Posts Tagged ‘ obesity ’

Is TV Viewing The Unhealthiest Screen Time For Kids?

Tuesday, April 9th, 2013

A new study published in Pediatrics suggests that it may be, at least when it comes to risk for obesity. 


91 teens (45 girls) around 14 years of age responded multiple times a day – via an electronic diary – to questions about what they were doing, over a 1-week period. Included were questions about a variety of screen time activities (for example, TV, video games, computer) and how much attention they were paying to each activity. Electronic diaries are an excellent method for getting kids to report on what they are doing in “real time” – it’s quick and easy for them to do and studies have shown that they provide reliable data using this method. The kids also had their height and weight measured by the research team in order to calculate their body mass index (BMI) – which is one metric used to measure risk for obesity.


The overall findings were intriguing. First, the raw amount of screen time reported by the kids was not associated with their BMI. The statistical association of interest involved TV, but again it wasn’t about how much TV the kids were watching. Rather, it was how engaged the kids were when watching TV that was associated with BMI – the more a kid reported that they were paying the MOST attention to TV (versus all other activities), the higher their BMI.


There are limitations to the study design that need to be addressed. The most prominent is that each teen was only observed during the 1-week period (this was a “cross-sectional” study).  Finding statistical associations in a cross-sectional design limits what we conclude because we can’t tease apart what leads to what.  It could be that kids with the highest BMI levels were the most likely to become engaged in TV viewing. It could be that TV viewing was one of the causative factors for their increased BMI levels. The point is that with these kinds of data we can’t distinguish between those interpretations. And of course we don’t have data on younger kids from this study, so technically there are no inferences to be made on non-teens.


Noting the limitation discussed above, researchers use cross-sectional data to generate and support hypotheses to be tested in future studies. The interesting idea that comes out of this paper is the speculation on the specific health risks associated with TV viewing versus other forms of screen time. One deserves particular mention. They note the potential impact of commercials promoting unhealthy foods – which may be particularly influential for kids who are highly engaged watchers. What’s interesting here is the idea that it’s not just about screen time, and it’s not just about TV – it’s about the specific risk of being a highly engaged TV viewer that seems to be linked with BMI. But future work will need to measure all these things and evaluate them longitudinally.


Clearly this paper is the beginning, and not the end, of the story. The story, however, may be quite informative for parents if future studies replicate and expand the finding – and particularly if longitudinal studies provide clearer evidence of the directionality of the findings and support for the hypothesized mechanisms. Starting with younger samples of kids and tracking them across time will help determine if engaged TV viewing is especially linked with increases in BMI. But right now the interesting idea for parents to think about – at all ages – the potential downside of when kids get too attached to passive activities. This study suggests that TV may be the worst culprit for multiple reasons. But the bigger picture is that we are probably moving away from talking about screen time per se – many kids are increasing rather than decreasing screen time – and shifting toward a focus on unhealthy habits and unhealthy content that may be linked with specific types of screen time.

So … right now keep on eye on when your kid seems most likely to pair eating with screen time, and see if you can discourage that link. And see for yourself at home if it seems to happen more when they are especially glued to the tube.

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Red-Hot Parenting Recap: The Top Child Health Topics In 2013

Monday, December 31st, 2012

In lieu of a review of the past month, I’d like to pose a question: What will be the big topics on child health and development in the coming year? Kara Corridan and I have taken a stab at predicting what these will be. We selected 6 topics: 

The Book That Will Change How Mental Disorders Are Diagnosed: Why you should know what the DSM-5 is and the hot-button issues it is raising

Kids And Play: New data and new thinking which suggests that kids are not getting enough of the right type of play

Pregnancy Health Risks: The emerging, and murky, data on potential prenatal risks and the complex decisions some pregnant women face

Injuries (The Downside Of Physical Activity): The realization that many youth are getting injured – some seriously – at an alarming rate

Post-Traumatic Stress Disorder: The very real consequences to kids when they are exposed to a number of traumas

Obesity: New efforts to combat this epidemic in kids

Click here to read our take on these topics. Since we published this, we have all been affected, in lasting ways, by the Sandy Hook shooting. So in addition to the above, I also anticipate much more debate and discussion about the 4 public health issues raised by that tragedy.

