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Recommendations Summary

Pediatric Weight Management (PWM) Assessing Physical Activity and Sedentary Behaviors

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

Recommendation(s)
PWM: Sedentary Behaviors that Increase the Risk of Pediatric Overweight and Obesity

Sedentary behaviors that may be associated with an increase in the risk of pediatric overweight and pediatric obesity and that should be included in Nutrition Assessment are: Excessive television viewing and excessive use of video games. ADA Evidence Analysis has shown that these factors are positively associated with childhood overweight and obesity.

Rating: Fair
Imperative

PWM: Physical Activity Behaviors that Decrease the Risk of Pediatric Overweight and Obesity

Physical activity behaviors that may be associated with a decrease in the risk of pediatric overweight and pediatric obesity and that should be included in Nutrition Assessment are: Regular physical activity and sports participation. ADA Evidence Analysis has shown that these factors may be negatively associated with childhood overweight and obesity.

Rating: Fair
Imperative
- Risks/Harms of Implementing This Recommendation
  None.
- Conditions of Application
  The above topics were selected for evidence analysis. However:
  - The practitioner should not limit their assessment to these factors
  - Modification of these factors should be considered when developing the nutrition prescription
  - Evidence analysis on other factors is currently underway and will be added to the guideline as they are finished.
- Potential Costs Associated with Application
  None.
- Recommendation Narrative
  - Evidence analysis was carried out on several physical activity and sedentary behavior factors associated with pediatric overweight and obesity
  - All factors are based only on observational (association) research and do not include research on interventions
  - The following physical activity and sedentary behavior factors were associated with an increased risk of pediatric overweight and obesity:
    
    Excessive television viewing (Grade II)
    
    Excessive use of video games (Grade III).
  - The following physical activity and sedentary behavior factors were associated with a decreased risk of pediatric overweight and obesity:
    
    Regular physical activity (Grade II)
    
    Sports participation (Grade III).
- Recommendation Strength Rationale
  No direct research was analyzed regarding the benefits of knowledge-based assessment and intervention practices. However, the work group felt strongly that knowledge of relevant scientific research is indispensable for responsible dietetic practice.
  
  The grades for the physical activity and sedentary behavior factors associated with childhood overweight and obesity were evenly split between Grade II and Grade III. However, while there is no risk to the patient or client, with respect to the practitioner's knowledge of these factors, the dietitian's ignorance of this research could result in substantial risk to the patient or client.
- Minority Opinions
  None.

Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

Is frequent television viewing associated with a higher risk or prevalence of overweight among youth?

Is frequent use of video games associated with a higher risk or prevalence of overweight among youth?

Is physical activity associated with a lower risk or prevalence of overweight among youth?

Does participation in sports or exercise programs reduce the risk or prevalence of overweight among youth?
- References
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  Ariza AJ, Chen EH, Binns HJ, Christoffel KK. Risk factors for overweight in five- to six-year-old Hispanic-American children: A pilot study. J Urban Health 2004;81:150-161.
  
  Berkey CS, Rockett HRH, Field AE, Gillman MW, Frazier AL, Camargo CA, Colditz GA. Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics 2000; 105: 1-9.
  
  Berkey CS, Rockett HRH, Gillman MW, Colditz GA, 2003. One-year change in activity and in inactivity among 10 to 15 year old boys and girls: Relationship to change in body mass index. Pediatrics. 111 (4): 836-843.
  
  Bogaert N, Steinbeck KS, Baur LA, Brock K, Bermingham MA. Food, activity and family--environmental vs biochemical predictors of weight gain in children. Eur J Clin Nutr. 2003 Oct;57(10):1242-9.
  
  Brewis A. Biocultural aspects of obesity in young Mexican schoolchildren. Am J Hum Biol. 2003 May-Jun;15(3):446-60.
  
  Crespo CJ, Smit E, Troiano RP, Bartlett SJ, Macera CA, Andersen RE. Television watching, energy intake, and obesity in US children. Arch Pediatric Adolescent Medicine 2001;155:360-65.
  
  Crooks DL. Food consumption, activity, and overweight among elementary school children in an Appalachian Kentucky community. American Journal of Physical Anthropology 2000;112: 159-170
  
  Dennison BA, Erb TA, Jenkins PL Television viewing and television in bedroom associated with overweight risk among low income preschool children. Pediatrics. 2002;109:1028-35.
  
  Dietz WH, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985;75:807-812
  
  Dowda, M., Ainsworth, B.E., Addy, C.L., Saunders, R. Riner, W. Environmental influences, physical activity, and weight status in 8 to 16 year-olds. Archives of Pediatric and Adolescent Medicine 2001; 155:711-717.
  
  DuRant R, Baranowski T, Johnson M, Thompson W. The relationship among television watching, physical activity, and body composition of young children. Pediatrics. 1994;94:449-455.
  
