Appetite 60 (2013) 58–64

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Appetite

journal homepage: www.elsevier .com/locate /appet

Research review

Daily energy balance in children and adolescents. Does energy expenditurepredict subsequent energy intake? q

David Thivel a,⇑, Julien Aucouturier b, Éric Doucet c, Travis J. Saunders a,c, Jean-Philippe Chaput a,c

a Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1b Université Droit et Santé Lille 2, EA 4488 ‘‘Activité Physique, Muscle, Santé’’, Faculté des Sciences du Sport et de l’Education Physique, 59790 Ronchin, Francec School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University, Ottawa, ON, Canada K1H 6N5

a r t i c l e i n f o

Article history:Received 20 July 2012Received in revised form 16 September2012Accepted 18 September 2012Available online 27 September 2012

Keywords:Energy intakeEnergy expenditurePediatricExerciseSedentary behaviors

0195-6663/$ - see front matter � 2012 Elsevier Ltd. Ahttp://dx.doi.org/10.1016/j.appet.2012.09.022

q Acknowledgements: J.P.C. holds a Junior Research CNutrition and Metabolism Society (SFNEP). No conflic⇑ Corresponding author.

E-mail address: dthivel@cheo.on.ca (D. Thivel).

a b s t r a c t

Both physical and sedentary activities primarily impact energy balance through energy expenditure, butthey also have important implications in term of ingestive behavior. The literature provides scarce evi-dence on the relationship between daily activities and subsequent nutritional adaptations in childrenand adolescents. Sedentary activities and physical exercise are generally considered distinctly despitethe fact that they represent the whole continuum of daily activity-induced energy expenditure. This briefreview paper examines the impact of daily activities (from vigorous physical activity to imposed seden-tary behaviors) on acute energy intake control of lean and obese children and adolescents, and whetherenergy expenditure is the main predictor of subsequent energy intake in this population. After an over-view of the available literature, we conclude that both acute physical activity and sedentary behaviorsinduce food consumption modifications in children and adolescents but also that the important discrep-ancy between the methodologies used does not allow any clear conclusion so far. When consideringenergy intake responses according to the level of energy expenditure generated by those activities, itis clear that energy expenditure is not the main predictor of food consumption in both lean and obesechildren and adolescents. This suggests that other characteristics of those activities may have a greaterimpact on calorie intake (such as intensity, duration or induced mental stress) and that energy intakemay be mainly determined by non-homeostatic pathways that could override the energetic and hor-monal signals.

� 2012 Elsevier Ltd. All rights reserved.

Contents

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Terms and definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Daily activities and subsequent EI in children and adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Normal weight children and adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Overweight and obese children and adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Energy expenditure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Television (TV) viewing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Video game playing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Other sedentary behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Imposed sedentary behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

ll rights reserved.

hair in Healthy Active Living and Obesity Research. D.T. is supported by a Research Award from the French Speakingt of interest to declare.

Fig. 1. Classification of daily activities according to the continuum of energyexpenditure in Metabolic Equivalent Tasks (METs). Adapted from Tremblay et al.(2010).

D. Thivel et al. / Appetite 60 (2013) 58–64 59

Introduction

Given concerns over the increasing rates of obesity in developednations, the control of energy balance (EB), as well as its compo-nent parts – energy intake (EI) and energy expenditure (EE) – arecurrently topics of major interest. Although often conceptualizedas distinct inputs in the EB equation, recent evidence suggests thatEE and EI are actually closely inter-related. It seems actually toosimplistic to consider physical activity and food consumption astwo independent ways to respectively manipulate EE and EI andthus control energy balance. As many as 50 years ago it was sug-gested that EI may be driven (at least in part) by the amount of en-ergy expended by an individual (Mayer, Roy, & Mitra, 1956). In thepast 20 years research on this topic has intensified, with severalstudies examining changes in caloric intake in response to acutemanipulations of EE in adults (Blundell & King, 1999; Blundell,Stubbs, Hughes, Whybrow, & King, 2003; Martins, Morgan, &Truby, 2008). These studies suggest that physical activity may in-deed impact both EI as well as EE in adults, although importantheterogeneity of the methodologies used between experimentsprecludes definitive conclusions in adults (Blundell et al., 2003).

