The Obesity Row
Dr Matthew Capehorn looks at whether or not it's fair to label videogames as chief culprit
That children are becoming, on average, increasingly overweight is a fact that nobody can argue with - but what's the real cause of the so-called 'Obesity Epidemic'? For many, videogames are a prime target - they encourage a sedentary lifestyle and children generally need little encouragement to sit and play for hours at a time.
But is that fair? Is it the fault of the games industry, of parents, of the government, of fast food chains? Some questions are impossible to answer fully, but here - in the first of a two-part look at games and health - Dr Matthew Capehorn, board member of the National Obesity Forum, explains the extent of the problem, discusses the controversial Change4Life campaign, and ponders whether games could in fact be a solution.
The Scale of the Obesity Epidemic
The prevalence of obesity in this country is increasing to epidemic proportions and is linked with significant physical and psychological problems. The Health Survey for England reported that in 2006, over one in four (25 per cent of men and 29 per cent of women) adults were obese, and over two in three (68 per cent of men and 71 per cent of women) were either overweight or obese. More people had an unhealthy weight than a healthy weight, and projections to 2010 suggested this was likely to increase and one in three adults could become obese. Given the rising levels of childhood obesity, this is only likely to increase further.
The National Child Measurement Programme (NCMP) provides high-level analysis of weight, in Reception (aged 4-5 years) and Year 6 (aged 10-11 years). The 2007/08 school year results have recently been published and show that in Reception, almost one in four children were overweight or obese (22.6 per cent) and one in ten obese (9.6 per cent), and that in Year 6 one in three children were overweight or obese (32.6 per cent) and one in five obese (18.3 per cent). The percentage of children who are obese is almost twice as high in Year 6 than in Reception.
Differences between boys and girls were significant but very small for both years. It has been calculated that these figures may in fact be an underestimate of the problem due to the effect of children opting out of being measured. The participation rates for 2007/08 reached approximately 88 per cent of those eligible.
The 2007 Foresight Report projected that by 2050, over 50 per cent of the adult population could be obese and 90 per cent overweight, and that two in three children could be overweight or obese. Clearly something needs to be done, and the Government has launched the Change4Life public health campaign to raise awareness of the problem.
The Change4Life Campaign
No one would disagree with the need for more public health campaigns to help raise awareness of public health problems such as smoking, alcohol consumption and obesity, however the Change4Life campaign has not been without its criticism.
Unlike the smoking and drink-driving television campaigns, which are deliberately hard-hitting to get across the potential harm caused by these conditions, the obesity campaign is more 'consumer-friendly' using attractive graphics to appeal to adults and children alike.
The campaign has been estimated to have cost GBP 75 million. One criticism has been that this has been a very expensive campaign to inform overweight people that they may be overweight and the possible consequences of this, when in fact that probably already know this. In fact, it is true that many people underestimate their weight, and those that think they have a healthy weight are in fact overweight, and those thinking they are a little 'chubby' are in fact obese, and so there is a need to reinforce this basic information.
Regrettably for some, and especially given the cost of the campaign, it does not go far enough with the management of the problem, and further resources need to be provided for structured weight management programmes for those people who require help in losing any excess weight.
Furthermore, the advertising campaign has been criticised for its content. Initially it implied that obesity is the main cause for diabetes, without distinguishing this 'type 2' diabetes from the 'type 1' which is due to a problem with the pancreas not producing enough insulin - which is not obesity-related. It was felt that this was confusing and could potentially be upsetting to these sufferers of type 1 diabetes.
The campaign was right to focus on how we have started to become 'lazy' as a society, so much so that our more sedentary lifestyle has now been given a name - the "obesogenic environment", ie the surroundings in which we live are helping to add to the obesity problem.
Over the last few decades we have embraced technology, and look for everything to be remote-controlled or designed for our convenience. We look forward to the day when robots do everything for us. We all want to drive our cars, even for short trips, rather than walk, and all park as close to the front door of the supermarket instead of consider walking an extra few hundred yards. We want to drive our children to school rather than encourage then to walk or cycle to school because society has caused us to be scared of the 'bogeyman' and harm coming to our children. We go into a shopping centre or hotel and there is a prominent escalator or lift, whereas the more healthy stairs are often very hard to find.
