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It is without a doubt that kids these days spend more time in front of screens than they used to even just a few years ago. In these years the prevalence of childhood and adolescent obesity has also seen a huge increase. Though it may not be the major contributor to this “obesity epidemic,” increased screen time definitely contributes to the problem and this relationship is repeatedly demonstrated in studies.

What the Evidence Says
Increasingly, food marketers are interested in children and youth as consumers “with spending power, purchasing influence, and as future adult consumers they are a valuable target for the food and beverage industries”(Aktas Arnas, 2006). Studies have shown that well over 50% of advertisements accompanying children’s TV shows are about foods, and up to 98% of these promote foods that are high in fat, sugar and/or sodium (Harris, Bargh, & Brownell, 2009).

Pre-school kids are particularly susceptible to commercial influences; at this age they pay attention and recognize the items being shown in advertisements and are more likely to ask for the things they see on TV both while watching and later on during trips to the grocery store. Furthermore, Roberto et al (Roberto, Baik, Harris, & Brownell, 2010). showed that kids much prefer foods that are associated with a known cartoon or TV figure over similar generic items. In later childhood, (older than 7 years old) children are able to understand the intent behind the advertisements and aren’t as outwardly influenced. Another reason for this can be that older children have experience with how their parents will react to their shopping/purchasing demands and this will moderate future demands or lack thereof (Aktas Arnas, 2006).

It is thought that the main reason increased screen time leads to weight gain is because it takes away time that could or would have been spent being active and leading to energy expenditure. This however, has not been shown to be the case; the amount of activity does not consistently appear to vary significantly in relation to screen time. It turns out that the main reason likely lies in the fact that kids will consume more calorie dense and nutrient poor foods and more of it while distracted by TV or a movie. Furthermore, food related advertisements may lead to eating/snacking independent of natural hunger and satiety cues. The result is more calories consumed overall which leads to weight gain.

During the Visit
If your patient screens “positive” on the media use survey and is overweight, obese or heading in that direction it will be important to discuss this topic with the family.
Recommendations
  • Educate parents about the significant effect advertisements have on kids, especially between the ages of 3-7. And if possible, keep kids distracted during commercials or use a DVR to record the show and fast forward through the commercials.
  • Recommend that all meals be eaten away from a screen. Turn the TV off! Can also emphasize the other benefits of family meal times – increased connectedness and communication.
  • Even though it might not be the major culprit, decreased physical activity due to time spent watching TV or playing video games does affect health. Recommend video games that involve dancing or sports. Suggest that they play these games with their kids.
  • Limit screen time in general and emphasize the importance of getting out and playing. There are indoor/safe options like the local YMCA where they can play.
  • If excessive, media usage can have a huge effect on nutrition and activity level and making changes in this area can potentially make a big difference in weight. Changing behavior is not easy, so try one change at a time and arrange a follow-up visit in 1-2 months to see how things are going. It will require commitment from both the family and provider.
Future Directions
As the body of research grows, there is more and more evidence that shows that increased screen time and advertisements has a huge, deleterious effect on the diet and lifestyle of kids which will then likely follow them into adulthood. We need to consider advocating for industry commitment to children’s health and for the removal of food related advertisements during children’s programming, especially those targeted at the pre-school age group. In recent years, there has been government promoted initiatives around increased activity and play time for kids with some noticeable results. We need to continue to add to this larger movement for a healthier generation of children and promote things such as family meal time and mindful eating.

