Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial

Ralph Maddison, Samantha Marsh, Louise Foley, Leonard H Epstein, Timothy Olds, Ofa Dewes, Ihirangi Heke, Karen Carter, Yannan Jiang, Cliona Ni Mhurchu, Ralph Maddison, Samantha Marsh, Louise Foley, Leonard H Epstein, Timothy Olds, Ofa Dewes, Ihirangi Heke, Karen Carter, Yannan Jiang, Cliona Ni Mhurchu

Abstract

Background: Screen-based activities, such as watching television (TV), playing video games, and using computers, are common sedentary behaviors among young people and have been linked with increased energy intake and overweight. Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child, small sample sizes, and short follow-up periods. The SWITCH (Screen-Time Weight-loss Intervention Targeting Children at Home) study aimed to determine the effect of a home-based, family-delivered intervention to reduce screen-based sedentary behaviour on body composition, sedentary behaviour, physical activity, and diet over 24 weeks in overweight and obese children.

Methods: A two-arm, parallel, randomized controlled trial was conducted. Children and their primary caregiver living in Auckland, New Zealand were recruited via schools, community centres, and word of mouth. The intervention, delivered over 20 weeks, consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content, which focused on training and educating them to use a wide range of strategies designed to reduce their child's screen time. Families were given Time Machine TV monitoring devices to assist with allocating screen time, activity packages to promote alternative activities, online support via a website, and monthly newsletters. Control participants were given the intervention material on completion of follow-up. The primary outcome was change in children's BMI z-score from baseline to 24 weeks.

Results: Children (n = 251) aged 9-12 years and their primary caregiver were randomized to receive the SWITCH intervention (n = 127) or no intervention (controls; n = 124). There was no significant difference in change of zBMI between the intervention and control groups, although a favorable trend was observed (-0.016; 95% CI: -0.084, 0.051; p = 0.64). There were also no significant differences on secondary outcomes, except for a trend towards increased children's moderate intensity physical activity in the intervention group (24.3 min/d; 95% CI: -0.94, 49.51; p = 0.06).

Conclusions: A home-based, family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9-12 years.

Trial registration: Australian New Zealand Clinical Trials RegistryWebsite: http://www.anzctr.org.au

Trial registration number: ACTRN12611000164998.