There are numerous examples of how our society has changed to result in us burning up far less calories than previous generations of adults and children did, and perhaps it is human nature to look for the 'lazy' way of doing things. However, one particular concern that I have is the implication that certain childhood pastimes, like gaming, is a cause of the obesity epidemic.
Videogames: a Cause, or a Possible Solution?
Is it really the case that we are encouraging a generation of children to avoid doing any exercise and spend all their time playing videogames?
Throughout history, children have always been encouraged to participate in 'quiet' pursuits and hobbies in addition to sports and other physical activities, whether at school or in their own leisure time. In our grandparents day, they were encouraged to draw, paint, or read books. In our parents day they were encouraged to do the same or to watch children's television after coming home from school. This was never instead of physical activity, but as well as.
Children cannot be expected to be running around and exercising all the time - in fact, when they are, we worry that they are having too much sugar or too many E-numbers in their diets. It's important to find a balance.
It's true that we should be concerned that this generation does not become more sedentary than the one before it. Watching television is now considered the most popular sedentary activity for children of all ages, with over a quarter of 11-16 year-olds watching more than four hours per day. The number of primary school children who walk to and from school has fallen from 62 per cent in 1989/91 to 56 per cent today. Activity levels for teenage girls are particularly low, with 64 per cent of 15 year-old girls being classified as 'inactive'.
Participation in school sport has decreased from 46 per cent in 1994 to 33 per cent in 1999 - however it appears that the amount of sport within schools may not be the only answer. Recent studies have suggested that children in schools that do a lot of sport are less active outside of school, and similarly those children at schools that do very little sport are more active outside of schools.
When both groups are compared the amount of daily/weekly activity is actually very similar, but clearly shows that the total amount is less than 20 or more years ago. What is not a welcome development is that children at many schools are prevented from playing football, or skipping, or other physical activities, for health and safety reasons, in case they hurt themselves, each other or the occasional dinner lady!
'Exergaming' and the Research
Recent studies have shown that the more active types of games consoles (Playstation dance mats, Nintendo Wii and Wii Fit, jOG system, etc) can encourage exercise and weight loss.
One study showed that 12 hours of active play with an 'exergaming' system over the space of a week can burn up as much as 1800 calories, which in younger children is a significant amount. In younger overweight children we often do not ask them or parents to restrict their calories at all and hope for weight maintenance, which as they grow, will result in them becoming proportionally less overweight with time. In those older children we often only request a calorie deficit of just a few hundred calories a day (equivalent to a chocolate bar and bag of crisps or fizzy drink). If a games console can provide a deficit of 1800 calories over a week this can be an invaluable tool.
In five minutes of exergaming, the equivalent of 600 steps can be taken, which is the equivalent of brisk walking. So, for an hour of playing these more active videogames, over half the recommended daily number of steps can be achieved. This could equate to the same amount of energy expenditure required to burn as many calories that are found in a chocolate bar, and has been shown to be double the number of calories burnt when compared to sedentary gaming.
Similarly heart rates were comparable during active gaming and brisk walking, and although assumed to be insufficient to help maintain or improve cardiovascular fitness, it was significantly better than sedentary gaming.
All current studies into the benefits of exergaming suggest that it is not as good, and should not be considered a replacement for 'proper' sports and other exercise. Society has a responsibility to encourage children to be as active as possible, not only to help fight the obesity epidemic but also for good cardiovascular fitness.
However, if we realise that children have always been encouraged to have solitary hobbies, and that this generation choose this to be videogaming, we need to accept this and move with the times. If our children are spending too much time playing on inactive gaming systems then we need to encourage more exergaming as an alternative, as this has been shown to potentially help manage the problem.
Who knows, for example, after playing a game of tennis on an active games system it may encourage children to pick up a tennis racquet to try the real thing!
Dr Matthew Capehorn is a board member of the National Obesity Forum.