  Dwyer JT, Stone EJ, Yang M, Feldman H, Webber LS, Must A, Perry CL, Nader PR, Parcel GS. Predictors of overweight and overfatness in a multiethnic pediatric population American Journal of Clinical Nutrition 1998;67:602-610
  
  Eisenmann, J.C., Bartee, R.T., Wang, M.Q. Physical activity, TV viewing and weight in U.S. youth: 1999 Youth Risk Behavior Survey. Obesity Research 2002; 10(5): 379-385
  
  Felton, G.M., Dowda, M., Ward, D.S., Dishman, R.K., Trost, S.G., Saunders, R., & Pate, R.R. (2002). Differences in physical activity between black and white girls living in rural and urban areas. Journal of School Health, 72 (6), 250-255
  
  Fontvieille AM, Kriska A, Ravussin E. Decreased physical activity in Pima Indian compared with Caucasian children. International Journal of Obesity 1993;17: 445-452.
  
  Francis LA, Lee Y, Birch LL. Parental weight status and girls' television viewing, snacking, and body mass indexes. Obes Res 2003;11:143-51.
  
  Giammattei J, Blix G, Marshah HH, Wollitzer AO, Pettitt DJ. Television watching and soft drink consumption: associations with obesity in 11- to 13-year old schoolchildren. Arch Pediatr Adolesc Med 2003;157:882-886.
  
  Gordon-Larsen P, Adair LS, Popkin BM. Ethnic differences in physical activity and inactivity patterns and overweight status Obesity Research 2002; 10: 141-149.
  
  Gordon-Larsen P. Obesity-related knowledge, attitudes, and behaviors in obese and non-obese urban Philadelphia female adolescents. Obesity Research 2001;9(2):112-18
  
  Gray A., & Smith, C. (2003). Fitness, dietary intake, and body mass index in urban native American youth. Journal of American Dietetic Association, 103(9), 1187-1191.
  
  Guillaume M, Lapidus L, Bjorntorp P, Lambert A. Physical activity, obesity and cardiovascular risk factors in children. The Belgian Luxembourg child study II. Obesity Research 1997; 5: 549-556.
  
  Hanley AJG, Harris SB, Gittelsohn J, Wolever TMS, Saksvig B, Zinman B. Overweight among children and adolescents in a Native Canadian community: prevalence and associated factors. Am J Clin Nutr, 2000; 71: 693-700.
  
  Hernandez B, Gortmaker SL, Colditz GA, Peterson KE, Laird LM, Parra-Cabrera S. Association of obesity with physical activity, television programs and other forms of video viewing among children in Mexico City. International Journal of Obesity and Related Metabolic Disorders 1999;23:845-854.
  
  Horn OK, Paradis G, Potvin L, Macaulay AC, Desrosiers S. Correlates and predictors of adiposity among Mohawk children. Preventive Medicine 2001; 33: 274-281.
  
  Janz KF, Levy SM, Burns TL, Torner JC, Willing MC, Warren JJ Fatness, physical activity, and television viewing in children during the adiposity rebound period: The Iowa bone development study. Preventative Medicine 2002;35:563-71
  
  Katzmarzyk, P., Malina, R.M., Song, T.M., Bouchard, C. Television viewing, physical activity, and health related fitness of youth in the Quebec family study. Journal of Adolescent Health 1998; 23:318-325.
  
  Kelishadi R, Pour MH, Sarraf-Zadegan N, Sadry GH, Ansari R, Alikhassy H, Bashardoust N. Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program - Heart Health Promotion from Childhood. Pediatr Int. 2003 Aug;45(4):435-42.
  
  Kimm SYS, Obarzanek E, Barton BA, Aston CE, Similo SL, Morrison JA, Sabry ZA, Schreiber GB, McMahon RP, 1996. Race, socioeconomic status, and obesity in 9- to 10- year old girls: The NHLBI growth and health study. Annual Epidemiology, 6 (4), 266-275.
  
  Lin BH, Huang CL, French SA. Factors associated with women's and children's body mass indices by income status. Int J Obes Relat Metab Disord. 2004 Apr;28(4):536-42.
  
  Locard E, Mamelle N, Billette A, Miginiac M, Munoz F, Rey S. Risk factors of obesity in a fiver year old population. Parental versus environmental factors. Int J Obes 1992;16:721-9.
  
  Lowry, R., Wechsler, H., Galuska, A., Fulton, J.E., & Kann, L. Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender. J Sch Health 2002;72(10):413-421.
  
  Maffeis C, Talamini G, Tato L. Influence of diet, physical activity and parents’ obesity on children’s adiposity: a four-year longitudinal study. International Journal of Obesity and Related Metabolic Disorders 1998;22: 758-764.
  
  Maffeis C, Talamini G, Tato L. Influence of diet, physical activity and parents’ obesity on children’s adiposity: A four-year longitudinal study. Int J Obes. 1998; 22: 758-764.
  
  McMurray RG, Harrell JS, Deng S, Bradley CB, Cox LM, Bangdiwala SI. The influence of physical activity, socioeconomic status, and ethnicity on the weight status of adolescents. Obesity Research 2000;8(2):130-39.
  
