Decrease Time Spent Viewing TV

In 2001 the American Academy of Pediatrics recommended that television viewing among children under two years old be "discouraged altogether."1 Additionally, more than a half dozen other child and health advocacy organizations and agencies have made similar recommendations in reports cited by the Institute of Medicine. For children over two, the current recommendation is to limit recreational screen time to no more than two hours per day.

The origins of recommendations to limit TV viewing as a method of preventing obesity stem from early research documenting a relationship between TV viewing and body fatness.3,4 Studies showed that the more hours of TV viewing, the higher the BMI, although not all studies have shown this relationship.5 One study of more than 4000 eight to sixteen year olds found that obesity prevalence was highest among those children watching four or more hours of TV per day and lowest among those watching one hour or less.6 There is evidence that reductions in TV viewing time leads to reduced body fatness or BMI.7,8 The limit on TV viewing has been broadened to all forms of recreational screen viewing combined.9,10

Obesity and low aerobic fitness are now considered common among American youth and both are associated with poorer academic performance. One study of nearly 2000 5th, 7th, and 9th graders found consistent positive associations between aerobic fitness and math, reading and language test scores and consistently poorer scores in children whose BMI-for-age was elevated.11 These data point to the importance of building aerobic fitness by decreasing screen time and encouraging vigorous active play, ideally outdoors.

A growing number of studies link screen viewing with decreased play,12 increased body fatness,13,14 and a heightened risk of childhood obesity. 15,16 Evidence continues to grow as a number of studies have examined the effects of media on food intake, behavior, and body fatness of children.17,18,19,20,21,22,23,24,25

Some studies suggest that parental limits on TV viewing and other sedentary screen activities are helpful for changing behavior and preventing childhood obesity.26,27,28 But parents report that they need guidance and support to implement changes in screen-viewing policies.29 Marketing Food to Children Leads to Increased Obesity

In January 2010, U.S. Surgeon General Dr. Regina M. Benjamin issued a report on the epidemic of overweight and obesity in America. In the discussion of the various causes of obesity, Dr. Benjamin’s report stated that "[t]he more time children spend watching television, the more likely they are to eat while doing so and the more likely they are to eat the high-calorie foods that are heavily advertised on television."30 In other words, eating in front of screens — TV screens, computer screens, and video screens — promotes mindless munching on high calorie foods and increases exposure to commercial messages both for more unwholesome snacks and for many other products such as movies and DVDs that encourage sedentary forms of entertainment for kids.

The food and beverage industries spend approximately $10 billion a year on marketing their products through the TV, Internet and cell phones. The majority of food products marketed to children and youth are high in total calories, sugars, salt, fat, and low in nutrients.31 Senator Harkin of Iowa remarked: "The food industry doesn’t spend $10 billion a year on ads to kids because they like to waste money. Their ads not only work, they work brilliantly."32

Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC) in the Obama administration, predicted that twenty years from now people will look back and say: "What were they thinking? They’re in the middle of an epidemic and kids are watching 20,000 hours of commercials for junk food."33

Through the use of cartoon characters recruited to pitch products to children, through the development of “adver-games” and other strategies targeting kids, through the Internet, cell phone, DVD and TV, marketers are collaborating in their efforts to control "share of mind." This marketing concept refers to the objective of building "cradle-to-grave" brand loyalty that threatens to turn our children into passive "super-consumers," indeed supersized consumers.34

Advertisements for unhealthy foods and sedentary forms of entertainment provide children with "pester power," and parents get worn down by their children’s constant requests for candy, sweetened cereals, cookies, cupcakes, and sugary soda — not to mention the latest movies, computer games and DVDs, all sedentary forms of entertainment.

The percentage increase in the number of new food products targeted to children has skyrocketed and this is because our children and teens have money to spend, as much as $365 billion a year according to one estimate.35 According to the IOM, television marketing strategies are contributing to the growing problem of childhood obesity: "Statistically, there is strong evidence that exposure to television advertising is associated with adiposity in children ages 2-11 years and teens ages 12-18 years."36

Finding Support

The website of the Montana Nutrition and Physical Activity [] program is a useful resource for those seeking to implement screen time reduction activities, including ways to participate in Screen-Free Week. This site also explains the many other benefits besides obesity prevention that can be derived from reducing screen time, including promoting healthy brain development in young children, supporting healthy eating and sleeping behaviors, and giving families more time to do things together. For more information about screen time reduction see the WE CAN! Website produced in collaboration with the National Institutes of Health.

