Television and children's consumption patterns. A review of the literature

The recent increase in childhood obesity has, among other things, focused attention on the role that television may play. This paper summarizes results of studies published in peer review journals since 1970 with data pertaining to the relationship between television use and children's food intake. Studies fall into four categories: content analyses; effects of television advertising on children's food behaviors; television and pediatric obesity, with effects on children's dietary intake and physical activity; and television use and children's food consumption patterns. Content analyses have shown that food is the most frequently advertised product category on children's TV. The majority of these ads target highly sweetened products, but more recently, the proportion from fast food meal promotions has been growing. Controlled studies on children's choices have consistently shown that children exposed to advertising choose advertised food products at significantly higher rates than do those not exposed. Purchase request studies have documented associations between number of hours of TV watched and number of requests from the child to the mother for specific food items, as well as the presence of those items in the home. Greater TV use has been associated with higher intakes of energy, fat, sweet and salty snacks, and carbonated beverages and lower intakes of fruit and vegetables. Several large studies have documented associations between number of hours of TV watched and both the prevalence and incidence of obesity. The combination of lifestyle factors that accompany heavy television use appear to place children at risk of obesity and poor nutritional status.     

Childhood obesity and the media

This article assesses the role played by media in contributing to the current epidemic of childhood obesity. Electronic media use, often referred to as screen time, is significantly correlated with child adiposity. Although the causal mechanism that accounts for this relationship is unclear, it is well established that reducing screen time improves weight status. Media advertising for unhealthy foods contributes to obesity by influencing children's food preferences, requests, and diet. Industry efforts have failed to improve the nutritional quality of foods marketed on television to children, leading public health advocates to recommend government restrictions on child-targeted advertisements for unhealthy foods.     

Exposure to food advertising on television among US children

OBJECTIVE: To examine exposure to food advertising on television (TV) among children aged 2 through 11 years. DESIGN: Weighted examination of the distribution of national advertisements (ads) using TV ratings data. SETTING: National ads from 170 top-rated TV shows viewed by children aged 2 through 11 years from September 1, 2003, through May 31, 2004. PARTICIPANTS: Sample of 224,083 ads. MAIN OUTCOME MEASURES: Television nonprogram content time was assessed across 6 mutually exclusive categories that included food products, non-fast food restaurants, fast food restaurants, other products, public service announcements, and TV promotions. Food advertising was assessed according to 7 food categories--cereal, snacks, sweets, beverages, fast food restaurants, non-fast food restaurants, and other food products--and then examined across more detailed categories. RESULTS: In 2003-2004, 27.2% and 36.4% of children's exposure to total nonprogram content time and product advertising, respectively, was for food-related products. Similar distributions were found by race. Cereal was the most frequently seen food product, making up 27.6% of all food ads. Comparisons with previous studies suggest that, over time, food ads account for a smaller share of the product ads seen by US children. CONCLUSIONS: Children aged 2 through 11 years are exposed to a substantial amount of food advertising through TV, but the dramatic increase in childhood obesity rates during the past few decades was not mirrored by similar changes in food advertising exposure. However, we found evidence of a very recent (2000-2005) upward trend in the amount of exposure to food advertising on TV among US children.     

Does children's screen time predict requests for advertised products? Cross-sectional and prospective analyses

OBJECTIVE: To examine children's screen media exposure and requests for advertised toys and food/drinks. DESIGN: Prospective cohort study. SETTING: Twelve elementary schools in northern California. PARTICIPANTS: Eight hundred twenty-seven third grade children participated at baseline; 386 students in 6 schools were followed up for 20 months. INTERVENTION: None. MAIN OUTCOME MEASURES: Child self-reported requests for advertised toys and foods/drinks. RESULTS: At baseline, children's screen media time was significantly associated with concurrent requests for advertised toys (Spearman r = 0.15 [TV viewing] and r = 0.20 [total screen time]; both P<.001) and foods/drinks (Spearman r = 0.16 [TV viewing] and r = 0.18 [total screen time]; both P<.001). In prospective analysis, children's screen media time at baseline was significantly associated with their mean number of toy requests 7 to 20 months later (Spearman r = 0.21 [TV viewing] and r = 0.24 [total screen time]; both P<.001) and foods/drinks requests (Spearman r = 0.14 [TV viewing] and r = 0.16 [total screen time]; both P<.01). After adjusting for baseline requests and sociodemographic variables, the relationship between screen media exposure and future requests for advertised foods/drinks remained significant for total TV viewing and total screen media exposure. The relationship with future requests for toys remained significant for total screen media exposure. CONCLUSIONS: Screen media exposure is a prospective risk factor for children's requests for advertised products. Future experimental studies on children's health- and consumer-related outcomes are warranted.     