References

    1. He M, Irwin JD, Sangster Bouck LM, Tucker P, Pollett GL. Screen-viewing behaviors among preschoolers: Parents’ perceptions. Am J Prev Med. 2005;29(2):120–125. doi: 10.1016/j.amepre.2005.04.004.
    1. Rideout VJ, Hamel E. The Media Family: Electronic Media in the Lives of Infants, Toddlers, Preschoolers and Their Parents. Menlo Park, California: Henry J. Kaiser Family Foundation; 2006.
    1. Valkenburg PM, Peter J. Social consequences of the internet for adolescents a decade of research. Curr Dir Psychol Sci. 2009;18(1):1–5. doi: 10.1111/j.1467-8721.2009.01595.x.
    1. Ministry of Health . The Health of New Zealand Children: Key Findings of the New Zealand Health Survey 2011/12. Ministry of Health: Wellington; 2012.
    1. Nelson MC, Neumark-Stzainer D, Hannan PJ, Sirard JR, Story M. Longitudinal and secular trends in physical activity and sedentary behavior during adolescence. Pediatrics. 2006;118(6):e1627–e1634. doi: 10.1542/peds.2006-0926.
    1. Network SBR. Letter to the Editor: Standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012;37(3):540–542. doi: 10.1139/h2012-024.
    1. Gopinath B, Baur L, Hardy L, Kifley A, Rose K, Wong T, Mitchell P. Relationship between a range of sedentary behaviours and blood pressure during early adolescence. J Hum Hypertens. 2011;26(6):350–356. doi: 10.1038/jhh.2011.40.
    1. Dietz WH, Jr, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75(5):807–812.
    1. Cleland VJ, Schmidt MD, Dwyer T, Venn AJ. Television viewing and abdominal obesity in young adults: is the association mediated by food and beverage consumption during viewing time or reduced leisure-time physical activity? Am J Clin Nutr. 2008;87(5):1148–1155.
    1. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986–1990. Arch Pediatr Adolesc Med. 1996;150(4):356–362. doi: 10.1001/archpedi.1996.02170290022003.
    1. Elgar FJ, Roberts C, Moore L, Tudor-Smith C. Sedentary behaviour, physical activity and weight problems in adolescents in Wales. Pub Health. 2005;119(6):518–524. doi: 10.1016/j.puhe.2004.10.011.
    1. Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282(16):1561–1567. doi: 10.1001/jama.282.16.1561.
    1. Rey-Lopez JP, Vicente-Rodriguez G, Biosca M, Moreno LA. Sedentary behaviour and obesity development in children and adolescents. Nutr Metab Cardiovasc Dis. 2008;18(3):242–251. doi: 10.1016/j.numecd.2007.07.008.
    1. Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB. TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study. PLoS Med / Public Library Sci. 2006;3(12):e488.
    1. Christakis DA, Zimmerman FJ, DiGiuseppe DL, McCarty CA. Early television exposure and subsequent attentional problems in children. Pediatrics. 2004;113(4):708–713. doi: 10.1542/peds.113.4.708.
    1. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, Goldfield G, Gorber SC. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys. 2011;8:98. doi: 10.1186/1479-5868-8-98.
    1. Biddle SJ, O’Connell S, Braithwaite RE. Sedentary behaviour interventions in young people: a meta-analysis. Br J SPorts Med. 2011;45(11):937–942. doi: 10.1136/bjsports-2011-090205.
    1. DeMattia L, Lemont L, Meurer L. Do interventions to limit sedentary behaviours change behaviour and reduce childhood obesity? A critical review of the literature. Obes Rev. 2007;8(1):69–81. doi: 10.1111/j.1467-789X.2006.00259.x.
    1. Leung MM, Agaronov A, Grytsenko K, Yeh M-C. Intervening to reduce sedentary behaviors and childhood obesity among school-Age youth: a systematic review of randomized trials. J Obes. 2012;2012:685430. doi: 10.1155/2012/685430.
    1. Maniccia DM, Davison KK, Marshall SJ, Manganello JA, Dennison BA. A meta-analysis of interventions that target children’s screen time for reduction. Pediatrics. 2011;128(1):e193–e210. doi: 10.1542/peds.2010-2353.
    1. Schmidt ME S, Haines J, O'Brien A, McDonald J, Price S, Sherry B, Taveras EM. Systematic review of effective strategies for reducing screen time among young children. Obesity. 2012;20(7):1338–1354. doi: 10.1038/oby.2011.348.
    1. Steeves JA, Thompson DL, Bassett DR, Fitzhugh EC, Raynor HA, Steeves JA, Thompson DL, Bassett DR, Fitzhugh EC, Raynor HA. A review of different behavior modification strategies designed to reduce sedentary screen behaviors in children. J Obes. 2012;2012:16. doi: 10.1155/2012/379215.
    1. Van Grieken A, Ezendam NPM, Paulis WD, van der Wouden JC, Raat H. Primary prevention of overweight in children and adolescents: a meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour. Int J Behav Nutr Phys Act. 2012;9(1):61. doi: 10.1186/1479-5868-9-61.
    1. Wahi G, Parkin PC, Beyene J, Uleryk EM, Birken CS. Effectiveness of interventions aimed at reducing screen time in children: a systematic review and meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med. 2011;165(11):979–986. doi: 10.1001/archpediatrics.2011.122.
    1. Koskinen P, Wilson R, Jensema C. Closed-Captioned Television: a new tool for reading instruction. Reading World. 1985;24(4):1–7. doi: 10.1080/19388078509557842.
    1. Saelens BE, Sallis JF, Nader PR, Broyles SL, Berry CC, Taras HL. Home environmental influences on children’s television watching from early to middle childhood. J Develop Behav Ped. 2002;23(3):127–132. doi: 10.1097/00004703-200206000-00001.
    1. Salmon J, Timperio A, Telford A, Carver A, Crawford D. Association of family environment with children’s television viewing and with low level of physical activity. Obesity. 2005;13(11):1939–1951. doi: 10.1038/oby.2005.239.
    1. Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH, Robinson TN. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162(3):239–245. doi: 10.1001/archpediatrics.2007.45.
    1. Faith MS, Berman N, Heo M, Pietrobelli A, Gallagher D, Epstein LH, Eiden MT, Allison DB. Effects of contingent television on physical activity and television viewing in obese children. Pediatrics. 2001;107(5):1043–1048. doi: 10.1542/peds.107.5.1043.
