# Lentis/Children,Video Games and Obesity

This chapter, "Children, Video Games and Obesity," aims to examine the relationship between children playing video games and obesity. With obesity now being perceived as a threat comparable to smoking, drinking, and poverty, researchers are examining the detrimental impacts of video games on the younger population. This chapter will investigate those impacts along with the potential benefits of video games and the positive outlook it may have in the future.

## Background

For many individuals, playing video games is a popular activity. It has shaped the lives of children and adults who find enjoyment from engaging in video games. On average, boys spend more than two hours per day playing video games, while girls spend more than an hour. Teens are shown to spend more time involved in gaming than younger children. There are games that allow the user to engage with other players and talk to unknown individuals. There are many categories of video games and some highlight content that may be deemed inappropriate for children and young adults:
* Use of abusive drugs and alcohol
* Criminal behavior
* Sexual assault and violence towards women
* Racial violence and stereotypes
* Abusive language
Obesity in children in today's society is a public health threat in developed countries. More than one in three children in the United States are overweight by the time they leave primary school. Obesity is primarily caused by an excessive caloric intake that is not lost through being active and fit. Consuming high-caloric dense food without an active lifestyle where children are engaged in other activities, they experience an imbalance of a proper lifestyle where their mental and physical health are at risk. Every hour that a child plays video games or watch television may increase their risk of obesity.
The idea that video game consumption must have a strong correlation to increased prevalence of obesity in children is not far fetched. There are a few hypothesis to this claim. The first being that long term video game use suggest a sedentary lifestyle with limited physical activity. The second determines that there is an increased caloric intake from eating during engagement in video games without any physical activity. Regardless, there is a public concern where it's important for people to recognize that some young gamers could be at risk of weight increase.

## Children

The term "child" has evolved in recent years. In previous generations, the term "child" could be represented as teenager or adolescent, or young people in general. Christian Smith, a professor of sociology at the University of Notre Dame, wrote about a new phenomenon that he refers to as, "adultolescence." He described this new phenomenon as the tendency to delay adulthood and retain a youth mindset. With the emergence of this new definition, it is clear that the term "child" has a much broader definition including those who are in there "adultolescene." Several case studies clearly suggest that this phenomenon of "adultolescence" is prevalent in playing video games. Although this chapter mainly focuses on the direct relationship between video games and obesity, our research will not limit the scope of the study to conventional definitions of the term "children." We will look into a larger age group that possibly could include young adults, or those people who are in their "adultolescence."

