Danie l le Duval lApr i l 6 t h , 2010

Television: Its link to Childhood and Adolescent

Obesity

Introduction

Ove

rweig

ht a

nd

Ob

esity

are

on

e o

f the n

atio

n’s

larg

est h

ealth

con

cern

s; sp

ecifi

cally th

e ra

pid

ly risin

g ra

tes o

f child

an

d

ad

ole

scen

t ob

esity.

Costs o

f hosp

italiza

tion

s re

late

d to

child

hood

ob

esity ro

se fro

m

$1

25

.9 m

illion

in 2

00

1

to $

23

7.6

millio

n in

2

00

5.

1

A m

ajo

r facto

r co

ntrib

utin

g to

ob

esity

rate

s is a se

den

tary

lifestyle

.

1. Cawley J. Health Affairs. 2010

Introduction

Excessive television viewing by children has long been discouraged by health professionals for a variety of reasons, including its link to childhood obesity.2

The American Academy of Pediatrics recommends viewing time of less than 2 hours, however the average child watches three hours of television per day.2

2. American Academy of Pediatrics Position Statement: Children, Adolescents, and Television. 2001.

Introduction

Watching greater than two hours of television daily resulted in twice the odds of being overweight. 3

Childhood and adolescent television viewing habits influenced adult BMI and cholesterol levels. 4

Childhood viewing habits were reflective of adult viewing habits as well as increased BMI. 53. Kaur H. Journal of Pediatrics. 2003. 4. Hancox R. Lancet. 2004. 5. Viner R. Journal of Pediatrics. 2005.

Theories

1. Television viewing displaces physical activity

2. Increased eating while viewing

3. Advertisements and product placements may influence eating habits

Television and Lack of Activity

Th

e re

com

men

datio

n

for p

hysica

l activity fo

r ch

ildre

n is 6

0 m

inu

tes

on

most d

ays o

f the

week.

On

ly 35

% o

f hig

h sch

ool

stud

en

ts met th

is re

com

men

datio

n.

6

Th

eorie

s sug

gest th

at

wh

ile ch

ildre

n a

re

spen

din

g six h

ou

rs daily

on

“screen

time” th

is tim

e is re

pla

cing

time

that co

uld

be sp

en

t g

ettin

g e

xercise

or

pla

ying

.

6. Centers for Disease Control and Prevention: Overweight & Obesity.

Television and Lack of Activity“T

ele

vision

view

ing

an

d its a

ssocia

tion

w

ith o

verw

eig

ht,

sed

en

tary

lifestyle

…”

7

Su

bje

cts: 1

5,3

49

hig

h

school stu

den

ts

Data

Colle

cte

d: Yo

uth

R

isk B

eh

avio

r Su

rvey

Resu

lts:

>2 h

ou

rs of T

V le

d to

1.5

tim

es ch

an

ce o

f bein

g

ove

rweig

ht

More

hou

rs of T

V

watch

ed

daily in

crease

d

chan

ce o

f sed

en

tary

lifestyle

7. Lowry R. Journal of School Health. 2002.

Television and Lack of Activity“T

V V

iew

ing

&

Ph

ysical A

ctivity in

C

hild

ren

”8

Su

bje

cts: 8

0 ch

ildre

n

ag

ed

9-1

2

Data

Colle

cte

d:

tele

vision

view

ing

for

fou

r days, p

hysica

l activity re

cord

ed

by a

n

acce

lero

mete

r

Resu

lts:

Weak g

en

era

l corre

latio

n

Sig

nifi

can

t corre

latio

n

wh

en

lookin

g a

t certa

in

facto

rs

8. Hager R. Journal of Adolescent Health. 2006.

Television and Snacking

Pre

vale

nce

of ch

ildre

n

(ag

es 6

-11

) wh

o sn

ack

d

aily h

as rise

n fro

m

74

% to

98

% fro

m 1

97

7

to 2

00

3.

98

% o

f those

wh

o sn

ack

(a

ges 6

-18

) eat 3

snack

s p

er d

ay, w

hile

50

% e

at

five

or m

ore

.