References

  • Aktas Arnas, Y. (2006). The effects of television food advertisement on children’s food purchasing requests. Pediatr Int, 48(2), 138-145. doi:10.1111/j.1442-200X.2006.02180.x
  • Anderson, G. H., Khodabandeh, S., Patel, B., Luhovyy, B. L., Bellissimo, N., & Mollard, R. C. (2015). Mealtime exposure to food advertisements while watching television increases food intake in overweight and obese girls but has a paradoxical effect in boys. Appl Physiol Nutr Metab, 40(2), 162-167. doi:10.1139/apnm-2014-0249
  • Batada, A., Seitz, M. D., Wootan, M. G., & Story, M. (2008). 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, 108(4), 673-678. doi:10.1016/j.jada.2008.01.015
  • Biddiss, E., & Irwin, J. (2010). Active video games to promote physical activity in children and youth: A systematic review. Arch Pediatr Adolesc Med, 164(7), 664-672. doi:10.1001/archpediatrics.2010.104
  • Borzekowski, D. L. G., & Robinson, T. N. (2001). The 30-Second Effect: An Experiment Revealing the Impact of Television Commercials on Food Preferences of Preschoolers. J Am Diet Assoc, 101(1), 42-46. doi:http://dx.doi.org/10.1016/S0002-8223(01)00012-8
  • Coon, K. A., Goldberg, J., Rogers, B. L., & Tucker, K. L. (2001). Relationships Between Use of Television During Meals and Children’s Food Consumption Patterns. Pediatrics, 107(1), e7. doi:10.1542/peds.107.1.e7
  • Coon, K. A., & Tucker, K. L. (2002). Television and children’s consumption patterns. A review of the literature. Minerva Pediatr, 54(5), 423-436.
  • Feldman, S., Eisenberg, M. E., Neumark-Sztainer, D., & Story, M. (2007). Associations between watching TV during family meals and dietary intake among adolescents. J Nutr Educ Behav, 39(5), 257-263. doi:10.1016/j.jneb.2007.04.181
  • Folkvord, F., Anschütz, D. J., Wiers, R. W., & Buijzen, M. (2015). The role of attentional bias in the effect of food advertising on actual food intake among children. Appetite, 84, 251-258. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-54094-033&site=ehost-live
    f.folkvord@maw.ru.nl
  • Francis, L. A., Lee, Y., & Birch, L. L. (2003). Parental weight status and girls’ television viewing, snacking, and body mass indexes. Obes Res, 11(1), 143-151. doi:10.1038/oby.2003.23
    Giammattei, J., Blix, G., Marshak, H. H., Wollitzer, A. O., & Pettitt, D. J. (2003). Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren. Arch Pediatr Adolesc Med, 157(9), 882-886. doi:10.1001/archpedi.157.9.882
  • Halford, J. C., Boyland, E. J., Hughes, G., Oliveira, L. P., & Dovey, T. M. (2007). Beyond-brand effect of television (TV) food advertisements/commercials on caloric intake and food choice of 5-7-year-old children. Appetite, 49(1), 263-267. doi:10.1016/j.appet.2006.12.003
  • Harris, J. L., Bargh, J. A., & Brownell, K. D. (2009). Priming effects of television food advertising on eating behavior. Health Psychol, 28(4), 404-413. doi:10.1037/a0014399
  • Matheson, D. M., Killen, J. D., Wang, Y., Varady, A., & Robinson, T. N. (2004). Children’s food consumption during television viewing. The American Journal of Clinical Nutrition, 79(6), 1088-1094. Retrieved from http://ajcn.nutrition.org/content/79/6/1088.abstract
    http://ajcn.nutrition.org/content/79/6/1088.full.pdf
  • Powell, L. M., Schermbeck, R. M., Szczypka, G., Chaloupka, F. J., & Braunschweig, C. L. (2011). Trends in the nutritional content of television food advertisements seen by children in the United States: analyses by age, food categories, and companies. Arch Pediatr Adolesc Med, 165(12), 1078-1086. doi:10.1001/archpediatrics.2011.131
  • Roberto, C. A., Baik, J., Harris, J. L., & Brownell, K. D. (2010). Influence of licensed characters on children’s taste and snack preferences. Pediatrics, 126(1), 88-93. doi:10.1542/peds.2009-3433
  • Straker, L., Maslen, B., Burgess-Limerick, R., & Pollock, C. (2009). Children have less variable postures and muscle activities when using new electronic information technology compared with old paper-based information technology. J Electromyogr Kinesiol, 19(2), e132-143. doi:10.1016/j.jelekin.2007.11.011
  • Temple, J. L., Giacomelli, A. M., Kent, K. M., Roemmich, J. N., & Epstein, L. H. (2007). Television watching increases motivated responding for food and energy intake in children. Am J Clin Nutr, 85(2), 355-361. Retrieved from http://ajcn.nutrition.org/content/85/2/355.full.pdf
  • Wansink, B., Shimizu, M., & Brumberg, A. (2013). Association of Nutrient-Dense Snack Combinations With Calories and Vegetable Intake. Pediatrics, 131(1), 22-29. doi:10.1542/peds.2011-3895

This toolkit was created with funding from Harvard Pilgrim Health Care