Is Sleep the Childhood Obesity Answer?


The cultural consciousness is slowly adapting to the idea that some relationship might exist between childhood obesity and sleep, but exactly “what’s up with that” is not yet clear to anyone.

The American Academy of Pediatrics (AAP) has several ideas, some of which are obvious. The way they phrase one of them is, “Screen time may displace more active pursuits.” This illustrates how the world is changing. The way things used to be — and still are for the majority (but soon might change) — if a kid goes out to play basketball, you could be pretty sure he is not watching reruns of his favorite TV show. Because the TV is in the family living room, and you would notice him on the couch.

Formerly, it was logistically difficult to fudge on the exercise factor. But, increasingly, kids are carrying around magical little devices that allow them to hunker down anywhere and watch music videos or play computer games. The other obvious reason to limit screen time is also in line with basic common sense. The reasoning goes like this: Seeing advertisements for food triggers cravings in children, so they eat more junk food. Therefore, the less TV they watch, the fewer advertisements they are exposed to, and the less fat they become.

This is fine, as far as it goes. But it becomes increasingly difficult to “limit screen time” when more and more kids have smartphones on their persons at all times. This trend is only heading in one direction, so the next best thing is to load up that phone with something that will be effective against childhood obesity, like the “W8 Loss 2 Go” iPhone app. Just sayin’.

What does the AAP think about sleep? This is another no-brainer. Staying up to watch TV or whatever can lead to a child’s not getting enough sleep. Because, just as a human can’t be in two different places at the same time, she or he can’t be awake and asleep at the same time. Sure, there are intermediate stages, and some people claim that watching TV is the mental equivalent of being in a coma. But we’re talking about the real, deep, undisturbed kind of sleep. A child who is asleep without a soundtrack is neither absorbing pseudo-food propaganda, nor eating. Q.E.D.

For healthcare professionals, in order to stave off future trouble, the organization recommends that any well-child visit should include the asking of two questions:

(1) How much screen time is being spent per day? and (2) Is there a TV set or Internet connection in the child’s bedroom?

For parents, perhaps that is a useful way to evaluate the healthcare professional. Does she or he ask those questions, even when there is no apparent problem? Because asking them shows concern for the child’s future well-being.

Unfortunately, Question #2 is almost obsolete, for the same reasons mentioned above. With a smartphone, it doesn’t matter what kind of connections are or are not in the room where the child sleeps. Or doesn’t sleep. Maybe at bedtime such devices should be left in a different room, recharging, or whatever it is they do.

The length of time spent sleeping has been linked to obesity, and some animal studies show that weight regulation might be connected with the timing of feedings. Little is known about the relationship between all three factors in humans.

A four-person research team (Kelly G. Baron, Kathryn J. Reid, Andrew S. Kern and Phyllis C. Zee) set out to develop “novel time-based interventions for weight management.” One thing they learned is, no matter when a person sleeps or for how long, eating after 8 PM seems to increase the risk of obesity. They write:

Fifty-six percent were ‘normal sleepers’ (midpoint of <5:30 AM) and 44% were ‘late sleepers’ (midpoint of sleep ≥5:30 AM). Late sleepers had shorter sleep duration, later sleep onset and sleep offset and meal times. Late sleepers consumed more calories at dinner and after 8:00 PM, had higher fast food, full-calorie soda and lower fruit and vegetable consumption. Higher BMI was associated with shorter sleep duration, later sleep timing, caloric consumption after 8:00 PM, and fast food meals.

Parents tend to get exasperated with kids who sleep all morning. The natural impulse is to urge, “Get up! Move around! Burn some calories! Do something useful!” But in South Korea, researchers made a discovery (published in the Journal of Sleep Research) that is counterintuitive, to say the least. It turns out that letting kids sleep in can somehow “reset” the sleep pattern, bringing it back closer to the healthy norm. This, in turn, is said to reduce a child’s obesity risk by 30% or more.

Pat Hagan reports that scientists at Seoul’s Hallym University Sacred Heart Hospital questioned 936 children (age 10 and 11) and took their weights and measurements. They asked about habitual diet, exercise, and sleep patterns. By factoring out some of the other answers, they found that sleeping late on weekends makes a demonstrable difference.

There is another thing to bear in mind. We are told that kids don’t get enough exercise, their lifestyle is too sedentary, etc. Meanwhile, a very large proportion of American children are given drugs whose whole point and purpose is to render them more sedentary. It’s a hard question, whether to dose a hyperactive five-year-old with a pharmaceutical which, while it may help him behave in school, might set him on the road to childhood obesity. It’s worth thinking about.

Your responses and feedback are welcome!

Source: “Policy Statement—Children, Adolescents, Obesity, and the Media,” Pediatrics, 6/23/11
Source: “Role of Sleep Timing in Caloric Intake and BMI,” Obesity via, 07/11
Source: “Weekend lie-in ‘Cuts childhood obesity by 30 per cent,’”, 04/20/12
Image by Uriel 1998 (Steven Saus), used under its Creative Commons license.

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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