## Statistics

It is easy to see a relationship between obesity and video games. If a child is addicted to video games, he's unlikely to get a sufficient amount of exercise. This lack of exercise will result in the failure to burn the necessary amount of calories to maintain his body weight. This will then convert the excess calories into fat which can lead to obesity. The prominence of video games has led to an increase in the number of overweight children in the United States. In the United States, one out of every three kids is either overweight or obese. Out of that 33% of children, 17% meet the qualification of obesity.
A study by the Yale University School of Medicine, National Institutes of Health, and the California Pacific Medical Center found that the average child today spends 45 hours a week with television, movies, magazines, music, the Internet, cellphones, and video games. The study analyzed seven different long term negative health effects including: attention deficit disorder with hyperactivity (ADDH), obesity, low academic achievement, tobacco use, drug use, alcohol use, and sexual behavior. The strongest connection was between screen-time and childhood obesity.
The statistics suggest that there may be a positive correlation between playing video games and child obesity is plausible.
Another study considered factors associated with obesity in 872 children in Switzerland. Researchers have found that for every hour a child spends playing video games doubled the possibility that the child is obese. There are other factors that can contribute to early obesity in children, such as a father who smoked or a mother who works outside the house. Factors that can lower the risk of obesity include physical activity and eating breakfast. The study further includes children from other countries living in Switzerland were more likely to be obese as Swiss children. It mentions how some non-swiss children live a sedentary lifestyle, watching more television and being less physically active than Swiss children.
Children engaging in video games often has shown to increase their body mass index when they're older. Another study in the UK considered the health and behavior of 16,000 children within the UK throughout several points in their lives and early adulthood. They found that those who were regularly exposed to playing video games as a child had a much higher BMI years later compared to others that did not engage in these activities. Having an irregular bedtime and the consumption of sugary drinks may suggest that these behaviors could be possible factors for the gradual weight gain that corresponds to the video game-BMI study. The research was managed by the University of Leeds, University College London, Queen's University Belfast, University of Stirling and The Behavioralist, London.
One should not assume, however, that all the evidence suggests that video games will necessarily produce obesity in children. A 2011 review of thirty-four studies in this area by Stacey Guy, et al. suggests that the “stigma” connecting video games with childhood obesity can be challenged. Some of these studies showed that children can receive benefits from gaming like increased physical activity and nutritional knowledge (depending on the games that are played). The researchers also noted that the popularity of “social gaming” in products like Farmville (Zynga Inc.) and Second Life (Linden Research, Inc.) provided new avenues for the prevention of obesity and the promotion of self-care.
Although there are many studies that link childhood obesity with time spent playing video games, this research strongly suggests an independent association. There is a possible connection between children engaging in video games to an increased likelihood to obesity as they grow older. There is a need for prevention programs that aim to reduce the risk factors identified from possible causes of childhood obesity.

## Potential Risks

Engaging in video games has been shown to affect sleep deprivation, depression, anxiety, aggression, and circadian rhythm disorders. Although not directly correlated, these factors may influence a child's health and could cause irrational decisions to be made that can further hamper their health. More studies need to be conducted, however, to understand the full extent of these connections to childhood obesity.
A child with obesity, however, can have both immediate and long-term effects on their health.

### Immediate Effects

* Obese children are more likely to have high cholesterol or high blood pressure which can lead to heart disease.
* Obese adolescents are more likely to have pre-diabetes that can lead into type 2 diabetes.
* Children and adolescents who are obese are at greater risk for bone and joint problems, asthma, and sleep apnea.
* Obese children and adolescents are at a greater risk of social and psychological problems including stigmatization and poor self-esteem.

### Long-Term Effects

* Children and adolescents who are obese are likely to stay obese throughout their adulthood. This puts them at risk for adult health problems, such as heart disease, type 2 diabetes, stroke, and several types of cancer.
* Obesity that is left untreated can cause a number of health conditions, such as high blood pressure, unhealthy cholesterol, asthma, and infertility.
* The social and emotional affects of obesity include discrimination, lower quality of life, depression, and lower wages.

## Potential Benefits

There are definitely some potential benefits to video games. For instance, public schools across the nation are using the iPad as teaching tool. Various applications for games, like Jeopardy, can help teach students new material in captivating ways. Some other benefits include:
* Video games can help children who are ill or injured. Some hospitals encourage children to play video games while undergoing painful treatments to distract them from pain and discomfort.
* A professor at Nottingham University wrote in a medical journal that playing games could help children with attention disorders.
* Some video games are known to improve hand-eye co-ordination.
* Some games induce decision making skills and develop critical thinking.

## Positive Outlook on Video Games
### Nintendo's Wii Fit, Microsoft's XBox Kinect and Sony's PlayStation Move

Major video game companies such as Nintendo and Microsoft, are aware of the potential relationship between obesity and playing video games. They are introducing a variety of games and devices that alleviate the risk of obesity while playing video games.
On December 1, 2007, Nintendo introduced Wii Fit, a video game that requires the user to exercise while playing the game. Upon release, Wii Fit quickly became popular among gamers, and this success quickly forced Nintendo's competitors, such as Microsoft and Sony, to introduce similar gaming devices.
On June 2, 2010, Sony introduced the PlayStation Move, a motion sensing controller that is used in game playing. The movement of this handheld device is captured by PlayStation Camera and allows interface between the game and the user.
On November 4, 2010, Microsoft introduced XBox KINECT, a motion sensing input device for the XBOX 360 video game console. This device detects the movement of the gamer, which allows users to play games with their body movements.
All of these devices have been hugely successful; Wii Fit is currently the third best-selling console in history with 22.61 million copies sold as of May, 2010. Microsoft has sold 10 million copies of XBox Kinect as of March 9, 2011 and Sony sold 8.8 million copies of PlayStation Move as of June 2011.