Sn

ack

ing

in 2

00

3 m

ad

e

up

rou

gh

ly on

e q

uarte

r of ch

ildre

n's d

aily

calo

ries, w

here

as in

1

97

7 th

e p

rop

ortio

n

was o

nly o

ne fi

fth.

9

9. Piernas C.Health Affairs. 2010

Television and Snacking

“ On the road to obesity…Television viewing increases intake of high-density foods”10

Subjects: 20 undergraduatesData Collected: amount consumed while

watching TV vs. notResults: Watching TV while eating resulted

in eating more vs. not watching 1 Slice of Pizza more (862 calories) More Mac & Cheese (470 calories)

10. Blass E. Physiology & Behavior. 2006.

Television and Snacking“D

oes E

atin

g d

urin

g

Tele

vision

Vie

win

g

Aff

ect P

resc

hool

Ch

ildre

n’s In

take?”

11S

ub

jects: 2

4 3

-5 ye

ar

old

s

Data

Colle

cte

d:

am

ou

nt co

nsu

med

at

meals w

hile

a ca

rtoon

w

as sh

ow

n vs. n

ot

Resu

lts: pre

schoole

rs ate

less w

hile

watch

ing

te

levisio

n

Th

ose

wh

o w

atch

ed

TV

w

hile

eatin

g a

t hom

e

actu

ally a

te m

ore

11. Francis L. Journal of the American Dietetic Association. 2006.

Food Advertising

Advertising may be the largest way that television viewing influences food choices and weight status in both children and adults.

Fifty percent of ads during Saturday morning cartoons are for food, with 9 out of 10 being for unhealthy foods. 12

One-fourth of all product ads aimed at adolescents are for food. 13

12. Batada A. Journal of the American Dietetic Association. 2008 13. Powell L. American Journal of Preventive Medicine. 2007.

Commercial Content

22%9%

11%

17%

12%

29%

Restaurants 29%Sweets 22%Snacks 9%Cereal 11%Beverage 17%Other 12%

14%

18%

27%

10%

12%19%

Restaurants 19%Candy 14%Snacks 18%Cereal & Bars 27%Beverage 10%Other 12%

12. Batada A. Journal of the American Dietetic Association. 2008 13. Powell L. American Journal of Preventive Medicine. 2007.

Adolescents Children

Television and Advertising

“Effect of television advertisements for foods on food consumption in children”14

Subjects: 42 children aged 9-11Data Collected:

Food consumption after food ads vs. non food ads Product recognition (Will overweight/obese status

affect this?) Results:

Overweight and obesity influenced food ad recognition More was eaten after watching food ads

14. Halford J. Appetite. 2004

Television and Advertising

“Beyond brand effect of television food advertisements/commercials on caloric intake and food choice of 5-7 year-old children.”15

Subjects: 93 children aged 5-7Data collected: identical to prior studyResults: increase in food consumption was

associated with exposure to food advertisements 17% more calories in normal weight children 14% more calories in overweight and obese children.

15. Halford J. Appetite. 2007

Possible Solution

“A R

an

dom

ized

Tria

l of th

e E

ffects o

f R

ed

ucin

g T

ele

vision

V

iew

ing

an

d

Com

pu

ter U

se o

n

Bod

y Mass In

dex in

You

ng

Ch

ildre

n”

16

Su

bje

cts: 7

0 ch

ildre

n

ag

ed

4-7

, >7

5th

perce

ntile

Data

Colle

cte

d:

BM

I

Food

Fre

qu

en

cy Q

uestio

nn

aire

Resu

lts:

Inte

rven

tion

gro

up

(re

du

ced

TV

by 5

0%

) had

lo

wer B

MI a

nd

low

er

en

erg

y inta

ke vs. th

e

con

trol g

rou

p

16. Epstein L. Archives of Pediatric and Adolescent Medicine. 2008.

Conclusion

Watch

ing

tele

vision

for

lon

g p

erio

ds o

f time

was a

ssocia

ted

with

h

igh

er B

MI, h

ow

eve

r, th

ere

was lim

ited

data

to

show

that w

atch

ing

te

levisio

n d

ispla

ced

p

hysica

l activity.