International epidemic of childhood obesity and television viewing

Childhood obesity is one of the most serious global public health challenges of the 21st century. The prevalence of this problem has increased at an alarming rate in many countries. The main causes of childhood obesity are; sedentary lifestyle, unhealthy eating patterns, genetic factors, socio-economic status, race/ethnicity, media and marketing, and the physical environment. Children are clearly being targeted as a receptive market by the manufacturing industry. Undoubtedly, television provides one of the most powerful media through which products can be advertised. Furthermore, food advertising accounted for the largest percentage of these advertisements in virtually all countries. Detailed nutritional analysis of food advertisements identified that up to 90% of food products have a high fat, sugar or salt content. Therefore TV viewing is recently identified as one of the risk factors contributing to development of childhood obesity by several mechanisms. This review provides some facts and figures about the global trend of rising obesity among children, amount and content of television and especially food advertisements being watched by children and its possible mechanisms how to cause adverse effects on children's health and contribute to childhood obesity.     

Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children

BACKGROUND: Decreasing television (TV)-viewing time may improve child health and well-being. These viewing patterns are shaped during the preschool years. Because mothers play an important role in determining how much TV their preschool children watch, a better understanding is needed of the maternal factors that influence children's TV viewing. OBJECTIVE: To examine the relationship of depressive symptoms and obesity in low-income mothers with TV-viewing time in their preschool children. METHODS: Cross-sectional, self-administered survey of 295 low-income mothers of 3- and 4-year-old children (92% white) enrolled in the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers reported children's usual weekday and weekend-day TV-viewing time. Maternal depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Maternal body mass index was calculated from self-reported height and weight measurements (weight in kilograms divided by height in meters squared). RESULTS: Children watched a mean of 2.2 +/-1.2 hours of TV per day. Those in the upper quartile of TV-viewing time (high TV viewers) watched 3 or more hours of TV per day. Of the mothers, 12% had both obesity (BMI > or =30) and depressive symptoms (CES-D score > or =16), 19% were obese only, and 18% had depressive symptoms only. Children were more likely to be high TV viewers if their mothers had clinically significant depressive symptoms (35% vs 23%; P =.03) or if their mothers were obese (35% vs 22%; P =.03). Forty-two percent of children were high TV viewers if the mother had both depressive symptoms and obesity, 30% if the mother had only depressive symptoms, 29% if the mother had only obesity, and 20% if the mother had neither depressive symptoms nor obesity (P =.06 overall; P for trend =.009 using the chi2 test). CONCLUSIONS: Among low-income preschool children, those whose mothers had either depressive symptoms or obesity were more likely to watch 3 or more hours of TV a day. Strategies to reduce TV viewing in young children should consider the role that maternal obesity and depressive symptoms may play in how preschool children spend their time.     

Television's influence on children's diet and physical activity

Understanding the impact of TV on children's diet and physical activity is important for developing strategies to prevent obesity and sedentary lifestyles. Determining parents' perceptions of television's influence on children's dietary intake and physical activity may provide useful information on this important topic. A questionnaire was developed to assess viewing habits and child requests for food and sport items advertised on TV. It was administered to 66 mothers of children, ages 3-8. Foods that children requested because they had seen them on TV paralleled the frequencies with which these foods were advertised on TV. Weekly viewing hours correlated significantly with (a) reported requests by children and purchases by parents of foods influenced by TV, and (b) children's caloric intake. Children's requests for sport items and physical activities were not significantly correlated with the number of hours of TV viewing. It appears from these data that parents perceive that television influences family purchasing patterns through the mechanism of their children's requests.     