### Effectiveness of Active Video Games (AVGs)

The release of Wii Fit and XBox Kinect has ushered in a new era of video games: Active Video Games (AVGs). AVGs, also known as "exergames," combines exercise and video games. The effectiveness of AVGs was studied by researchers at Michigan State University. The research involved 354 participants and focused on the heart rate, oxygen consumption and energy expenditure of each participant. Researchers concluded that "the effects of playing AVGs did not differ significantly between children and adults in terms of HR (Heart Rate) and VO2 (Volume of Oxygen Consumption). However, children yielded larger effects than adults in terms of [energy expenditure]." Thus, the implementation of these AVGs could be more effective to children who play video games.

### VR (Virtual Reality) Games

The creation of virtual reality headsets like the Oculus Rift and the HTC Vive in the early 2010s introduced a new type of video games: VR (Virtual Reality) Games. Many video game companies, such as Survios and Beat Games, took advantage of virtual reality to create games that combined fun with fitness.
On June 13, 2017, FitXR introduced BoxVR, a VR game where the player does boxing movements through workouts. The player is required to squat and to swing their arms in order to succeed at the game.
On February 8, 2018, Survios introduced Sprint Vector, a VR game where the player races against a computer AI offline or other players online. The player is required to swing their arms in order to move their character.
On May 1, 2018, Beat Games introduced Beat Saber, a VR game where the player slices blocks to the rhythm of a song. The player is required to swing their arms in order to slice the blocks.
Each of these VR games have been successful. FitXR has sold over 50 thousand copies of BoxVR as of November 2018. Survios has sold around 27,704 units for Sprint Vector on the gaming platform Steam as of November 2022. Beat Games “has sold over four million copies across platforms and over 40 million songs from paid downloadable content” for Beat Saber as of February 2021.

### Effectiveness of VR (Virtual Reality) Games

One early study of the potential positives impact of virtual reality games on the health of children was published in 2011 by Leon M. Straker, et al. in the BMC journal. Thirty children from Australia and New Zealand ages ten to twelve years with poor motor coordination participated in the study and made use of virtual reality games for sixteen weeks. The study revealed that the use of the VR games may have a positive impact on gross motor development, especially in comparison to the use of games with a traditional interface such as keyboard, mouse, or game pad. Researchers noted, in particular, increased expenditures of energy, heart rate, and ventilation volume when children played with VR games in comparison to play with traditional interface games.
The effectiveness of VR games has been investigated by researchers from Games for Health Journal in 2018. The research involved 41 healthy men and women between the ages 18 and 39 and three different VR games. Each one of the participants “played each game for 10 minutes while researchers measured their heart rate and oxygen consumption with VO2 max testing equipment.” The researchers found that “the physical activity required for all three of the games met energy expenditure benchmarks for moderate- to vigorous-intensity exercise.” Therefore, the creation of VR games can be an effective workout for anybody.
Positive Results of Parental Monitoring
It is clear that children spend more time with electronic media, including video games, than they do with any other activity. This can lead to childhood obesity. Recent studies, suggest, however that parental monitoring can serve as a remedy for over-use of media. If parents carefully monitor their child’s use of media, then the child can gain the benefits of media use without suffering negative side effects, like the risk of obesity.
A 2012 study by Douglas Gentile, et al., noted that parental monitoring of children’s media usage can reduce negative effects of media exposure on children. The study involved 1,323 children, their parents, and teachers. Three primary types of monitoring were included: active mediation, restrictive mediation, and coviewing. Active mediation involves parent-child conversations about media and was most effective. Restrictive mediation involved parental limitations of the amount of time and the content of media used by children. Coviewing, as the name indicates, refers to parents and children using media together.
Another 2014 study conducted by Douglas Gentile, et al. begins by noting that the American Association of Pediatrics (AAP) suggests that nearly half (47%) of all children exceed the recommended limits of two hours of media consumption per day. Children spend an average of 40 hours per week in viewing television, movies, and/or video games. The only activity they spend more time doing is sleeping. The study took place over a seven-month period and demonstrated that parental involvement resulted in better academic and social performance of students and aided their health, especially in allowing for more sleep.