The one thing we know for sure is that 2013 will be a very important year for continuing our collective conversation about child health and development. Wishing you all a peaceful and good New Year.

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Is Maternal Obesity Linked With Autism? Let’s Take A Closer Look At the Study

Monday, April 9th, 2012

You may have seen or heard this morning about a new study that found links between maternal obesity and risk for autism. Here’s a breakdown on the study, the findings, and the take-home message.

What Did This Study Do? The research – published in Pediatrics – explored links between maternal metabolic conditions – specifically diabetes, hypertension, and obesity – and neurodevelopmental disorders in early childhood – particularly autism spectrum disorders (ASD) and developmental delays (DD). The sample was informative – it is a population-based sample in California that is participating in a very large investigation. That said, it’s important to keep in mind that maternal history of diabetes and hypertension during pregnancy, and obesity prior to pregnancy, were gathered retrospectively via a phone interview with the mother when kids were between 24 and 60 months of age, and also from medical records when available (which they were for over half the sample). I highlight this to emphasize that this is far from a definitive study  - not that it’s a bad study, just that it is more like the first word, rather than the last word, on this topic. Do note that the available data suggested that moms could reliably report retrospectively (when they compared their responses to available medical records) – but still, this is not as informative as a prospective study. Moms were selected based on the profiles of 3 types of youth – those with ASD, those with DD, and a general population (GP) control group with neither condition. The researchers then set out to examine if there were links between the maternal metabolic conditions and these three groups of kids. So keep in mind here that this is a statistical test of association, not a more controlled experimental test that can, if you will, “prove” the associations. These kinds of studies are critical first steps to determine if future research is warranted – and not the last steps that convince the scientific community that there is a causative process at play.

What Did They Find? Keeping all of the above in mind (you have to in order to make sense of the results), the study did find a statistical link between a mother’s report of having any of the metabolic conditions and the odds of having a child diagnosed with ASD and DD. It was a moderate statistical finding (meaning statistically significant but clearly not the only factor that contributes risk for ASD and DD). To give you a sense of the data, here are the percentages of mothers with a metabolic condition, broken down by youth diagnosis:

ASD: 28.6% of the mothers

DD: 34.9% of the mothers

GP: 19.4% of the mothers

So you can see how this is a moderate statistical link – for example: 1) the majority of moms of kids with ASD did not have any metabolic conditions, 2) almost 20% of the moms of kids from the general population control group did have a metabolic condition; and 3) the finding comes from the somewhat elevated rates in the ASD and DD groups compared to the GP group. More fine-grained analyses showed that obesity in particular was associated with ASD (after controlling for other factors) – but that diabetes had an effect on a number of cognitive and social outcomes.

What’s The Take-Home Message? There are two messages from my point of view. First, from the perspective of science, the study authors devote most of their attention in their discussion of the results on the biological mechanisms by which maternal diabetes – not maternal obesity – may impact brain development in babies. This is an important avenue for future research and a key contribution from the study. Second, from the perspective of being a prospective parent, the real take-home is that management of maternal metabolic conditions is not only critically important for a number of health outcomes, but also for promoting brain development in the early years of life. Rather than focusing on metabolic conditions as “causes” of disorders, it’s probably better advised to consider them as modifiable influences on development. Maternal obesity is important in this sense because it is one of many factors associated with diabetes – though keep in mind that gestational diabetes can of course occur without obesity. Diabetes – whether in place prior to pregnancy or occurring during pregnancy – is important because it might have biological influences on brain development. So this study just reinforces the bigger message that I hope everyone is aware of – that pregnant women should get vigilant care for potential or existing metabolic conditions during pregnancy, especially diabetes. It’s critical for the well-being of both mom and baby.

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When Will “SHOCK” Parenting Go Out Of Style?

Saturday, March 31st, 2012

Here we go again – another parent makes a big splash with outrageous claims about her parenting methods. This time it’s that Vogue article about one mother’s reaction to hearing that her daughter was obese – which turned out to be a pathologically inconsistent set of messages and dietary practices. I have three reactions to all this.

First, IF the claims are true, then I agree with the take offered by my fellow blogger Heather Morgan Shott. Heather tackles this issue much better than I could.

