1. Danielle Duvall April 6 th, 2010 Television: Its link to Childhood and Adolescent Obesity

2. Introduction Overweight and Obesity are one of the nation’s largest health concerns; specifically the rapidly rising rates of child and adolescent obesity. Costs of hospitalizations related to childhood obesity rose from $125.9 million in 2001 to $237.6 million in 2005. 1 A major factor contributing to obesity rates is a sedentary lifestyle. 1. Cawley J. Health Affairs. 2010

3. 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.

4. 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. 5 3. Kaur H. Journal of Pediatrics. 2003. 4. Hancox R. Lancet. 2004.5. Viner R. Journal of Pediatrics. 2005.

5. Theories 1. Television viewing displaces physical activity 2. Increased eating while viewing 3. Advertisements and product placements may influence eating habits

6. Television and Lack of Activity The recommendation for physical activity for children is 60 minutes on most days of the week. Only 35% of high school students met this recommendation. 6 Theories suggest that while children are spending six hours daily on “screen time” this time is replacing time that could be spent getting exercise or playing. 6. Centers for Disease Control and Prevention: Overweight & Obesity.

7. Television and Lack of Activity “ Television viewing and its association with overweight, sedentary lifestyle…” 7 Subjects: 15,349 high school students Data Collected: Youth Risk Behavior Survey Results:  >2 hours of TV led to 1.5 times chance of being overweight  More hours of TV watched daily increased chance of sedentary lifestyle 7. Lowry R. Journal of School Health. 2002.

8. Television and Lack of Activity “TV Viewing & Physical Activity in Children” 8 Subjects: 80 children aged 9-12 Data Collected: television viewing for four days, physical activity recorded by an accelerometer Results:  Weak general correlation  Significant correlation when looking at certain factors 8. Hager R. Journal of Adolescent Health. 2006.

9. Television and Snacking Prevalence of children (ages 6-11) who snack daily has risen from 74% to 98% from 1977 to 2003. 98% of those who snack (ages 6-18) eat 3 snacks per day, while 50% eat five or more. Snacking in 2003 made up roughly one quarter of children's daily calories, whereas in 1977 the proportion was only one fifth. 9 9. Piernas C.Health Affairs. 2010

10. Television and Snacking “ On the road to obesity… Television viewing increases intake of high-density foods” 10 Subjects: 20 undergraduates Data Collected: amount consumed while watching TV vs. not Results: 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.

11. Television and Snacking “Does Eating during Television Viewing Affect Preschool Children’s Intake?” 11 Subjects: 24 3-5 year olds Data Collected: amount consumed at meals while a cartoon was shown vs. not Results: preschoolers ate less while watching television  Those who watched TV while eating at home actually ate more 11. Francis L. Journal of the American Dietetic Association. 2006.

12. 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.

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

14. Television and Advertising “Effect of television advertisements for foods on food consumption in children” 14 Subjects: 42 children aged 9-11 Data 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

15. 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 5-7 Data collected: identical to prior study Results: 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

16. Possible Solution “A Randomized Trial of the Effects of Reducing Television Viewing and Computer Use on Body Mass Index in Young Children” 16 Subjects: 70 children aged 4-7, >75 th percentile Data Collected:  BMI  Food Frequency Questionnaire Results:  Intervention group (reduced TV by 50%) had lower BMI and lower energy intake vs. the control group 16. Epstein L. Archives of Pediatric and Adolescent Medicine. 2008.

17. Conclusion Watching television for long periods of time was associated with higher BMI, however, there was limited data to show that watching television displaced physical activity. (7,8) Watching television was associated with snacking and eating more than one normally would at mealtimes. (10) However, preschoolers only consumed larger portions when they were used to eating in front of the television at home. (11)

18. Conclusion Children and adolescents are exposed to a large amount of food advertisements, many of them being for energy-dense foods.(12,13) Children consumed more calories after watching food advertisements versus when they only watched non-food advertisements. (14,15)

19. Conclusion Considering that adult viewing habits are often reflective of viewing habits during youth (5) and that eating in front of the television is a learned behavior (11), it is important to teach proper eating and viewing habits while children are still young. Reducing television viewing may have a positive effect by lowering BMI and reducing energy intake. (16)

20. 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.

21. 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.