Food Packaged with Toys: An Investigation on Potential Obesogenic Effects in Indian Children

Objective

To investigate, in a large pan Indian sample of school children, whether gadgets (toys) added to food increase food consumption, and if contemporary exposure to TV and/or advertising is a further promoting factor.

Methods

A total of 1,680 Indian children were first randomized to food exposure with or without toy and then to a five-level exposure to TV viewing and advertising according to a 2?×?5 full factorial ad libitum eating design study. The sample size was computed to detect a difference of 20 Kcal of caloric intake (assuming the same standard deviation of 20 Kcal in both groups) between “food with gadget” (Toy) and “food alone” (No Toy) groups in each level of the exposure to TV and advertising factor, given an alpha error equal to 0.05 and a power of 0.90.

Results

Mean caloric intake both in “Toy” and “No Toy” group was around 223 Kcal. When considering exposure to TV and advertising, mean values varied negligibly between 222 and 225 Kcal. According to linear models for the effect of gadget and exposure to TV and/or advertising on children’s intake, no significant adjusted associations were found, neither as main effects nor as interactions.

Conclusions

Food consumption by children is not influenced by the presence of added toys, even after adjustment for several potential confounding factors. The city where they live and age significantly influences Indian children’s caloric intake.

     

Childhood obesity: trends and potential causes

The increase in childhood obesity over the past several decades, together with the associated health problems and costs, is raising grave concern among health care professionals, policy experts, children's advocates, and parents. Patricia Anderson and Kristin Butcher document trends in children's obesity and examine the possible underlying causes of the obesity epidemic. They begin by reviewing research on energy intake, energy expenditure, and "energy balance," noting that children who eat more "empty calories" and expend fewer calories through physical activity are more likely to be obese than other children. Next they ask what has changed in children's environment over the past three decades to upset this energy balance equation. In particular, they examine changes in the food market, in the built environment, in schools and child care settings, and in the role of parents-paying attention to the timing of these changes. Among the changes that affect children's energy intake are the increasing availability of energy-dense, high-calorie foods and drinks through schools. Changes in the family, particularly an increase in dual-career or single-parent working families, may also have increased demand for food away from home or pre-prepared foods. A host of factors have also contributed to reductions in energy expenditure. In particular, children today seem less likely to walk to school and to be traveling more in cars than they were during the early 1970s, perhaps because of changes in the built environment. Finally, children spend more time viewing television and using computers. Anderson and Butcher find no one factor that has led to increases in children's obesity. Rather, many complementary changes have simultaneously increased children's energy intake and decreased their energy expenditure. The challenge in formulating policies to address children's obesity is to learn how best to change the environment that affects children's energy balance.     

Association between abdominal obesity,screen time and sleep in adolescents

ObjectiveTo assess the association between abdominal obesity, food intake, sleep deprivation, and screen time in adolescents.MethodsThis cross-sectional study was conducted with 432 adolescents aged 14–19 years, from public and private schools. Anthropometric and body composition measures included body weight, waist circumference, body mass index for age, waist-to-hip ratio, waist-to-height ratio, and body fat percentage. Abdominal obesity was defined by age and sex specific cut-off points for waist circumference. Food intake, screen time, sexual maturation, and sleep duration were evaluated by self-administered questionnaires.ResultsThe prevalence of excess body weight and abdominal obesity was 16.7% and 27.5%, respectively. Students in the adult phase (post-puberty), with inadequate waist-to-height ratio, high body fat percentage, and screen time ≥ 3 h/day were, respectively, 2.5 (95% CI 1.40–4.46), 7.44 (95% CI 1.08–51.46), 2.79 (95% CI 1.04–7.50), and 1.43 (95% CI 1.24–3.89) more likely to have abdominal obesity. Low intake of unprocessed or minimally processed foods was associated with inadequate sleep duration, while high intake of ultra-processed foods was associated with high screen time.ConclusionsAbdominal obesity was associated with the adult phase, short sleep duration and high screen time. The degree of food processing was associated with screen time and sleep duration. Assessing the risk factors of abdominal obesity may be a useful strategy for preventing cardiovascular disease in adolescents.     

