title: Electronic games and environmental factors associated with childhood obesity in Switzerland.
abstract: OBJECTIVE
  Environmental factors and behaviors associated with obesity have not been well described in children living in Europe. Although television watching has been repeatedly associated with obesity, it is unclear whether other sedentary activities, such as use of electronic games, are independently associated with obesity in children. The hypothesis was that various types of sedentary activities are associated with obesity in children living in Switzerland.
  
  
  METHODS
  This was a cross-sectional study of children (grades one to three) from four communities in the Greater Zurich Area (Switzerland). Obesity was defined as a combination of overweight (BMI) and overfat (skinfold thicknesses). Environmental factors were assessed by questionnaire. The children's physical activity was estimated by their teacher (scale 0 to 10).
  
  
  RESULTS
  Of 922 eligible subjects, 872 (94.6%) took part in the study. Use of electronic games [odds ratio (OR) = 2.03 per hour per day, 95% confidence interval (CI): 1.57 to 2.61, p < 0.001], television (OR = 2.83 per hour per day, 95% CI: 2.08 to 3.86, p < 0.001), physical activity (OR = 0.80 per unit, 95% CI: 0.72 to 0.88, p < 0.001), maternal work (OR = 1.93, 95% CI: 1.13 to 3.29, p = 0.02), and paternal smoking (OR = 1.78, 95% CI: 1.07 to 2.96, p = 0.03) were independently associated with obesity. Further adjustment for socioeconomic status, when available, did not change these results.
  
  
  CONCLUSIONS
  In this sample of children living in Switzerland, the use of electronic games was significantly associated with obesity, independently of confounding factors. The association of obesity with television use and lack of physical activity confirms results from other populations and points to potential strategies for obesity prevention.
authors.affiliation: Division of Gastroenterology and Nutrition, North 1559, The Children's Hospital of Philadelphia, Thirty-Fourth Street and Civic Center Boulevard, PA 19104-4399, USA. nstettle@cceb.med.upenn.edu
authors.forename: Nicolas
authors.initials: N
authors.lastname: Stettler
authors.forename: Theo M
authors.initials: TM
authors.lastname: Signer
authors.forename: Paolo M
authors.initials: PM
authors.lastname: Suter
mesh_terms: D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008019:Life Style; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D012885:Skinfold Thickness; D012923:Social Class; D013383:Suburban Population; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D013690:Television; D018910:Video Games