*3.2.5 TV watching*

*Public Health in Developing Countries - Challenges and Opportunities*

eating. Highly impulsive children often do not think about the reactions or their consequences. Besides overeating, these children seem to be vulnerable to food triggers like the smell and taste of the food. It has been suggested that poor control of neural centres related to impulsivity and/or addiction could foster impaired control of food intake leading to overeating and subsequent obesity. Adaptive decisionmaking and the ability to delay gratification may positively influence eating behaviour, particularly in an energy-rich food environment, where conscious control of

energy intake is essential for the maintenance of healthy body weight [36].

The Wardha study showed a good correlation between physical inactivity and childhood obesity. On univariate analysis, the odds ratio (OR) of obesity in school children was 2.064 if they played outdoors for less than 30 min a day. Step-down multiple logistic regression analysis showed OR for the same children

**222**

**Figure 1.**

*3.2.4 Physical activity*

*Vicious cycle of obesity in school children.*

Sedentary lifestyle is associated with higher adiposity. Every additional hour of TV-time per day increases the prevalence of obesity in children by 2% [23]. Govindan et al. found that watching TV for >2 h/d was significantly associated with obesity (boys OR 1.19, p < 0.01, girls OR1.19, p < 0.01) [39]. The National Institutes of Health, US also consider TV-time of >2 h as a definite risk for obesity [40]. TV watching (passive screen time) is unhealthier than active screen time (computer and video games) [41]. Hours of TV watching also directly correlate with increased intake of foods frequently advertised on TV like sweets, sweetened beverages, cookies, chocolates, sweetened cereals and salted snacks [42]. This habit of watching TV or playing games on mobile phones starts at an earlier age. During preschool period, most mothers have a tendency to feed children by distracting them. They let them watch cartoons on television or play games on mobile phones. This makes their job of feeding easier as the children do not resist feeding. In the process, they tend to overeat, being too distracted to signal the feeders that they are full. This tendency to overfeed themselves continues into adolescence also.

## *3.2.6 Psychosocial factors*

Pengpid and Peltzer looked for impact of loneliness, lack of close friends, anxiety and worrying, suicidal ideation and bullying on occurrence of overweight/ obesity in school-going children in Oceania. The OR for being overweight with lack of close friends was 0.72 (95% CI 0.56–0.92, p < 0.01) and with suicidal ideation OR was 1.42 (95% CI 1.21–1.66, p < 0.001). The association with other factors was not significant on multivariate regression analysis [11]. The lifetime risk for anxiety disorders is higher for obese adolescents in comparison to non-obese ones [43]. There is a bi-directional relationship between eating disorders and depression making both difficult to treat [44].
