Association of Video Game Use With Body Mass Index and Other Energy-Balance Behaviors in Children | Media and Youth | JAMA Pediatrics | JAMA Network
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    Original Investigation
    April 6, 2020

    Association of Video Game Use With Body Mass Index and Other Energy-Balance Behaviors in Children

    Author Affiliations
    • 1Research Department of Behavioural Science and Health, University College London, London, England
    • 2School of Medicine Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
    • 3Institute for Social Marketing, University of Stirling, Stirling, United Kingdom
    • 4The Behaviouralist, London, England
    • 5Leeds Institute of Health Sciences, University of Leeds, Leeds, England
    JAMA Pediatr. 2020;174(6):563-572. doi:10.1001/jamapediatrics.2020.0202
    Key Points

    Question  What are the mediating energy-balance behaviors between video game use and body mass index?

    Findings  In this secondary analysis of cohort data including 16 376 children in the UK, video game use at age 5 years was associated with higher body mass index SD score at age 14 years. This association was partially mediated by the consumption of sugar-sweetened beverages and the regularity of children’s bedtimes.

    Meaning  Findings of this study indicate that consumption of sugar-sweetened beverages and regularity of bedtimes appeared to be associated with higher body mass index among children with greater video game use early in life, but this association was small and did not seem clinically meaningful.


    Importance  Childhood obesity is one of the biggest public health threats facing the UK, and video game use is considered a risk behavior for obesity among children. However, few studies have explored the prospective association between video game use and body mass index (BMI) or the potential mediators of this association.

    Objectives  To investigate whether a longer-term association exists between video game use at a young age and BMI SD score in later years, independent of television use, and to ascertain whether this association is mediated by other energy-balance behaviors.

    Design, Setting, and Participants  This cohort study is a secondary analysis of data from the Millennium Cohort Study, a nationally representative sample of children who were born in the UK between September 1, 2000, and January 31, 2002, that focused on data collected when the children were aged 5, 7, 11, and 14 years. Data for all variables, except BMI, were provided by parental or caregiver reporting if the children were younger than 14 years of age. At age 14 years, the children self-reported their own behavior. Initial data analysis was conducted between September 18, 2018, and September 28, 2018, with supplementary analyses conducted from October 7, 2019, to November 22, 2019.

    Main Outcomes and Measures  The main outcome variable was BMI SD scores, with video game use as the exposure variable of interest. Physical activity, bedtime regularity, sugar-sweetened beverage consumption, and high-calorie food consumption were included as potential mediating behaviors.

    Results  The full sample comprised 16 376 children and had a nearly equal number of boys (8393 [51.3%]) and girls (7983 [48.7%]). Every 1 SD increase in the number of hours of video game use at age 5 years was associated with a β = 0.018 higher BMI SD score at age 14 years (95% CI, 0.004-0.032). A small partial mediation of this association was found (direct association: β = 0.017 [95% CI, 0.003-0.031]; indirect association: β = 0.0011 [95% CI, 0.0003-0.0019]), suggesting that irregular bedtimes and higher consumption of sugar-sweetened beverages were mediators. The mediation model accounted for 36.7% (95% CI, 35.5-37.8) of the variance of the BMI SD score at age 14 years.

    Conclusions and Relevance  Results of this study suggest a small (and not clinically meaningful) association between video game use in early childhood and higher BMI in later years, which may be mediated by irregular bedtimes and higher consumption of sugar-sweetened beverages. Future interventions to prevent childhood obesity should incorporate health promotion in mainstream video games to target children most at risk because of their high level of video game use.