ReviewObesiTV: How television is influencing the obesity epidemic
Highlights
► There is direct association between hours of TV watching and body weight. ► Television is a sedentary replacement for a physical lifestyle. ► TV advertisement promotes overeating. ► Television promotes “mindless” eating. ► TV programs can lead to false expectations about weight gain and weight loss.
Introduction
Obesity is a major public health concern in the United States. It is estimated that nearly 70% of adult Americans are overweight; of those individuals, 50% are obese [38]. The numbers are similarly alarming for children and adolescents. Over the past two decades, the prevalence of obesity has more than doubled for children aged 2–5 (5.0% to 12.4%) and 6–11 years (6.5% to 17.0%), and more than tripled for adolescents aged 12–19 years (5.0% to 17.6%) [20].
This rise in obesity has been accompanied by increases in a host of other chronic illnesses, including type 2 diabetes, cardiovascular disease, hypertension, and cancer. In addition, obese individuals are more likely than their leaner peers to experience negative stereotyping and social discrimination [61], [100], [101], [104]. Because the physiological and psychological consequences of obesity can lead to increased morbidity and mortality, and decreased quality of life, researchers, clinicians and policymakers alike are concerned with discovering the psychosocial mechanisms through which this epidemic is spreading. While the bottom line with respect to becoming obese is seemingly simple – caloric consumption exceeds caloric expenditure – the factors that contribute to this positive energy balance are multidimensional and complex [3].
There is a growing body of literature that indicates a number of direct and indirect ways in which television could be contributing to the obesity epidemic. Direct influences include a culturally-accepted shift in the amount of time spent watching television; a rise in the prevalence, intensity and targeted use of televised advertisements for palatable foods; and a tendency toward “mindless” eating while watching television. Indirect ways in which television could promote obesity include the extensive and expansive use of product placements in television shows; the proliferation of programming that features food preparation, consumption, and weight loss as entertainment; and the portrayal of an idealized body image, which can lead to discrimination and stereotyping.
This paper will provide an interdisciplinary portrayal of the interaction between television and obesity. To this end, the research literature reviewed in this paper comes from a variety of disciplines including nutrition, psychology, pediatrics, public health, sociology, marketing, media studies, and communication. Thus, while this type of review may not be typically found in Physiology and Behavior; it is critical for the scientific and policy-making community as well as the public to consider the multidimensional ways in which television could influence obesity.
Section snippets
Overview of television viewing in the United States
Television viewing has changed dramatically over the past 65 years. In 1945, fewer than 10,000 homes had a television set, there were only six stations, and broadcasting hours were limited [120]. Now, it is estimated that over 99% of American households have at least one television set, with an average of three television sets per household [65], [95]; there are more than 800 stations [95], and shows are broadcast 24 hours/day, seven days/week. Accordingly, time spent watching television has
Television and obesity
This significant amount of screen time is cause for concern in light of several studies that have demonstrated associations between the time individuals spend watching television and their health. Seminal research published in 1985 by Dietz and Gortmaker demonstrated a significant, positive association between hours of television viewed and obesity in children and adolescents [29]. In the intervening 25 years, numerous studies have confirmed this relationship [14], [27], [29], [63], [64], [81].
Direct contributions of television to the obesity epidemic
The observed association between poor health and television viewing is multi-causal. Direct explanations include time spent watching television displaces time spent engaging in physical activity; the food industry's use of targeted advertisements for foods of low nutritional value; and “mindless” consumption of calorie-dense foods while watching television.
Indirect contributions of television to the obesity epidemic
In addition to the direct influences of television on obesity, indirect factors related to television viewing could promote excess weight gain. For example, food companies often use discreet, yet targeted, placement strategies to advertise their products to consumers. Such strategies may manipulate viewers’ preferences for unhealthy foods or subconsciously influence their desire to eat when they are not hungry. In addition, television plays an important role in shaping social norms and personal
Ways to reduce the negative impact of television on the obesity epidemic
The simplest way to minimize the impact of television on the obesity epidemic is to watch less of it. In fact, an Expert Panel on Children, Television and Weight Status was convened in 2006 by the Centers for Disease Control and Prevention and, after reviewing the literature, found the following several strategies promising: 1) eliminate television from children's bedrooms; 2) turn off television while eating; and 3) provide healthcare professionals with ways in which to help patients reduce
Conclusion
Television's role in influencing the obesity epidemic is significant, and may be explained by both direct and indirect pathways. These, in aggregate, work to alter individuals’ energy balance, with a tendency towards increases in caloric intake and decreases in caloric expenditure. However, the causes of obesity are multidimensional, and include changes in biological, psychological, social, political, and environmental norms. Thus, while decreasing time spent watching television and altering
Acknowledgments
This article was produced as part of the First Tufts University Seminar on the Obesity Epidemic and Food Economics that was organized by Drs. Emmanuel N. Pothos (Chair), Robin B. Kanarek and Susan B. Roberts in Boston and Medford, MA.
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These authors contributed equally to this article.