  Muller MJ, Koertzinger I, Mast M, Langnase K, Grund A. Physical activity and diet in 5 and 7 years old children. Nutrition Society. 1999;2(3a):443-44.
  
  Muller, MJ, Grund, A, Krause, H, Siewers, M, Bosy-Westphal, A, & Rieckert, H. Determinants of fat mass in prepubertal children. Br J Nutr 2002;88:545-554.
  
  Neutzling, M.B., Taddei, J.A.A.C., & Gigante, D.P. Risk factors of obesity among Brazilian adolescents: a case-control study. Public Health Nutr. 2003 Dec;6(8):743-9.
  
  Obarzanek E, Schreiber GB, et al. Energy intake and physical activity in relation to indexes of body fat: National heart, lung, and blood institute growth and health study. American Journal of Clinical Nutrition 1994; 60: 15-22.
  
  O'Loughlin J, Gray-Donald K, Paradis G, Meshefedjian G One- and two-year predictors of excess weight gain among elementary schoolchildren in multiethnic, low-income, inner city neighborhoods. American Journal of Epidemiology 2000; 152: 739-746
  
  Proctor MH, Moore LL, Gao D, Cupples LA, Bradlee ML, Hood MY, Ellison RC. Television viewing and change in body fat from preschool to early adolescence: The Framingham children’s study. International Journal of Obesity. 2003; 27: 827-833.
  
  Robinson TN, Hammer LD, Killen JD, Kraemer HC, Wilson DM, Hayward C, Taylor CB, 1993. Does television viewing increase obesity and reduce physical activity? Cross-sectional and longitudinal analyses among adolescent girls. Pediatrics, 91(2), 273-280.
  
  Skinner JD, Bounds W, Carruth BR, Morris M, Ziegler P. Predictors of children's body mass index: A longitudinal study of diet and growth in children aged two to eight years. Int J Obes Relat Metab Disord. 2004 Apr; 28(4): 476-482.
  
  Stettler, N., Signer, T.M., Suter, P.M. (2004). Electronic games and environmental factors associated with childhood obesity in Switzerland. Obesity Research, 12 (6), 896-903.
  
  Storey ML, Forshee RA, Weaver AR, Sansalone WR. Demographic and lifestyle factors associated with body mass index among children and adolescents. Int J Food Sci Nutr 2003; 54: 491-503.
  
  Strauss RS, Knight J. Influence of the home environment on the development of obesity in children.
  Pediatrics. 1999 Jun;103(6):e85.
  
  Sugimori H, Yoshida K, Izuno T, Miyakawa M, Suka M, Sekine M, Yamagami T, Kagamimori S. Analysis of factors that influence body mass index from ages 3 to 6 years: A study based on the Toyama cohort study. Pediatr Int. 2004 Jun;46(3):302-10.
  
  Tanasescu M, Ferris AM, Himmelgreen DA, Rodriguez N, Pérez-Escamilla R. Biobehavioral factors are associated with obesity in Puerto Rican children. J Nutr 2000;130:1734-42.
  
  Toyran M, Ozmert E, Yardakok K. Television viewing and its effect on physical health of school age children. The Turkish Journal of Pediatrics 2002; 44: 194-203.
  
  Wake M, Hesketh K, Waters E. Television, computer use and body mass index in Australian primary school children. Journal of Paediatric Child Health 2003;39:130-34
  
  Wardle J, Guthrie C, Sanderson S, Birch L, Plomin R. Food and activity preferences in children of lean and obese parents. Int J Obes 2001; 25: 971-7.
  
  Dowda, M., Ainsworth, B.E., Addy, C.L., Saunders, R. Riner, W. Environmental influences, physical activity, and weight status in 8 to 16 year-olds. Archives of Pediatric and Adolescent Medicine 2001; 155:711-717.
  
  Guillaume M, Lapidus L, Bjorntorp P, Lambert A. Physical activity, obesity and cardiovascular risk factors in children. The Belgian Luxembourg child study II. Obesity Research 1997; 5: 549-556.
  
  Horn OK, Paradis G, Potvin L, Macaulay AC, Desrosiers S. Correlates and predictors of adiposity among Mohawk children. Preventive Medicine 2001; 33: 274-281.
  
  Levin S, Lowry R, Brown DR, Dietz, WH. Physical activity and body mass index among US adolescents. Archives of Pediatric and Adolescent Medicine. 2003; 157: 816-820.
  
  O'Loughlin J, Gray-Donald K, Paradis G, Meshefedjian G One- and two-year predictors of excess weight gain among elementary schoolchildren in multiethnic, low-income, inner city neighborhoods. American Journal of Epidemiology 2000; 152: 739-746
  
  Salbe, AD., Weyer, C., Harper, I., Lindsay, RS., Ravussin, E., & Tataranni, A. Assessing risk factors for obesity between childhood and adolescence: II. Energy metabolism and physical activity. Pediatrics 2002;110:307-314.
- References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
  None.