Technology has become an integral part of our daily lives. In many ways, it shapes the pace and flow of society. Unfortunately, it may shape our waistlines and steer many toward a more stagnant lifestyle. The overweight and obesity epidemic declared by the World Health Organization in 1997 continues to grow. According to the 2016 National Survey of Children's Health, the rates for pediatric obesity range from 19.2% up to 37.7% across the 50 states and the District of Columbia (National Survey of Children's Health, 2016). This growth is not only isolated to the United States. Worldwide, overweight and obesity is estimated to affect over 60 million children by 2020 (de Onis, Blossner, & Borghi, 2010). In addition, other studies indicate that there is a correlation between physical activity and screen time (but not other inactive activities) and BMI, BMI-for-age z score, % body fat, and waist circumference in children (Lee et al., 2015). Research repeatedly shows a positive relationship between regular exercise and the prevention of cardiovascular disease and its risk factors such as diabetes, hypertension, and obesity (Varghese et al., 2016).

Of course, technology is not all bad. There are many ways that the technology boom positively impacts our society. Schools are incorporating technology to promote inclusion and increased engagement into physical education classes (Faber, Kulinna, & Darst, 2007; Hill & Turner, 2007). Technology provides access for many to online resources and media that offer information designed to improve health and wellness at home and in the community (American Heart Association, 2017). These resources are now more portable and accessible than ever with the expanded use of smartphones and tablets giving rise to exergaming, a new division of the health promotion field (Witherspoon, 2013). Individuals are now able to utilize gaming systems that measure and assess effort and various mobility metrics. Examples of these systems are Nike + Kinect Training and exercise/health apps such as Sworkit, Sworkit Kids, and Charity Miles, in addition to YouTube exercise channels and/or videos to help improve fitness levels and eating habits (Chaddha, Jackson, Richardson, & Franklin, 2017). Several of these have become staples in the home as well as in the workplace. There is evidence to suggest that fitness trackers/wearables could help to improve activity in children as well (Ridgers, McNarry, & Mackintosh, 2016).

So, what do we do as healthcare providers? The American Academy of Pediatrics along with numerous other organizations state that the causes of decreased activity are multifactorial and have compiled guidelines for age-appropriate activity recommendations for children ranging from infancy through adolescence. Advocacy is key, and healthcare providers are encouraged to counsel patients/families not only in word but also in deed. In other words, be a good example and follow the recommendations yourself (Council on Sports Medicine and Fitness and Council on School Health, 2006). Another part of promotion is to educate and inform patients, coworkers, and others on settings that could bolster our children's activity level. Children typically spend nearly half of their waking day at school. Physical education classes may or may not be available in many schools; it will take consistent and determined efforts to implement, support, and improve policies affecting physical education (Cooper et al., 2016). In many ways, our children's initial encounter with physical education probably plays a more significant role in their long-term health and well-being than any of their academics. This exposure teaches them the "physical literacy" of exercise and its importance and incorporation into daily life (American Heart Association and American Stroke Association, 2015; Orlowski, Lorson, Lyon, & Minoughan, 2013). Additional resources exist with compiled recommendations and benefits for activity, both as structured and unstructured play, as well as what limitations to place on screen/sedentary time (Krakow, 2011; O'Malley & Thivel, 2015).

As healthcare providers, our objective is to improve the health and quality of life of our patients. More specifically, as healthcare providers in pediatrics, we have the ideal window of time to impact, influence, and affect positive lifelong health. Our responsibility regarding activity and screen time is to continue to advocate and promote a holistic approach with a consistent message. We need to educate and empower our patients and families to seek, integrate, and employ activity into daily life, whether it is walking/riding bikes to school, participating in organized sports, or engaging in unstructured play (Centers for Disease Control and Prevention, 2011; National Physical Activity Plan Alliance, 2016). As a physical therapist, my profession continues to be tasked with promoting and restoring mobility in patients. However, the strain of the obesity epidemic on our healthcare system will continue to shift our focus toward treating the complications of obesity. We must engage and focus on proactive and aggressive lifestyle changes (Maibach, 2007) to both prevent and treat obesity complications. Our influence on the pediatric population we serve will inevitably shape the dynamics of the health of our world in the future.

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