In addition to the impact of physical activity, recent evidencesuggests that time spent in sedentary behaviors (watching televi-sion, playing seated video games, surfing the web, reading, andother seated activities) may also result in nutritional adaptationsin adults (Chaput, Klingenberg, Astrup, & Sjodin, 2011; Chaput,Klingenberg, & Sjodin, 2010; Chaput & Tremblay, 2007). However,to date the relationship between an individual’s daily activities andenergy consumption has been mainly studied and reviewed inadults and requires more attention in children and youth.

The fact that caloric intake is impacted by daily activities alsoraises questions as to whether EE or EI mainly determine EB. Con-sidering the double impact of daily activities on both expenditureand intake may lead to reconsider our strategies to affect EB. In2011, Chaput and Sharma opened this debate by suggesting thatphysical activity in weight management is more about ‘‘caloriesin’’ than ‘‘calories out’’ (Chaput & Sharma, 2011). However, therehas been no attempt to date to summarize the available evidencelinking EE of daily activities to subsequent EI in children and ado-lescents. There is evidence in other research fields where EB isexperimentally altered that children differ from adults in the con-trol of food intake. For example, studies looking at variation in EBwith energy preloads have shown that young children have a bet-ter ability than adults or adolescents to adapt subsequent EI andthus maintain EB (Cecil et al., 2005). Thus, the present paper exam-ines the impact of different daily activities, ranging from sedentarybehavior to vigorous physical activity, on subsequent EI in childrenand adolescents and aims to determine whether or not EE is themain parameter determining this nutritional response.

Terms and definitions

For years, studies have been using the term ‘‘sedentary activi-ties’’ or ‘‘sedentary condition’’ in opposition to ‘‘exercise’’ or ‘‘phys-ical activity condition’’ to define their control condition. The actualinterest in sedentary behaviors has led to an important debateregarding the definitions and appellations of human activities.Waked rest position activities such as sitting and bed rest havebeen classified as ‘‘physical inactivities’’ (Thyfault & Booth, 2011)though there appears to be converging agreement that they shouldbe referred to as sedentary behaviors. As recently underlined bythe Sedentary Behavior Research Network (SBRN), there is a needfor a universal definition of sedentary activities vs. inactivity thathave not the same energy cost, behavioral and metabolic implica-tions (Sedentary Behaviour Research Network, 2012). Accordingly,

the SBRN proposed that any waking behavior characterized by anEE of 61.5 Metabolic Equivalent Tasks (METs) (such as sitting orreclining posture) should be classified as sedentary behaviorswhile inactivities should describe those who do not sustain a suf-ficient amount of moderate to vigorous physical activity (thusnot meeting the specified physical activity guidelines) (SedentaryBehaviour Research Network, 2012). In their recent review, Tremb-lay and collaborators proposed the ‘‘movement continuum’’ illus-trating the different focus of sedentary and exercise physiology(Tremblay, Colley, Saunders, Healy, & Owen, 2010). Referring totheir model, human activities are classified according to their en-ergy requirements in METs (Fig. 1). In the present paper, the activ-ities will be classified under two main categories: sedentarybehaviors and physical activities; and considered in regard to theamount of EE they generate in children and adolescents.

Daily activities and subsequent EI in children and adolescents

Physical activity

In the context of EB, physical activity and exercise are generallypromoted for their influence on EE. It has, however, been pointedout that physical activity also leads to nutritional adaptations(i.e., changes in EI and appetite sensations) at all ages whateverthe weight status (Blundell et al., 2003; King, Burley, & Blundell,1994; Martins et al., 2008; Thivel, Blundell, Duche, & Morio,2012). About 50 years ago, food consumption was thought to beregulated with such flexibility that exercise-induced EE was di-rectly compensated for by an increase in caloric intake (Mayeret al., 1956). However, such a compensatory adjustment has notbeen confirmed and EI is now thought to be regulated not onlyby the need for fuel, but by a combination of psychological, biolog-ical and environmental factors (Blundell & King, 1999). This acuteuncoupling between physical activity-induced EE and EI has beenextensively discussed and reviewed in adults (Blundell et al.,2003; King et al., 1994; Martins et al., 2008); however, it remainsunclear and understudied in children and adolescents.