Second, IF this story was embellished, then I suggest in the future articles of this nature come with a warning label that says: “The truth has been stretched – and then some – in order to gain viewer’s eyes, make their blood boil, and give them something juicy to talk about.” This is especially relevant since the author of the Vogue article has a deal in place to expand her thoughts in a book. I don’t know if you recall what transpired when the Tiger Mom book came out early last year, but the sequence was roughly this: 1) the most outrageous quotes from the book were used to publicize it, 2) the author then suggested that those lines were clearly not to be taken literally, and 3) then it was suggested that the book was really just a memoir and not an endorsement of any type of unhealthy or damaging parenting practices. When all was said and done, we could look to recent research for some sanity, as it demonstrates what we would expect: 1) parents who push their kids really hard to achieve success without providing warmth, love and support place their kids at risk for depression and other not so great outcomes, and 2) it is possible to set high standards for your kids and help them be achievement oriented and actually act in a loving and supportive way at the same time. So to me the simple warning label suggested above would certainly help me figure out what the real message is the next time a SHOCKING book or article comes out.

Third, rather than focus more on this Vogue article, I’d love to hear real stories about real parents who are digging deep and trying hard to do the best for their kids. It’s not easy getting the balance right with respect to body image and health these days: we’re stuck between a multitude of social forces which, on the one hand, promote obesity, and, on the other hand, push kids toward eating disorders. Many parents struggle with their own histories of eating issues and body image concerns, and they are hopefully finding ways to promote realistic healthy eating habits and corresponding physical and cognitive pathways to positive self-esteem. I’d love to hear stories about how real parents handle these challenges. So consider this an invitation to share your story about how you balance all these concerns and what obstacles you face – we need to focus on REAL parenting rather than SHOCK parenting.

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Sleep Challenges, Part Two: Childhood And Middle Childhood

Saturday, December 31st, 2011

There are lots of transitions in kids sleep patterns and habits, including big ones that happen during the toddler years. That said, there are also critical changes that occur during childhood and middle childhood (I’m focusing here on 5 – 11 years of age). Most importantly, this is a developmental period where the consequences of sleep deprivation can be especially harmful. So the 2nd installment of my three-part series on sleep challenges focuses on childhood and middle childhood. 

What are the expectations? The biggest issue is that kids are in school for a good part of the year and as such are expected to have consistent sleep schedules that provide sufficient sleep to handle their cognitive, social, and emotional load. Kids between 5 and 11 years old should be getting between 10 and 11 hours of solid sleep every night, with consistent bedtimes and wake-up times. They also should not be tired during the day.

What are the challenges? Let’s start with the biggest challenge – understanding how much sleep your child actually needs and the negative consequences of not getting it. It’s troubling that study after study reports most kids get less sleep than they need – typically 1 hour less per night than is suggested. Add to this the observation from new studies that many kids get inconsistent sleep that can vary greatly from night to night. Such irregular sleep patterns have been shown to lead to substantial metabolic changes that promote risk for obesity and diabetes. And recent scientific reports – such as one that I flagged as one of the most influential studies of 2011 – have shown that sleep deprivation can have accumulating negative effects on cognitive development in childhood during key ages for learning (e.g., from 2nd grade through 4th grade). The culprits that undermine sleep can be many, including a lack of careful supervision of kids’ sleep habits, TV and electronics being available at bedtime (especially in the bedroom), increasing activities outside of school, and increasing time demands after school (such as homework).

How should you handle these challenges? We don’t typically think that sleep needs to be monitored in bigger kids like it does when we are dealing with babies or toddlers. But this isn’t true – in fact kids’ increasing independence screams out for parental monitoring given the sleep epidemic these days and the very real and serious consequences of sleep deprivation. A good start is to become familiar with the signs of sleep deprivation in children, which include the following

  • being very hard to wake-up on a consistent basis
  • sometimes falling asleep much earlier than usual
  • falling asleep frequently in the car
  • hearing from observers (such as teachers) that they seem tired, are yawning a lot, etc

If your child is showing some of these behaviors, it may be time to monitor their sleep habits more closely. Work backwards from when they need to get up and the amount of sleep they require to set a firm bedtime. Limit use of electronics before bedtime (maybe follow at a minimum a 30-minute rule – all technology gets shut down 30 minutes before bedtime). Promote reading as a good form of winding down. And try to be vigilant to make sure your child gets consistent sleep during the week – or put another way, try to avoid irregular sleep habits.

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