The impact of home computer use on children's activities and development

The increasing amount of time children are spending on computers at home and school has raised questions about how the use of computer technology may make a difference in their lives--from helping with homework to causing depression to encouraging violent behavior. This article provides an overview of the limited research on the effects of home computer use on children's physical, cognitive, and social development. Initial research suggests, for example, that access to computers increases the total amount of time children spend in front of a television or computer screen at the expense of other activities, thereby putting them at risk for obesity. At the same time, cognitive research suggests that playing computer games can be an important building block to computer literacy because it enhances children's ability to read and visualize images in three-dimensional space and track multiple images simultaneously. The limited evidence available also indicates that home computer use is linked to slightly better academic performance. The research findings are more mixed, however, regarding the effects on children's social development. Although little evidence indicates that the moderate use of computers to play games has a negative impact on children's friendships and family relationships, recent survey data show that increased use of the Internet may be linked to increases in loneliness and depression. Of most concern are the findings that playing violent computer games may increase aggressiveness and desensitize a child to suffering, and that the use of computers may blur a child's ability to distinguish real life from simulation. The authors conclude that more systematic research is needed in these areas to help parents and policymakers maximize the positive effects and to minimize the negative effects of home computers in children's lives.     

Media and children's aggression, fear, and altruism

Noting that the social and emotional experiences of American children today often heavily involve electronic media, Barbara Wilson takes a close look at how exposure to screen media affects children's well-being and development. She concludes that media influence on children depends more on the type of content that children find attractive than on the sheer amount of time they spend in front of the screen. Wilson begins by reviewing evidence on the link between media and children's emotions. She points out that children can learn about the nature and causes of different emotions from watching the emotional experiences of media characters and that they often experience empathy with those characters. Although research on the long-term effects of media exposure on children's emotional skill development is limited, a good deal of evidence shows that media exposure can contribute to children's fears and anxieties. Both fictional and news programming can cause lasting emotional upset, though the themes that upset children differ according to a child's age. Wilson also explores how media exposure affects children's social development. Strong evidence shows that violent television programming contributes to children's aggressive behavior. And a growing body of work indicates that playing violent video games can have the same harmful effect. Yet if children spend time with educational programs and situation comedies targeted to youth, media exposure can have more prosocial effects by increasing children's altruism, cooperation, and even tolerance for others. Wilson also shows that children's susceptibility to media influence can vary according to their gender, their age, how realistic they perceive the media to be, and how much they identify with characters and people on the screen. She concludes with guidelines to help parents enhance the positive effects of the media while minimizing the risks associated with certain types of content.     

Food advertising to children and its effects on diet: review of recent prevalence and impact data

In the context of a global obesity epidemic that has led to an unprecedented burden of non‐communicable disease, the role of food and beverage marketing to children has been scrutinised in numerous studies. This article discusses the broader concept of an obesity‐promoting food environment, before reviewing key, recent (last 5 yr) international research findings with regard to both the prevalence and effects of food and beverage advertising on children's intake. Evidence relating to the two main avenues of food marketing exposure, television, and the Internet, is explored and consideration is given to the differences in consumer experience of these types of promotion. Despite methodological differences and the varying population samples studied, the outcomes are broadly consistent – food advertising is prevalent, it promotes largely energy dense, nutrient poor foods, and even short‐term exposure results in children increasing their food consumption. Policymakers are implored to drive forward meaningful changes in the food environment to support healthier choices and reduce the incidence of obesity and related diseases. This article aims at providing an overview of recent developments in this field. After limiting the search to the last five full years 2009–2014, we searched the following databases: Web of Knowledge and PubMed (keyword search terms used: television, Internet, new media, food advertising, food marketing, children, food intake, energy intake, consumption, and combinations of these terms). In addition we used the references from the articles obtained by this method to check for additional relevant material.     

Home environmental influences on children's television watching from early to middle childhood

Identifying correlates of children's television (TV) watching could help identify strategies to reduce children's TV watching and impact children's weight status. Children's TV time and home environment factors were assessed longitudinally among 169 families with children followed from 6 to 12 years of age. TV watching increased with age, as did the number of in-home TVs and the presence of videocassette recorders (VCRs), the frequency of meal eating while watching TV, and the percentage of children with bedroom TVs. Greater meal eating while watching TV was consistently related to overall TV watching and increases in TV watching over time. The number of in-home TVs and the presence of a bedroom TV were less consistent correlates. TV watching was related to weight status when children were younger, and when children were older, more than 2 hours of TV daily was a risk factor for higher weight. Modifying TV access, particularly by reducing the frequency of meals eaten while watching TV, could promote lower children's TV watching and adiposity.     

