Abstract
Background
Despite accumulated evidence suggesting that increased screen time in children and adolescents may be associated with obesity-related behaviors, potential sex-specific differences have not been fully characterized. This systematic review aimed to synthesize evidence on the association between screen time and obesity-related outcomes in children and adolescents, with a focus on sex-specific pathways and implications for public health interventions.
Methods
A systematic review was conducted following PRISMA 2020 guidelines. Eligible studies included those assessing screen time exposure and obesity-related outcomes in children or adolescents, with sex-specific analyses. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Findings were synthesized based on direction of association and patterns of sex differences.
Results
Of the 22 studies included in the review, 18 studies (82%) reported a significant positive association between screen time and obesity-related outcomes. Female-specific associations were more frequently linked to adiposity measures, metabolically unhealthy obesity, and psychological factors such as body image and weight concern. In contrast, male-specific associations were more often related to behavioral pathways, including increased caloric intake, problematic screen use, and sleep disruption.
Conclusions
Screen time is associated with obesity in children and adolescents, but its effects are mediated through sex-specific pathways involving behavioral, physiological, and psychological mechanisms. Public health interventions should incorporate sex-specific strategies which include promoting physical activity and addressing psychosocial factors among girls, and targeting problematic screen use, screen-related eating, and sleep disruption among boys. Integrated approaches across family, school, and digital environments are needed to enhance effectiveness in obesity prevention and management.
Key messages
• Screen time is consistently associated with obesity in children and adolescents, and operates through sex-specific behavioral, physiological, and psychological pathways.
• Effective interventions should move beyond reducing screen time alone and incorporate sex-specific, multi-component strategies targeting behavior, sleep, and psychosocial factors.