## Case Studies

In March 2011, Rebecca Christie, 28, was sentenced to 25-years in prison for second degree murder and child abuse charges. She allowed her three-year-old daughter, Brandi Wulf, to die of malnutrition and dehydration while she was occupied with chatting and playing World of Warcraft. This case study shows how the new phenomenon of “adultolescence” can be present with video games.
In July 2007, Michael Straw, 25, and Iana Straw, 23, pleaded guilty for child neglect charges. They both allowed their two children to be severely malnourished while they were preoccupied with the online video game “Dungeons & Dragons”. As a result of this, both of the children suffered health complications. According to the police, the hospital staff had to treat the younger child for “a mouth infection, dry skin, and severe dehydration” and the older child for “starvation and genital infection.” Patrick Killen, spokesman for Nevada Child Abuse Prevention, stated that “it’s easy for someone to get addicted to something and neglect their children.” This case study shows another occurrence of the presence of “adultolescence” with video games.
In August 2011, Chris Staniforth reportedly played the game "Halo" on his XBox for 12 consecutive hours. As a result he suffered from a deep vein thrombosis. The night before his death, Chris called a friend because he was experiencing some complications. His friend stated, "He said his heart rate had been incredibly low but it went back to normal and he fell asleep again." The following morning Chris and his friend were searching for jobs when Chris "dropped a packet of chewing gum and as he picked it up, he jolted back and began to spasm." His friend called the medics, but it was too late. The deep vein thrombosis, that caused Chris' death, was triggered by sitting in one position for long periods of time. A coroner said his death was caused by a clot formed in his left calf that eventually reached his lungs. Once it reached his lungs, it caused a fatal blockage. Professor Brian Colven, an expert on blood-related conditions, stated to newspapers, "There's anxiety about obesity and children not doing anything other than looking at computer screens.”
In August 2015, Rustam, 17, reportedly played the game “Defence of the Ancients” on his computer for over 22 consecutive days. A police spokeswoman reported that Rustam had “played the game almost all the time, stopping only to take a nap and grab a snack” in those 22 days. This all happened due to Rustam having a broken leg. As a result of this, he would collapse on August 30 from a possible thrombosis. He was rushed to a nearby hospital but was pronounced dead when he arrived. The doctors reported that “he could have died from second class syndrome thrombosis from not moving around.” Patel Astakhov, the Russian representative for children, stated that “it is important to follow what your kids are doing” and that “a dependence on computer games is one of the biggest dangers for the kids nowadays.”

## Conclusion

The statistics and case studies suggest a positive correlation between playing video games and obesity. This does not mean, however, that playing video games necessarily leads to obesity in all cases. Other factors must be taken into consideration including lifestyle, diet, exercise, and sleep cycles. Although playing video games does not necessarily result in obesity, it may be a contributing factor. Studies suggest that as hours spent playing video games increases, the chance of obesity also increases. The introduction of various gaming devices including Wii Fit, XBox KINECT and PlayStation MOVE may offset the potential risk of obesity caused by playing games. In addition, the introduction of virtual reality headsets and games may offset the potential risk of obesity caused by video games.

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