Aetiology of overweight and obesity in children and adolescents

The epidemic diffusion of obesity in industrialised countries has promoted research on the aetiopathogenesis of this disorder. The purpose of this review is to focus mainly on the contribution that European research has made to this field. Available evidence suggests that obesity results from multiple interactions between genes and environment. Parents obesity is the most important risk factor for childhood obesity. Twin, adoption, and family studies indicated that inheritance is able to account for 25% to 40% of inter-individual difference in adiposity. Single gene defects leading to obesity have been discovered in animals and, in some cases, confirmed in humans as congenital leptin deficiency or congenital leptin receptor deficiency. However, in most cases, genes involved in weight gain do not directly cause obesity but they increase the susceptibility to fat gain in subjects exposed to a specific environment. Both genetic and environmental factors promote a positive energy balance which cause obesity. The relative inefficiency of self-adapting energy intake to energy requirements is responsible for fat gain in predisposed individuals. The role of the environment in the development of obesity is suggested by the rapid increase of the prevalence of obesity accompanying the rapid changes in the lifestyle of the population in the second half of this century. Early experiences with food, feeding practices and family food choices affect children's nutritional habits. In particular, the parents are responsible for food availability and accessibility in the home and they affect food preferences of their children. Diet composition, in particular fat intake, influences the development of obesity. The high energy density and palatability of fatty foods as well as their less satiating properties promotes food consumption. TV viewing, an inactivity and food intake promoter, was identified as a relevant risk factor for obesity in children. Sedentarity, i.e. a low physical activity level, is accompanied by a low fat oxidation rate in muscle and a low fat oxidation rate is a risk factor of fat gain or fat re-gain after weight loss. Conclusion Further research is needed to identify new risk factors of childhood obesity, both in the genetic and environmental areas, which may help to develop more effective strategies for the prevention and treatment of obesity.     

Parental TV viewing, parental self-efficacy, media equipment and TV viewing among preschool children

This study examined if parental TV viewing, parental self-efficacy or access to media equipment were associated with TV viewing among UK preschool-aged children. Data were derived from a cross-sectional survey of 252 parents of 3–5-year-old children. Parents reported child and parent TV viewing and the number of TVs, DVDs, computers, games consoles, hand-held games consoles, music players and laptop computers in the home. Parents also completed scales which assessed their self-efficacy to limit the screen viewing (SV) and promote the physical activity (PA) and their own PA self-efficacy. Analysis indicated that around two thirds of the children spent two or more hours per day watching TV while 75 % of parents watched ≥2 h of TV per day. Logistic regression models showed that children who had a parent who watched ≥2 h of TV per day were over five times more likely to also watch ≥2 h of TV per day. Each unit increase in parental self-efficacy to limit SV was associated with a 77 % reduction in the likelihood that the child watched ≥2 h of TV per day. Each additional piece of media equipment in the home was associated with a 28 % increase in the likelihood that parents watched ≥2 h of TV per day. Conclusion: Family-based interventions focusing on changing access to home media equipment and building parental self-efficacy to reduce child TV viewing could form part of efforts to reduce TV viewing among preschool children.     

Association between the family environment and television viewing in Australian children

AIM: To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status. METHODS: Parents reported the amount of time children watched TV/video both for 'the previous school day' and 'usually' and described aspects of the family environment influencing TV access as part of a large cross-sectional study in the Barwon South-western region of Victoria, Australia. Child weight status was based on measured height and weight. All data were collected in 2003/2004. RESULTS: A total of 1926 children aged 4-12 years participated. Parent-reported mean +/- SE TV time for the previous school day was 83 +/- 1.5 min. Children who lived in a family with tight rules governing TV viewing time (22%), or who never watched TV during dinner (33%), or had only one TV in the household (23%) or had no TV in their bedroom (81%) had significantly less TV time than their counterparts. Overweight or obese children had more TV time than healthy weight children 88 +/- 2.9 versus 82 +/- 1.7 min per day (P=0.04). They were also more likely to live in a household where children had a TV in their bedroom than healthy weight children (25% vs. 17%, P<0.001). CONCLUSION: Strategies to reduce TV time should be included as part of broader strategies to prevent childhood obesity. They should include messages to parents about not having a TV in children's bedrooms, encouraging family rules restricting TV viewing, and not having the TV on during dinner.     