60 D. Thivel et al. / Appetite 60 (2013) 58–64

Some studies have shown differences in the response to physicalactivity of the orexigenic hormone ghrelin between children andadults. In 12 year old children Sauseng et al. have reported a signif-icant increase in acylated ghrelin, the active form of the hormone, inresponse to incremental exercise to exhaustion (Sauseng et al.,2011). MacKelvie and coworkers also showed a significant increasein acylated ghrelin in normal weight children and to a lesser extentin overweight adolescents following a 5 day moderate intensityexercise intervention (Mackelvie et al., 2007). Furthermore, in thelatter study the change in acylated ghrelin after a meal test was cor-related with increased subjective markers of appetite. Overall, thestudies by Sauseng et al. and MacKelvie et al. are in contrast withadult studies where a decrease acylated ghrelin is observed in nor-mal weight (Broom, Stensel, Bishop, Burns, & Miyashita, 2007) andoverweight adults (Marzullo et al., 2008). Sauseng et al. hypothe-sized that increased acylated ghrelin levels in youth could ensuresufficient EI when EE is increased (Sauseng et al., 2011). As recentlyunderscored, little data are available regarding the impact of acuteexercise on subsequent EI in both lean and overweight/obese chil-dren and adolescents, and the important heterogeneity in the meth-odologies used make any conclusion difficult (Thivel, Blundell,et al., 2012). Changes in body composition appear the best way toinvestigate this EI compensation to EE on a long term basis, butthe possible acute coupling response of EI to EE, whatever themethodologies and the exercise characteristics (duration, intensity,modality, frequency) used, remains to be determined.

Normal weight children and adolescents

The first paper that has questioned the impact of acute physicalactivity (intermittent cycling exercise) on subsequent EI in chil-dren showed that an intensive bout of exercise (75% VO2max;38 ± 5 min) did not induce any energy consumption alteration(measured at an ad libitum buffet meal) while lower intensity(50% VO2max; 56 ± 7 min) led to a 700 kJ decrease in EI followingthe session in normal weight girls aged 9–10 years compared toa resting session (Moore, Dodd, Welsman, & Armstrong, 2004). Inthis work, both exercises generated the same EE (1500 kJ) but re-sulted in different EI responses. In a more recent study, Bozinovskiand colleagues studied normal weight 14–15-year-old adolescentswho performed a 15-min exercise bout at ventilatory thresholdgenerating a mean expenditure of 300 kJ, and on a separate occa-sion a 45-min trial at the same intensity with an average expendi-ture of 800 kJ (Bozinovski et al., 2009). In this study, the twoexercises induced different EE but subsequent EI 30 min after exer-cise was not significantly different to the resting session (valuesnot reported, EI assessed using an ad libitum buffet meal).

Normal weight pre-pubertal children have been reported todecrease their ad libitum energy consumption 30–45 min after45-min sessions of resistance, swimming or aerobic exercises com-pared to a resting session (Nemet, Arieli, Meckel, & Eliakim, 2010).However, reductions in EI did not appear to be related to theinduced EE, as the largest reduction in EI was observed after aresistance training session (averaged: �800 kJ), as opposed to theaerobic session which induced a higher expenditure (mean1350 kJ) (Nemet et al., 2010). Interestingly, we are aware of onlyone study that reported a close compensation between the EE in-duced by an exercise bout and the subsequent food consumption(Tamam, Bellissimo, Patel, Thomas, & Anderson, 2012). After twoexercise bouts generating an expenditure of 260 kJ and 330 kJ, nor-mal weight adolescent boys respectively responded by increasingtheir ad libitum caloric intake by 340 and 260 kJ 30 min after exer-cise. However, when compared to the control session (participantsplayed board games during the control sessions) food intake wasnot significantly different, which suggests that physical activitymay have had no real impact on EI in this investigation. It should

also be noted that the buffet meal employed in this study only con-tained a highly palatable food item (pizza) which may have com-promised the results (Thivel, Duché, & Morio, 2012).

