Physicians are used to thinking in terms of medications, surgery and rehabilitation for medical problems, but in some cases, these problems are connected to social and even technological changes.Much of the fifth Israel Medical Convention recently organized by the Hadassah Medical Organization (HMO) was so occupied with nearly intractable issues combining medicine with societal problems that it was almost depressing.The conference – free to the public at Jerusalem’s International Convention Center and sponsored jointly this time with Haifa’s Bnai Zion Medical Center and Tzrifin’s Assaf Harofeh Medical Center – was attended by 1,100 doctors and other medical professionals as well as interested individuals.Presiding over it was outgoing HMO director-general Prof. Shlomo Mor-Yosef, who referred to another intractable problem – the long doctors’ strike – which remained not far below the surface.Prof. Eitan Kerem, Hadassah’s chairman of pediatrics, delved into a major health problem affecting children throughout the Western world that few societies and governments have been able to influence – inactivity and overweight, as youngsters increasingly glue themselves to computer and TV screens, and SMS their fingers to exhaustion.“Instead of military weapons creating revolution, these media have become tools of revolution,” he said, noting that children are becoming as affected as their parents or even more so. The average Western youngster sees 4.5 hours of TV a day, spends 1.5 hours on the computer, and then invests 1.25 hours playing computer games – a total of over seven hours daily. And this, he added, is during the school year; during the summer vacation, it goes on almost around the clock.While children used to get some exercise by playing ball or other games , this is less common than ever before. Children who have a TV in their own room are even more likely to become addicted, said Kerem.“Even in the car, children won’t stay quiet unless they have a DVD player on their laps or on the back of neck rests of front-seat passengers,” he said, adding that at home, TV sets are turned on most of the time, like background music.In Israel, a study conducted six years ago recommended that children aged 11 to 15 should watch no more than 2.5 hours of TV a day. But this is very outdated.“We are fifth to ninth in the world regarding how many of our children watch more than this voluntary limit,” according to Kerem. Most children here watch TV alone; only a fifth are viewers alongside their parents, and 17 percent with friends.The American Academy of Pediatrics recently recommended barring children under two from watching TV – which has been widely disregarded by parents.Infants watch TV before they reach their first birthday, said Kerem, as it is regarded by some parents as an ideal babysitter.“This is when brain development is at its height.When young children are alone for hours on end, their parents have less of a positive influence on them. It’s very hard for them to separate the world of fantasy from the world of reality. Many think that characters on TV actually exist. And they are affected by the violence they see. For every hour of violence on the screen, the risk of ADD-ADHD [ a t t e n t i o n - d e f i c i t disorder/attention deficit hyperactivity disorder] is four times as great,” he stated.A study that followed up children for 30 years into adulthood found that viewing violence in the media caused them to become more violent.“We see much more depression among teens.When we ask them about their lives, those who watch the most TV have poorer grades; fewer get along with their parents or are happy with school, and more get into trouble,” Kerem related.Some children watch TV after midnight, and this is especially common among high school pupils, he said. In the summer, some teenagers go to bed exhausted at 4 a.m. and wake up only in the afternoon. Today’s youngsters sleep an hour or two less per night than a decade or two ago. Being exposed to artificial light at night reduces the amount of the hormone melatonin produced in the brain during darkness and can affect a variety of things, from sleep, academic achievement and vision, to anxiety, mood changes and even the development of cancer.Almost every home where a schoolchild lives has a computer. They are usually unsupervised, and parents don’t know where their children are or what they see and do, said the pediatrician. “Children are also increasingly used to multitasking – communicating with their friends through social networks and e-mails, playing games, checking out video sites and photos and maybe doing their homework at the same time.”But, he continued, “there is a big price they pay for this activity, as being exposed to cursing, violence, sexual messages and advertisements for harmful products has become natural to them. A child who watches TV regularly will witness some 10,000 violent acts a year. And all this sedentary activity adds up to obesity, sleep problems, ADD/ADHD, aggressive behavior, academic problems and depression.”Obesity among children aged two to five has doubled in recent years, he said. “In our clinic, we see kids who weigh over 120 kilos! The more TV they see, the fatter they become.”Media advertisements, especially in the summer, when more young children and teens are watching, typically promote unhealthy foods with lots of sugar, salt, fat and simple carbohydrates.“So what can be done? These situations exist in almost every home,” participants at the conference mumbled to themselves and their neighbors, shrugging over the inevitability of risks. Kerem said that while these were major problems, things could be done to minimize harm to children’s psyches and bodies.“If parents don’t allow TV sets in children’s rooms, they will automatically be better off. If TVs are not turned on all the time, it will also be an improvement,” he said. Parents must increase their supervision, and children need rules and boundaries – no TV for more than a few hours a day. The family should also eat together several times a week. This, said Kerem, improves family unity and parental involvement and interest, and nutrition is much better when it is not based on junk food and snacks.Educating parents about this must start even in well-baby (tipat halav) centers, he added.DR. GAD Reisler of Assaf Harofeh’s pediatrics division focused on additional problems pertaining to teenagers.