Randomised controlled trial adapting US school obesity prevention to England.

OBJECTIVES: To determine whether a school obesity prevention project developed in the United States can be adapted for use in England. METHODS: A pilot cluster randomised controlled trial and interviews with teachers were carried out in 19 primary schools in South West England. Participants included 679 children in year 5 (age 9-10). Baseline and follow-up assessments were completed for 323 children (screen viewing) and 472 children (body mass index). Sixteen lessons on healthy eating, physical activity and reducing TV viewing were taught over 5 months by teachers. Main outcome measures were hours of screen activities, body mass index, mode of transport to school and teachers' views of the intervention. RESULTS: Children from intervention schools spent less time on screen-viewing activities after the intervention but these differences were imprecisely estimated: mean difference in minutes spent on screen viewing at the end of the intervention (intervention schools minus control schools) adjusted for baseline levels and clustering within schools was -11.6 (95% CI -42.7 to 19.4) for a week day and was -15.4 (95% CI -57.5 to 26.8) for a Saturday. There was no difference in mean body mass index or the odds of obesity. CONCLUSIONS: It is feasible to transfer this US school-based intervention to UK schools, and it may be effective in reducing the time children spend on screen-based activities. The study has provided information for a full-scale trial, which would require 50 schools ( approximately 1250 pupils) to detect effects on screen viewing and body mass index over 2 years of follow-up.     

The relationship between life-style and cardio-metabolic risk indicators in children: the importance of screen time

Aims:  To examine differences between children with obesity and normal weight children (aged 7–13 years) in terms of physical activity, screen time, food intake and blood parameters indicative of cardio‐metabolic risk. Further, to explore the relationship between physical activity, screen time and food intake with cardio‐metabolic parameters. Methods: Forty‐three children with obesity were compared with 43 normal weight peers. Physical activity was monitored by accelerometers and screen time and food intake by diaries. Blood parameters indicative of cardio‐metabolic risk were analysed. Results: The group of children with obesity had significantly less vigorous activity (p = 0.013), more daily screen time (p = 0.004) and consumed more fat (p = 0.04) than the group of normal weight children. The former group also demonstrated higher values of triglycerides (p = 0.001), HbA1c (p = 0.009), C‐peptide (p = 0.001), had a higher HOMA‐R score (p = 0.001), and lower levels of HDL (p = 0.001). After controlling for weight category, regression analyses revealed that screen time was significantly and positively related to the HOMA‐R score and C‐peptide levels independent of physical activity and intake of fat and sugar. Conclusions: The results indicate that screen time is an important behavioural factor related to obesity and cardio‐metabolic risk indicators in children.     

Screen time is more strongly associated than physical activity with overweight and obesity in 9‐ to 16‐year‐old Australians

Background: Both reduced moderate‐to‐vigorous physical activity (MVPA) and increased screen time have been implicated in the aetiology of childhood overweight/obesity. This study aimed to determine which behaviour had the stronger association with overweight/obesity. Method: 2200 randomly selected 9‐ to 16‐year‐old Australians provided four 24‐h use‐of‐time recalls. Participants were classified into weight status categories and as high or low physical active, and high or low screen time according to Australian guidelines (≥60 min MVPA; ≤120 min recreational screen time daily). Multivariate logistic regression was used to calculate the odds ratios (OR) for overweight/obesity for each screen time and MVPA category. Results: Increased likelihood of overweight or obese was often associated with high screen time (ORs, 2.13–2.55 for boys and 1.47–1.72 for girls), but only sometimes and less strongly associated with low MVPA (ORs, 0.49–2.55 for boys and 1.06–1.47 for girls). Analyses conducted for combined screen time and MVPA categories showed screen time to be a stronger indicator of weight status than physical activity, especially in boys. Conclusion: Overweight and obesity were more strongly associated with screen time than physical activity. Screen time may be an important target for interventions aimed at reducing childhood overweight and obesity.