Dear Doctor: My son is obsessed with electronic gaming. He spends hours a day doing this. Is this unhealthy?
Dear Reader: I have a teenage son as well, so this is a question with which both you and I struggle. When I was younger, in the infancy of computer games, the games were of low resolution and the goal was simply to develop enough skill to master them. To me, this was a fun activity, often separating me from the mundane and stressful activities of everyday life.
Today's games are more complex, requiring a variety of skills in complex reasoning and hand-eye coordination. Proficient players record their techniques on YouTube, and the truly elite compete in auditoriums, watched online by hundreds of thousands of people. Is there a downside to this? Definitely -- if parents don't manage it properly.
The first potential problem with these games is the prolonged sitting required. This type of sedentary behavior can lead to obesity.
A 2004 study performed in Switzerland compared obesity rates and the hours that people spent either playing electronic games or watching television. Researchers found a significant correlation between playing electronic games and obesity, with a connection especially likely among people who spent more than two hours a day playing games. On the plus side, the obesity rates were not as high among game-players as among people who watched television, supposedly because of the passive nature of watching television and the greater amounts of unhealthy food consumed while watching it.
Other studies have not shown this obesity risk, but then they've only compared the risk of more than one hour of gaming per day versus less than one hour of gaming per day.
In a study by the American Academy of Pediatrics in 2009, children and teens who said they played more than 45 minutes of video games per day were more likely to report poorer health and increased psychological distress than those who played less than that amount. Those gamers also were found to have more behavior problems.
And consider this: In an Australian survey study of 3,000 adolescents ages 11 through 17, those who had the highest levels of psychological distress were those who spent the most time playing electronic games or roaming the internet. It may be that gaming itself is not the full problem. Rather, the gaming may be an outlet for children with emotional issues.
However, the biggest problem with gaming is that it can be addictive. The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) identifies Internet Gaming Disorder as a condition that warrants further studies.
My feeling is that electronic games can have benefits for children and adolescents, but exposure to them must be limited.
I recommend that you watch for addictive behavior from your son in connection to these games and that you limit the amount of time he spends with them each day. The American Academy of Pediatrics recommends no more than two hours of screen time per day. If your son is playing these games and in addition watches television, he may have an increased risk of obesity, poorer health and behavior problems.
When it comes to activity, keep two other pieces of advice in mind. One, encourage your son to substitute more active video games over the more passive variety and, even better, encourage him to pursue sports and other forms of exercise.
(Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.)
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