Ran Goldman, MD (biography and disclosures)
What I did before
Children are less physically active than in previous generations. With advances in computer based gaming, safety concerns and sedentary life style of today’s families, children have been significantly less active. This resulted in higher rates of children fulfilling the criteria for ‘overweight’ and ‘obese’.
Children 8- 18 years old spend close to 25% of their awake time watching TV, resulting in increased rate of obesity . With the use of more screen-based gaming and communication devices, the portion may be even higher.
Several studies in the past, both in a laboratory based investigation as well in real-life circumstances research, reported that children playing active video games have a moderate or vigorous levels of physical activity [2-4].
I used to recommend to families to engage their children in active video games if they decide to purchase a gaming system, in hopes that these games will enhance physical activity by moving and dancing in front of the screen.
What changed my practice
A recent study  by a group from the Baylor College of Medicine in Houston, Texas, suggests that active video games have no effect on the amount of physical activity in children, compared to non-active games. Eighty four children were recruited, and along with their parents completed surveys. They were randomized to receive two computer games that were either very active games or inactive games. The children wore accelerometers for 7 days in order to measure their physical activity levels.
There was no difference in level of physical activity between the groups. The authors suggested that children with the active games either did not do more activity or compensated for the increased intensity by being less active at other times in the day.
What I do now
There is no alternative to healthy outdoor physical activity. I now recommend to all parents (with overweight/obese children or not) to significantly limit use of video games and other screen-based devices for their children, and to remove them from the child’s room, if possible. While no clear recommendations exist, I suggest to parents to limit screen time to an hour a day during weekdays. Parents should support their child’s healthy living by following the Canadian Paediatric Society’s recommendation  to have 60-180 minutes a day (!) of physical activity in different intensities for all children.
References / Additional reading (Note: Article requests might require a login ID with CPSBC or UBC)
3. Barnett A, Cerin E, Baranowski T. Active video games for youth: a systematic review. J Phys Act Health. 2011;8(5):724-737 (View article with UBC)
4 Madsen KA, Yen S, Wlasiuk L, Newman TB, Lustig R. Feasibility of a dance videogame to promote weight loss among overweight children and adolescents. Arch Pediatr Adolesc Med. 2007;161(1):105–107 (View article with CPSBC or UBC)
5. Baranowski T, Abdelsamad D, Baranowski J, O’Connor TM, Thompson D, Barnett A, Cerin E, Chen TA. Impact of an active video game on healthy children’s physical activity. Pediatrics. 2012;129(3):e636-642 (View)
6. Lipnowski S, LeBlanc CMA, Canadian Paediatric Society, Healthy Active Living and Sports Medicine Committee. Healthy active living: Physical activity guidelines for children and adolescents. Paediatr Child Health 2012;17(2):209-10 (View)