Overweight and obese children and adolescents

As in normal weight children, Nemet and collaborators alsoasked overweight pre-pubertal children to complete an aerobic, aresistance and a swimming session for 45 min each. Their resultsshowed increased energy consumption after the sessions (althoughnot to a significant extent after the aerobic and resistance condi-tions), but once more the intake response did not match with theamount of energy expended (Nemet et al., 2010). In another study,obese adolescents significantly decreased their food intake (ad libi-tum buffet meal) 30 min after an acute bout of intensive cycling(70% of VO2max); however, while the average increase in EE was1256 kJ, the participants decreased their intake by 431 kJ (Thivelet al., 2011). Later on, a similar 70% VO2max exercise session induc-ing a 1017 kJ of EE has been shown to significantly decrease EI atboth lunch (�1281 kJ) and dinner time (�732 kJ) in obese 12–15 years old teenagers (EI was assessed during ad libitum buffetmeals at both lunch and dinner time) (Thivel, Metz, et al., 2012).Similar to Moore et al. (Moore et al., 2004) in lean adolescents, ob-ese adolescents have also been shown to respond differently afterisoenergetic (1398 kJ) low (40% VO2max) or high (75% VO2max)intensity exercise in terms of subsequent EI (ad libitum meal served30 min after exercise) (Thivel, Isacco, et al., 2012). While no mod-ification was observed at the buffet meal after the low intensityexercise, a significant decrease in intake was detected after themore intense session (Thivel, Isacco, et al., 2012). Taman et al. re-cently observed a 138 kJ reduction at a buffet meal after (30 min)a 263 kJ exercise session in obese adolescent boys, which was how-ever not significantly different to the meal consumption observedduring the resting session. As noted earlier for lean participants,this intervention employed a highly palatable buffet meal whichmay have influenced these results (Thivel et al., 2012).

As recently underlined, one of the main methodological issuethat could explain the disparities between studies in both leanand obese youth remains the interval of time between the end ofthe exercise and the assessed EI (Thivel, Blundell, et al., 2012).Depending on the studies, EI is assessed from 15 min to an hourafter the exercise while the physiological impact of exercise mayhave considerably changed. This is clearly illustrated by the higherEI decreased observed at dinner time in obese adolescents com-pared to lunch time (both meals assessed thanks to ad libitum buf-fet) while the exercise was set during the morning (Thivel, Isacco,et al., 2012; Thivel et al., 2011). Finally, there is little informationon the chronic impact of EE on EI in children and adolescents ofany weight.

Energy expenditure

Although it remains difficult to draw firm conclusions regardingthe impact of acute exercise on subsequent caloric intake in chil-dren and adolescents, it seems that the amount of energy ex-pended during the exercise is not compensated for by anincreased EI, and may even result in reductions in EI (which re-mains to be questioned on a chronic basis). Further, there appearsto be no clear relationship between the EE of a bout of physicalactivity and the subsequent feeding response (Table 1). Focusingsolely on post-exercise EI to understand the acute regulation of en-ergy balance may, however, lead to misinterpretations. It should benoted that increasing EE through physical activity may not onlyinfluence EI, but may also affect EE by inducing spontaneous adap-tations in physical activity. First described by Rowland, the ‘‘activ-itystat hypothesis’’ effectively proposes that the control of physical

Table 1Energy intake response (kJ) to the energy expenditure (kJ/min) induced by daily activities from sitting to exercise in lean and obese children. ( ) corresponds to overweight/obeseand ( ) to lean children. Data are ranged from the lowest to the highest induced energy expenditure (in kJ/min).

Abbreviations: SD = standard deviations; TV = television; EE = energy expenditure and EI = energy intake; VG = video games.

D. Thivel et al. / Appetite 60 (2013) 58–64 61

activity is operated centrally according to a set point of energyexpenditure (Rowland, 1998). This theory predicts that more activ-ity at one time will be compensated for by less activity at anothertime in defense of this individual’s set point. This phenomenon hasbeen recently illustrated in both adults (Pontzer et al., 2012) andchildren (Fremeaux et al., 2012).

It has been shown in adults that an exercise session accom-plished in the morning (particularly when it is of higher intensity),led to a decreased spontaneous daily physical activity EE (assessedby accelerometers) (Wang & Nicklas, 2011). This behavior compen-sation has also been reported in obese adolescents, especially afterintense exercise using heart rate records or metabolic chambers(Kriemler et al., 1999; Thivel, Isacco, et al., 2012). The reducedspontaneous physical activity EE observed after a physical activitysession has been shown sufficient to compensate for the energy ex-pended during exercise, leading to equal total daily EE (assessedusing metabolic chambers) between the exercise and a restingday in obese youth (Thivel, Isacco, et al., 2012). Such data also indi-cate that the impact of a physical activity session on daily EB maybe mainly due to its effects on EI and not to EE, as commonlybelieved.