“They like to do things with peers, and sometimes they do dangerous things,” he noted. Physical changes of adolescence begin years earlier than they used to, so teens feel like adults. Violence, drugs, smoking, eating disorders and being in risky places are common, he said. Now, with the Internet, gambling and porn are more accessible than ever.“It is perhaps better to have virtual friends from Facebook than to have no friends, but having real ones is better,” said Reisler. “There isn’t much we can do, as risks are built into adolescence. We have to direct them to better places and reduce risky behavior by promoting connections to the family. Ask where they’re going, who are their friends. Set limits. Eat together three or four times a week and express love for them. It’s easy to think that kids of this age don’t need us and that they know everything, but they do need us.”Well-known sexologist Dr. Itzhak Ben-Zion, who was recently appointed chief psychiatrist of Kupat Holim Leumit, presented a worrisome picture of Israeli adolescents today. The former Soroka Medical Center deputy director-general said many children are no longer really children. Accurate sex information among youths is very poor, even though “sex is everywhere they look.It’s the most common search word on the Internet, and over half of TV shows have at least some sexual content, not to mention violence.”Many teens are addicted to Internet, e-mail and social networks. The majority go into sites they know their parents would not want them to see.“The new media are not [solely] bad,” he noted.“They can be used for good purposes such as giving reliable sex education and information on prevention of sexual diseases, but they also give access to erotic photos and videos, phone sex arrangements, viewing live sex acts, solicitation and prostitution. There is access, affordability and anonymity.”KADIMA MK Rachel Adatto, who heads the Knesset Health Lobby, addressed the gathering wearing her “medical hat,” as she is a trained gynecologist and lawyer. She recently introduced a private member’s bill (which passed on its first reading in the Knesset plenum) to restrict the appearance of anorexic presenters and models in the media.“It’s meant not only to restrict women fashion models, but celebrities of both sexes who serve as copycat role models for young people,” she said.Anorexia, bulimia and other eating disorders, which can be fatal in up to 17% of sufferers, are largely affected by the media. “Every year,” said Adatto, “1,500 Israeli kids are diagnosed. The death rate rises the longer it continues. Only 35% of anorectics and 45% of bulimics are cured.”Out of 33 countries, Israel ranks second in the rate of girls who diet. At the same time, the obesity rate is 17% among Israeli girls and 20% among boys, according to the latest statistics. “Most lack any guidance,” said Adatto.Some anorectics are treated in special eating disorder facilities, but many others are in closed psychiatric departments, said the MK, who visited numerous victims around the country when preparing the bill. “I know a 25-year-old girl who admitted to me that she adopted anorexia when she was only 11. Losing weight has been a way of life for her since then.”One teen told Adatto that she took 120 laxative pills daily to lose weight. Another bill presented in the Knesset would bar the sale of laxatives to people under 24 unless they presented a doctor’s prescription. The disease almost always begins when a young person goes on a diet to lose a few kilos. They get compliments and are thus encouraged to lose more. Some parents notice, said the MK, but others pay little attention.While encouraging healthful nutrition is important, she urged mothers not to boast about having lost weight and looking better, as this could badly influence their daughters.“Most adolescents are used to comparing themselves with others all the time. Thin is beautiful, they think.They have a poor image of themselves. Be careful what you say about children. Be alert. Never call them fat like a teddy bear. Their lives could be ruined,” the gynecologist advised.Adatto presented a number of photos in which models’ images underwent Photoshop editing to make them look even skinnier. Before-and-after shots of famous Israeli model Bar Refaeli showed how the computer program used a “scalpel” that made her look like an unattractive scarecrow to promote clothing sales. After Adatto’s protest, messages against the image appeared on Facebook, and the company was persuaded to halt the campaign.Another image, used by the Gap clothing chain, showed a female model with her ribs sticking out. The MK said that Gap had agreed only to “take it into consideration” that such images could promote eating disorders, but had not changed its policy.She noted that Adi Barkan, for years a modeling agency head, had promoted the very-thin look for years.“He encouraged them to vomit and to take laxatives. He even threatened them,” she said. “But then he realized what he had done and did an about face.He now campaigns against anorexia and is helping promote awareness of the bill.”The MK hopes that the bill, which she presented with Likud MK Danny Danon some 18 months ago and which would bar the presentation in the media of celebs with a body-mass index of under 18.5, will pass into law.“The legislation is not aimed at punishing the models, but those who use them – advertisers, modeling agencies and so on,” she explained. “Some claim the bill harms ‘freedom of expression,’ but this is not true. The models can gain a few kilos and work.”The Kadima MK concluded that in looking into the possibility of legislation, she had found that only France had major legislation barring the presentation of too-skinny models and presenters. Some others, such as Italy, had voluntary agreements between the government and the fashion world.Parents, the government, the health system and educators here and around the world will have to wake up to these problems and take action before it is too late.