1 AAP (American Academy of Pediatrics) Children, adolescents, and television. Pediatrics 2001; 107(2):423-426

3 Robinson TN et al. Does television viewing increase obesity and reduce physical activity? Cross-sectional and longitudinal analyses among adolescent girls. Pediatrics 1993; 91(2):273-280

4 Gortmaker SL et al. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med 1996; 153()4: 356-362

5 Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. 2000; Med Sci Sports Exerc 32(5):963-975

6 Crespo CJ, Smit E, Troiano RP et al. Television watching, energy intake, and obesity in US children: Results from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 155(3): 360-365

7 Robinson TN. Reducing children’s television viewing to prevent obesity. A Randomized controlled trial. JAMA 1999; 282(16):1561-1567

8 Gortmaker SL, Peterson K, Wiecha J, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999; 153(4):409-418

9 Institute of Medicine. Progress in Preventing Childhood Obesity: How do we Measure Up? National Academies Press, Washington DC 2007: p. 327

10 Institute of Medicine, 2005 p308

11 Roberts CK, Freed B, McCarthy WJ. Low aerobic fitness and obesity are associated with lower standardized test scores in children. J Pediatrics 2010; Jan 25 online

12 Schmidt ME, Pempek TA, Kirkorian HL, et al. The effects of background television on the toy play behavior of very young children. Child Development 2009; 79(4): 1137-1151

13 Robinson TN. Television viewing and childhood obesity. Pediatr Clin North Am 48(4)” 1017-1025

14 Jackson DM, Djafarian K, Stewart J, Speakman JR. Increased television viewing is associated with elevated body fatness but not with lower total energy expenditure in children. Am J Clin Nutr 2009; 89:1031-1036

15 Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. National Academies Press, Washington DC 2005; pp. 301-305

16 Mendoza JA, Zimmerman FJ, Christakis DA. Television viewing, computer use, obesity, and adiposity in US preschool children. International Journal of Behavioral Nutrition and Physical Activity 2007, 4:44doi:10.1186/1479-5868-4-44 [The electronic version of this article is the complete one and can be found online at:; accessed March 13, 2010]

17 Chamberlain LJ, Wang Y, Robinson TN. Does children’s screen time predict requests for advertised products? Cross-sectional and prospective analyses. Arch Pediatr Adolesc Med. 2006; 160(4):363-368

18 Bellisimo N, Pencharz PB, Thomas SG, Anderson GH. Effect of television viewing at mealtime on food intake after a glucose preload in boys. Pediatr Res. 2007; 61(6): 745-749

19 Blass EM, Anderson DR, Kirkorian HL, et al. On the road to obesity: Television viewing increases intake of high-density foods. Physiol Behav. 2006; 88:597-604

20 Francis LA, Birch LL. Does eating during television viewing affect preschool children’s intake? J Am Diet Assoc. 2006; 106(4): 598-600

21 Fitzpatrick E, Edmunds LS, Dennison BA. Positive effects of family dinner are undone by television viewing. J Am Diet Assoc. 2007; 107:666-671

22 Kirkorian HL, Pempek TA, Murphy LA, et al. The impact of background television on parent-child interaction. Child Development 2009; 80(5): 1350-1359

23 Chou S-Y, Rashad I, Grossman M. Fast-food restaurant advertising on television and its influence on childhood obesity. J Law Economics 2008; 51:599-618

24 Martin CK, Coulon SM, Markward N, et al. Association between energy intake and viewing television, distractibility, and memory for advertisements. Am J Clin Nutr 2009; 89:37-44

25 Anschutz DJ, Engels RCME, VanStrien T. Side effects of television food commercials on concurrent non-advertised sweet snack food intakes in young children. Am J Clin Nutr 2009; 89:1328-1333

26 Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics 2010; 125:420-428

27 Coon KA, Goldberg J, Rogers BL, Tucker KL. Relationships between use of television during meals and children’s food consumption patterns. Pediatrics 2001; 107(1):E77

28 Robinson TN, Saphir MN, Kraemer HC et al. Effects of reducing television viewing on children’s request for toys : a randomized controlled trial. J Dev Behav Pediatr 2001; 22(3): 179-184

29 Mendoza JA, Zimmerman F, Christakis DA. Television viewing, computer use, obesity, and adiposity in US preschool children. International Journal of Behavioral Nutrition and Physical Activity 2007, 4:44doi:10.1186/1479-5868-4-44 [The electronic version of this article is the complete one and can be found online at:; accessed March 13, 2010]

30 U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville, MD: Office of the Surgeon General, January 2010, p. 4.

31 IOM, 2005 report, p 4

33 Quoted by N.R.Kleinfield, “Diabetes and Its Awful Toll Quietly Emerge as a Crisis”, January 9, 2006

34 Samuels et al. “Food and Beverage Industry Marketing Practices Aimed at Children: Developing Strategies for Preventing Obesity and Diabetes”, November 2003, A Report on the Proceedings from a meeting sponsored by the California Endowment, held in San Francisco June, 2003

35 Samuels et al, p 9

36 Samuels et al, p 9

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