Television (TV) viewingWatching TV is currently considered as the main sedentary

activity in adult and pediatric populations and its implication inthe progression of overweight and obesity has been repeatedlyhighlighted (Swinburn & Shelly, 2008). It has been shown that thetime spent watching TV does not only imply a low level of EE butalso a higher eating frequency and energy consumption (Coon,Goldberg, Rogers, & Tucker, 2001; Crespo et al., 2001; French, Story,Neumark-Sztainer, Fulkerson, & Hannan, 2001; Matheson, Killen,Wang, Varady, & Robinson, 2004; McNutt et al., 1997; Sonneville& Gortmaker, 2008; Stroebele & de Castro, 2004), regardless ofappetite sensations (Bellisle, Dalix, & Slama, 2004; Temple, Giacom-elli, Kent, Roemmich, & Epstein, 2007). A substantial proportion ofchildren and adolescents’ daily EI has been found to be consumedin front of the TV set (during both weekends and week days) (Gore,

Foster, DiLillo, Kirk, & Smith West, 2003; Matheson et al., 2004; Vanden Bulck & Van Mierlo, 2004), which could explain the higher adi-posity indicators (waist circumference, fat mass, body mass index)described in children and adolescents that are used to having theirmeals while watching TV (Isacco et al., 2010).

Although children and youth have been shown to increase theirfood intake when they watch TV (Gore et al., 2003; Matheson et al.,2004; Van den Bulck & Van Mierlo, 2004), the composition of thishigher intake is also altered by TV. The consumption of healthyitems such as fruits and vegetables is lower while the consumptionof sweetened beverages, snacks and other energy dense foods areincreased (Blass et al., 2006; Coon et al., 2001; Francis, Lee, & Birch,2003; French et al., 2001; Rey-Lopez et al., 2012; Vader, Walters,Harris, & Hoelscher, 2009). There is evidence that TV viewing de-lays satiation, reduce satiety signals from previously ingested foodand limits the ability of individuals to monitor satiety signals, alltogether favoring increased energy consumption (Bellisle et al.,2004; Bellissimo, Pencharz, Thomas, & Anderson, 2007; Brunstrom& Mitchell, 2006; Francis & Birch, 2006).

Watching TV favors a reduced EE (compared with activitiesrequiring body motions for instance) but also leads to a higher foodintake in children and adolescents (using self reported data)(Matheson et al., 2004). Food consumption patterns while watch-ing TV have been largely investigated but it remains unknownwhether or not watching TV without access to food could affectsubsequent EI. In free-living conditions, many children and adoles-cents have access to TV before taking their meals with their familybut no work has clearly investigated the potential impact of a TVsession on the following meals.

In 2010, Nemet and collaborators compared the impact of differ-ent physical activity sessions (swimming, resistance and aerobictraining) on the following EI in pre-pubertal lean and overweightchildren (Nemet et al., 2010). In their design, they also imple-mented a control session where they asked the participants towatch TV for 45 min. According to their work, 45 min of physicalactivity in the form of swimming or resistance training led to a low-er EI than watching TV in normal weight children, while overweight

62 D. Thivel et al. / Appetite 60 (2013) 58–64

children ate less after the TV session compared to the physicalactivity bout. The authors also pointed out a higher energy con-sumption after TV viewing in overweight (3374 ± 213 kJ) comparedto lean (2537 ± 272 kJ) kids (Nemet et al., 2010). Unfortunately, EEhas not been assessed during the 45 min of the TV session, whichdoes not permit any hypothesis regarding a possible link betweenthe expended and consumed energy.

