screen time. The studies by Maddison et al. (2014) and Smith et al. (2014), who cover a broader spectrum with sample sizes of 251 to 361 subjects, confirm these results. They also found no significant change in BMI, only Smith et al. (2014) reported a significant reduction in screen time.
Mitchell et al. (2013) were able to determine an effect of reported screen time on the change in BMI of the upper percentiles (50, 75, 90) in their longitudinal study “Greater screen time is associated with adolescent obesity”, while no interaction was observed for the 10th and 25th percentiles . For the studies of the six included RCTs, this would mean that different results would emerge depending on the initial BMI value of the children measured. Those studies that already examine overweight and obese children should be able to achieve a positive effect on BMI. Madison et al. (2014), Christison et al. (2016) and Robinson et al. (2013) only include overweight or obese children, while Smith et al. (2014) included those who have an increased risk of overweight and obesity. However, they do not show a clear effect after the intervention, just as Nollen et al. (2015) and Lynch et al. (2016), who do not include weight status in the inclusion and exclusion criteria. If the focus of the analysis is on gender separation, the studies that dealt exclusively with male (Smith et al., 2014) or exclusively with female test subjects (Nollen et al., 2015) come to the fore. They are similar in that both studies use digital media (apps or computers) to support the intervention program and to increase the motivation of children and young people. They both confirmed no significant differences in BMI, but boys were able to reduce their screen time while girls were not. On the one hand, it is questionable to what extent it is realistic to achieve a reduction in screen time by introducing screens and their benefits via apps. On the other hand, it is uncertain why girls in the study by Nollen et al. (2015) were unable to achieve this effect when boys could (Smith et al., 2014). Both groups of participants self-assessed their screen time using a questionnaire. In a study by Feierabend et al. (2017a) it is observed that girls spend more time using digital media with 206 minutes per day than boys with 194 minutes. This was also calculated using self-assessments. It remains to be seen whether the estimates correspond to the actual time or whether girls tend to overestimate themselves while boys underestimate themselves or whether one gender can classify itself more realistically. The results of Nollen et al. also remain unclear. (2015) and Smith et al. (2014), as children must be trusted to be correct and accurate in the self-completed questionnaire.

conclusion

The results show that it is possible to use digital media to reach children and young people, motivate them and send them repeated reminders, tasks and individual challenges. This can strengthen both interest and self-awareness and initiate self-control. A more conscious diet, less sedentary behavior and more physical activity could be achieved to a small extent, but there was no significant effect on BMI. It is obvious that none of the multifactorially applied interventions had a significant impact on the prevention of overweight and obesity. Only the intervention with the smartphone app developed for young people found an effect on reducing screen time, demonstrating the benefits of digital media. This makes it even clearer how important the topic is for the future and the development of an effective concept to combat the obesity epidemic. There is still a need for research to develop innovative and evidence-based approaches. The studies should consider whether it is possible to set actual limits on screen time. The topic will by no means lose its relevance, as the diversity of electronic media is increasing rapidly and no stopping or even reversing trend can be seen (Sandner, 2017). Furthermore, the long-term influence should be examined through follow-up studies. The study “Family, Community and Clinic Collaboration to Treat Overweight and Obese Children: Stanford GOALS – a Randomized Controlled Trial of a Three-Year, Multi-Component, Multi-Level, Multi-Setting Intervention” by Robinson et al. (2013) lays the first foundation for a comprehensive investigation with a high level of evidence. <<

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