(7,8

)

Watch

ing

tele

vision

was

asso

ciate

d w

ith

snack

ing

an

d e

atin

g

more

than

on

e n

orm

ally

wou

ld a

t mealtim

es.

(10

) H

ow

eve

r, pre

schoole

rs on

ly con

sum

ed

larg

er

portio

ns w

hen

they

were

use

d to

eatin

g in

fro

nt o

f the te

levisio

n a

t h

om

e.

(11

)

Conclusion

Ch

ildre

n a

nd

ad

ole

scen

ts are

exp

ose

d to

a la

rge

am

ou

nt o

f food

ad

vertise

men

ts, man

y of th

em

bein

g fo

r en

erg

y-den

se fo

od

s.(1

2,1

3)

Ch

ildre

n co

nsu

med

m

ore

calo

ries a

fter

watch

ing

food

ad

vertise

men

ts versu

s w

hen

they o

nly w

atch

ed

n

on

-food

ad

vertise

men

ts. (1

4,1

5)

Conclusion•

Con

siderin

g th

at a

du

lt vie

win

g h

ab

its are

ofte

n

refl

ective

of vie

win

g

hab

its du

ring

you

th

(5)

an

d th

at e

atin

g in

fron

t of th

e te

levisio

n is a

le

arn

ed

beh

avio

r (1

1), it

is imp

orta

nt to

teach

p

rop

er e

atin

g a

nd

vie

win

g h

ab

its wh

ile

child

ren

are

still you

ng

.

Red

ucin

g te

levisio

n

view

ing

may h

ave

a

positive

eff

ect b

y lo

werin

g B

MI a

nd

re

du

cing

en

erg

y inta

ke.

(16

)

Sources

1. Cawley J. The economics of childhood obesity. Health Affairs. 2010;29:364-371.

2. American Academy of Pediatrics Position Statement: Children, Adolescents, and Television. Pediatrics. 2001;107:423-426.

3. Kaur H, Choi W, Mayo M, Harris K. Duration of television watching is associated with increased body mass index. J Pediatr. 2003;143:506-511.

4. Hancox R, Milne B, Poulton R. Association between child and adolescent televising viewing and adult health: a longitudinal birth cohort study. Lancet. 2004;364:257-262.

5. Viner R, Cole T. Television viewing in early childhood predicts adult body mass index. J Pediatr. 2005;147:429-435.

6. Center for Disease Control and Prevention. Overweight and Obesity. Available at: http://www.cdc.gov/obesity/data/index.html. Accessed March 23, 2010.

7. Lowry R, Wechsler H, et al. Television viewing and its association with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender. J Sch Health. 2002;72:413-421.

8. Hager R. Television viewing and physical activity in children. J Adolescent Health. 2006;39:656-661.

Sources

9. Blass E, Anderson D, et al. On the road to obesity: Television viewing increases intake of high-density foods. Physiol Behav. 2006;88:597-604.

10. Piernas C, Popkin B. Trends in snacking among US Children. Health Affairs. 2010; 29:398-404

11. Francis L, Birch L. Does Eating during Television Viewing Affect Preschool Children’s Intake? J Am Diet Assoc. 2006; 106: 598-600.

12. Batada A, Seitz M, Wootan M, Story M. Nine out of 10 food advertisements shown during Saturday morning children’s television programming are for foods high in fat, sodium, or added sugars, or low in nutrients. J Am Diet Assoc. 2008;108:673-678.

13. Powell L, Szcyzpka G, Chaloupka F. Adolescent exposure to food advertising on television. Am J Prev Med. 2007;33:S251-S256.

14. Halford J, Gillespie J, et al T. Effects of television advertisements for foods on food consumption in children. Appetite. 2004;42:221-225.

15. Halford J, Boyland E, et al. Beyond brand effect of television food advertisements/commercials on caloric intake and food choice of 5-7 year-old children. Appetite. 2007;49:263-267.

16. Epstein L, et al. A Randomized Trial of the Effects of Reducing Television Viewing and Computer Use on Body Mass Index in Young Children. Arch Pediatr Adolesc Med. 2008;162:239-245.