Video game playingThe modernization of our society and improvement in technol-

ogies have favored the development of electronic devices and vi-deo games. One third of American youth report playingelectronic games every day (Lenhart et al., 2008) and 50% admiteating while playing computer or video games (Moag-Stahlberg,Miles, & Marcello, 2003). As for TV viewing, playing video gameshas been incriminated for the low level of EE it generates (Janz &Mahoney, 1997), which could possibly favor the progression ofoverweight and obesity (Carvalhal, Padez, Moreira, & Rosado,2007; Ray & Jat, 2010; Schneider, Dunton, & Cooper, 2007; Stettler,Signer, & Suter, 2004). Since overconsumption of food has been re-ported in adults during computer-related activities (Chaput, Dra-peau, Poirier, Teasdale, & Tremblay, 2008; Chaput & Tremblay,2007), it seems reasonable to hypothesize that video gaming mightalso stimulate EI in children and adolescents.

The impact of video games on EE in children and adolescents hasbeen mainly questioned and particularly with the appearance of ac-tive video games, requiring more body movements. It has beenshown that watching TV seated or playing seated video gamesincreased EE by 20% and 22%, respectively (using indirectcalorimeter), compared to rest in 8–12 years old children(Lanningham-Foster et al., 2009). Recent systematic reviews haveshown that active video games generate a higher EE in childrenand adolescents compared with passive ones (Barnett, Cerin, &Baranowski, 2011; Peng, Lin, & Crouse, 2011) and Graves and col-laborators found a 51% increased EE during 15 min of an activeWii session compared to sedentary video game play in normal-weight 13–15 years old (EE assessed using accelerometers) (Graves,Stratton, Ridgers, & Cable, 2008). This higher EE (measured thanksto indirect calorimetry) during active video game play has beenfound to reach 2–3 times the energy expended during seated TVviewing (Graf, Pratt, Hester, & Short, 2009) and the ‘‘Dance DanceRevolution’’ game (Konami Digital Entertainment) has been shownto produce an increased EE (indirect calorimetry) of 172 ± 69%above resting energy expenditure (duration of 15 min) in leanchildren (Lanningham-Foster et al., 2009).

Regarding its impact on EE, it has been suggested that active vi-deo games could be a potential way to increase physical activityand even to combat obesity. However, the majority of evidencein this field of research comes from acute experiments and Chaputand Sjödin underlined that the chronic use of active video gamesmay favor compensation in food intake and then be unlikely toproduce any weight loss (Chaput & Sjodin, 2011). Unchanged bodyweight has effectively been reported after a 6-month active videogame program in overweight and obese children, suggesting sucha compensatory adjustment in food intake and/or physical activity(Maddison et al., 2011).

Very few data are available regarding the impact of video gameson EI. Recently, lean adolescents have been shown to increase theirEI (ad libitum buffet meal) in a test lunch after an 1-h passive videogame session compared to a rest session (+335 kJ), without con-comitant appetite sensation modifications nor any increase inobjective markers of appetite (i.e., appetite-related hormones)(Chaput, Visby, et al., 2011). The authors also measured EE usingindirect calorimetry and found a 107 kJ increased expenditure dur-ing the video game session compared to rest. These data clearlyunderline an uncoupling between the produced EE and EI following

video games. According to the authors, the higher intake observedwas due to the mental stress generated by the practice of videogames (Chaput, Visby, et al., 2011). In 2010, Mellecker and collabo-rators asked 27 eleven years old children to play a sedentary videogame on two separate occasions, once seated and once walking on atreadmill at 1.2 km/h (Mellecker, Lanningham-Foster, Levine, &McManus, 2010). The aim of the study was to match conditionson mental stress using the exact same game. Adding a physicalactivity component to the video game practice did not induce anyEI modification. It seems, however, difficult to compare an active vi-deo game with a sedentary one which is simply being played duringa bout of physical activity. Further work is needed to better under-stand the relative role of mental stress induced by video games onthe subsequent nutritional adaptations.