    1. French SA, Gerlach AF, Mitchell NR, Hannan PJ, Welsh EM. Household obesity prevention: take action - group-randomized trial. Obesity. 2011;19(10):2082–2088. doi: 10.1038/oby.2010.328.
    1. Goldfield GS, Mallory R, Parker T, Cunningham T, Legg C, Lumb A, Parker K, Prud'homme D, Gaboury I, Adamo KB. Effects of open-loop feedback on physical activity and television viewing in overweight and obese children: a randomized, controlled trial. Pediatrics. 2006;118(1):e157–e166. doi: 10.1542/peds.2005-3052.
    1. Maddison R, Foley L, Mhurchu CN, Jiang Y, Jull A, Prapavessis H, Hohepa M, Rodgers A. Effects of active video games on body composition: a randomized controlled trial. Am J Clin Nutr. 2011;94(1):156–163. doi: 10.3945/ajcn.110.009142.
    1. Maloney AE, Bethea TC, Kelsey KS, Marks JT, Paez S, Rosenberg AM, Catellier DJ, Hamer RM, Sikich L. A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time. Obesity. 2008;16(9):2074–2080. doi: 10.1038/oby.2008.295.
    1. Ni Mhurchu C, Roberts V, Maddison R, Dorey E, Jiang Y, Jull A, Tin Tin S. Effect of electronic time monitors on children’s television watching: pilot trial of a home-based intervention. Prev Med. 2009;49(5):413–417. doi: 10.1016/j.ypmed.2009.09.003.
    1. Roemmich JN, Gurgol CM, Epstein LH. Open-loop feedback increases physical activity of youth. Med Sci Sports Exerc. 2004;36(4):668–673. doi: 10.1249/01.MSS.0000121947.59529.3B.
    1. Maddison R, Mhurchu CN, Foley L, Epstein L, Jiang Y, Tsai M, Dewes O, Heke I. Screen-time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial study protocol. BMC Pub Health. 2011;11:524. doi: 10.1186/1471-2458-11-524.
    1. Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007;335(7612):194. doi: 10.1136/bmj.39238.399444.55.
    1. Ministry of Health . New Zealand Health Survey: Annual Update of key Findings 2012/13. Ministry of Health: Wellington; 2013.
    1. Bandura A, Bandura A. Social Foundations of Thought and Action: A Cognitive Social Theory. New York: Pretince Hall, Englewood Cliffs; 1986.
    1. Hursh SR, Bauman RA. The behavioral analysis of demand. Adv Behav Econ. 1987;1:117–165.
    1. Epstein LH, Roemmich JN. Reducing sedentary behavior: role in modifying physical activity. Exerc Sport Sci Rev. 2001;29(3):103–108. doi: 10.1097/00003677-200107000-00003.
    1. Epstein LH, Saelens BE, O’Brien JG. Effects of reinforcing increases in active behavior versus decreases in sedentary behavior for obese children. Int J Behav Med. 1995;2(1):41–50. doi: 10.1207/s15327558ijbm0201_4.
    1. Epstein LH, Saelens BE, Myers MD, Vito D. Effects of decreasing sedentary behaviors on activity choice in obese children. Health Psychol. 1997;16(2):107–113. doi: 10.1037/0278-6133.16.2.107.
    1. Saelens BE, Epstein LH. Behavioral engineering of activity choice in obese children. Int J Obes Relat Metab Disord. 1998;22(3):275–277. doi: 10.1038/sj.ijo.0800570.
    1. Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med. 2000;154(3):220–226. doi: 10.1001/archpedi.154.3.220.
    1. Norton K, Olds T. Anthropometrica. Sydney, Australia: University of New South Wales Press; 1996.
    1. Rush E, Puniani K, Valencia ME, Davies PSW, Plank LD. Estimation of body fatness from body mass index and bioelectrical impedance: comparison of New Zealand European, Maori and Pacific Island children. Eur J Clin Nutr. 2003;57:1394–1401. doi: 10.1038/sj.ejcn.1601701.
    1. Ridley K, Olds TS, Hill A, Ridley K, Olds TS, Hill A. The Multimedia activity recall for children and adolescents (MARCA): development and evaluation. Int J Behav Nutr Phys Act. 2006;3(1):10. doi: 10.1186/1479-5868-3-10.
    1. Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;195(9131/03):3508.
    1. Ministry of Health . NZ Food, NZ Children. Key results of the 2002 National Children’s Nutritional Survey. Wellington, New Zealand: Ministry of Health; 2003.
    1. Metcalf P, Scragg R, Sharpe S, Fitzgerald E, Schaaf D, Watts C. Short-term repeatability of a food frequency questionnaire in New Zealand Children aged 1–14 y. Eur J Clin Nutr. 2003;57:1498–1503. doi: 10.1038/sj.ejcn.1601717.
    1. Kendzierski D, DeCarlo KJ. Physical activity enjoyment scale: Two validation studies. J Sport Exerc Psychol. 1991;13(1):50–64.
    1. Motl RW, Dishman RK, Saunders R, Dowda M, Felton G, Pate RR. Measuring enjoyment of physical activity in adolescent girls. Am J Prev Med. 2001;21(2):110–117. doi: 10.1016/S0749-3797(01)00326-9.
    1. Salmon J, Owen N, Crawford D, Bauman A, Sallis JF. Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychol. 2003;22(2):178–188. doi: 10.1037/0278-6133.22.2.178.
    1. Marsh S, Foley LS, Wilks DC, Maddison R. Family‐based interventions for reducing sedentary time in youth: a systematic review of randomized controlled trials. Obes Rev. 2013;15(2):117–133. doi: 10.1111/obr.12105.
    1. Robison JL. To reward?… or not to reward?: questioning the wisdom of using external reinforcement in health promotion programs. Am J Health Promot. 1998;13(1):1–3. doi: 10.4278/0890-1171-13.1.1.
    1. Timperio A, Salmon J, Ball K. Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update. J Sci Med Sport. 2004;7(1 Suppl):20–29. doi: 10.1016/S1440-2440(04)80274-3.
    1. Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, Oxman AD, Moher D. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;337:a2390. doi: 10.1136/bmj.a2390.
    1. Sonneville KR, Rifas‐Shiman SL, Kleinman KP, Gortmaker SL, Gillman MW, Taveras EM. Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial. Obesity. 2012;20(7):1449–1454. doi: 10.1038/oby.2012.43.
    1. Roberts DF, Foehr UG. Trends in media use. Futur Child. 2008;18(1):11–37. doi: 10.1353/foc.0.0000.

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