To the Editor I read with great pleasure the article titled “Association of Video Game Use With Body Mass Index and Other Energy-Balance Behaviors in Children” by Goodman et al.1 The article explores the association between body mass index (BMI) and video game use, identifying physical activity, bedtime regularity, sugar-sweetened beverage consumption, and high-calorie food consumption as potential mediating behaviors.1 The authors state that they found a small but not clinically meaningful association.1 I believe the authors should have also included aggression as a potential mediating behavior owing to its effect on stress and anxiety levels. Previous studies have demonstrated that video games certainly spike up aggressive behaviors in children,2 which can contribute to stress levels in users. This stress from violent video games can not only increase vitals such as heart rate and blood pressure but also increase the release of stress hormones such as epinephrine and norepinephrine. Previous research has also shown that high psychological stress levels can be responsible for contributing to increases in BMI.3 When people are stressed, their metabolic rate lowers, resulting in weight gain.