Other sedentary behaviorsAlthough screen time represents a large part of children and

adolescents’ time and likely stimulates food consumption muchmore than other sedentary activities (mainly due to the activationof the hypothalamo-pituitary-adrenal axis and to their ability toact as a distractor to food cues), children and youth are alsoconfronted to other daily activities that could be defined as‘‘non-screen sedentary behaviors’’ and that could also impact theirenergy consumption. Knowledge-based work and cognitive taskshave been shown to increase EI in university students (Chaput &Tremblay, 2007; Chaput et al., 2008) but no data are available inthe pediatric population. Since the time spent to do their homeworkhas been identified as the main after-school activity in children(with screen time) (Atkin, Gorely, Biddle, Marshall, & Cameron,2008; Biddle, Gorely, Marshall, & Cameron, 2009), it appears neces-sary to question its impact on EB (both intake and expenditure),which remains unexplored so far. Although no results are reportedconcerning EE, it has been shown that 15 min of board games and15 min of intensive exercise (at ventilatory threshold) similarly af-fect EI in both lean and obese adolescents (higher energy consump-tion in obese) (Tamam et al., 2012). Although those data have to beconsidered carefully regarding the highly palatable composition ofthe meals (pizza) and the very short exercise duration (15 min), itmight indicate that subsequent EI is not driven by the activity-induced EE, irrespective of weight status.

Other daily sedentary activities have been associated with theprogression of overweight and obesity mainly because of the lowlevel of EE they generate (e.g., motorized transportation) (Andeg-iorgish, Wang, Zhang, Liu, & Zhu, 2012), without considering theirpotential impact on EI. There is a need for more investigationsregarding the impact of those non-screen sedentary activities onboth sides of the EB equation to fully appreciate their potentialin inducing weight gain (Active Healthy Kids Canada & Group,2012).

Imposed sedentary behaviorsSimilar to sitting, bed rest or other reclining postures generate

very low levels of EE; however, their implication in the progressionof obesity may also involve EI alterations. It has been recentlyshown in adults that an acute sitting session decreases EE (usingan indirect calorimeter) compared to a control session withoutreducing appetite sensations, leading the authors to hypothesizethat it could favor a positive caloric balance and then weight gain(Granados et al., 2012). However, other data have shown that leanadults compensate for a 2 week of bed rest by decreasing theirspontaneous EI (self reported) in order to match for the lower EEand then preserve EB (Bergouignan, Rudwill, Simon, & Blanc,2011). In the first of two studies on the topic, it was shown thatEI was lower in lean adolescents after one hour of sitting comparedto a passive video game session without any alteration of appetitesensations (Chaput, Visby, et al., 2011). Additionally, 3 h of bed rest

D. Thivel et al. / Appetite 60 (2013) 58–64 63

during the morning have been shown to significantly increase EI inobese adolescents (mainly at dinner time during an ad libitum buf-fet meal) compared to a control session (3428 ± 514 and2788 ± 218 kJ, respectively) (Thivel, Metz, et al., 2012). Here again,those nutritional adaptations have not been accompanied by anyappetite sensation alterations. Although those discrepancies maybe due to the duration of the imposed activity (1 h vs. 3 h), itmay be hypothesized that normal-weight and obese youth responddifferently to imposed sedentary behaviors in terms of EI.

Conclusion

Collectively, the available literature provides contradictory re-sults regarding the impact of daily activities (physical activitiesand sedentary behaviors) on subsequent EI responses. This ismainly due to a large heterogeneity in the study designs used lead-ing to a lack of a common methodology, and to the difficulty tocontrol all the factors influencing energy balance. Although someshort-term studies have used indirect calorimetry to assess energyexpenditure, most of them have used accelerometers that presentsome precision and reliability issues which clearly limit the inter-pretation of their data (Chen et al., 2003). The use of self-reporteddietary questionnaires also limits the objectivity of some energyintake results. Although the doubly-labeled water technique re-mains an expensive method for short-term studies, future mediumand long-term investigations should track energy balance usingthis method, in addition to qualitative measures like energy intakediary and accelerometers, to provide more accurate results (de Jon-ge et al., 2007).

All the results discussed in this paper suggest that children andadolescents do experience nutritional adaptations after both phys-ical activities and sedentary behaviors that have to be particularlyconsidered in the regulation of EB. It seems likely that the subse-quent EI alterations are not driven by the amount of energy ex-pended during those activities (Table 1). Other characteristics ofthose activities may have a greater impact on EI, such as theirintensity, duration and type of activity. In particular, screen-basedsedentary behaviors are more likely to stimulate food intake(regardless of appetite sensations) than non-screen sedentarybehaviors. This also suggests that EI in the current obesogenic envi-ronment may be mainly determined by non-homeostatic pathwaysthat can override the energetic and hormonal signals.

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