Elsevier

Journal of Nutrition Education and Behavior

Volume 44, Issue 5, September–October 2012, Pages 415-422
Journal of Nutrition Education and Behavior

Research Article
Decrease in Television Viewing Predicts Lower Body Mass Index at 1-Year Follow-Up in Adolescents, but Not Adults

https://doi.org/10.1016/j.jneb.2011.12.008Get rights and content

Abstract

Objective

To examine associations between television viewing, sugar-sweetened beverage consumption, eating out, physical activity, and body weight change over 1 year.

Design

Secondary data analysis from randomized intervention trial.

Setting

Households in the community.

Participants

Adults (n = 153) and adolescents (n = 72) from the same households.

Intervention

Households were randomized to a home-based obesity prevention intervention or to a no-intervention control group for a 1-year period.

Main Outcome Measures

Self-reported television viewing (TV) hours, diet, and physical activity. Body mass index (BMI) computed from measured weight and height (primary outcome measure).

Analysis

Mixed-model regression.

Results

Among adolescents, a significant prospective association was observed between decreases in television viewing hours and lower BMI z score at 1-year follow-up (decreased TV hours: BMI z score mean = 0.65; no change or increase TV hours: BMI z score = 0.92; P < .02). No significant prospective associations were observed among adults.

Conclusions and Implications

Reducing television viewing may be an effective strategy to prevent excess weight gain among adolescents.

Introduction

Specific environmental and behavioral variables have received research attention as possible important contributing factors to the obesity epidemic.1 Behaviors related to energy balance include television viewing (TV), eating out, sugar-sweetened beverage (SSB) intake, and physical activity (PA). Television viewing is a highly prevalent activity among youth and adults.2, 3 Cross-sectional studies consistently show that TV is related to overweight and obesity, among both youth4, 5, 6, 7, 8, 9 and adult populations.10, 11, 12, 13 Among youth, prospective studies have shown positive associations between TV and excess weight gain.14, 15 However, other studies reported no association.16 Among adults, fewer studies are available. A large cohort study found no association between changes in TV and weight gain over 6 years.17 Obesity treatment interventions that include a TV reduction component have been successful in reducing body weight.18, 19, 20

Sugar-sweetened beverages have received a great deal of attention as potential contributors to excess weight gain and the development of obesity. Overall conclusions reported by 7 recent reviews reveal mixed opinions within the scientific community about the interpretation of available empirical data.21, 22, 23, 24, 25, 26, 27

Eating out, particularly at fast-food restaurants, has been identified as a potential obesigenic exposure.28, 29 Cross-sectional studies consistently show that frequency of eating out or fast-food frequency is associated with overweight and obesity among adults.10, 30, 31 Results of available studies are less consistent with youth populations.32, 33 Prospective34, 35, 36, 37, 38, 39 and experimental studies40 consistently show a positive association between eating out, fast-food consumption, and weight gain.

Although the individual contribution of each of these behaviors to excess weight gain and obesity may be small, it is important to examine their possible role in promoting excess weight gain. Associations between these behaviors and risk for excess weight gain may differ among adults and adolescents because of their different physical and social developmental stages.41, 42 The authors are aware of no previous studies that have examined the prospective association of these obesigenic behaviors among adole-scents and adults living in the same household (HH) environment.

The purpose of the present study is to examine the cross-sectional and prospective associations between energy balance behaviors and body weight change in adolescents and adults recruited from the same HHs. This paper is a secondary analysis of data from a community-based obesity prevention intervention that targeted entire HHs.42 Families were enrolled in a larger trial to test an HH-level intervention for weight gain prevention. The intervention had no significant effects on change in body weight over a 1-year period, but it was successful in reducing TV and increasing PA.42 It was hypothesized that decreases in TV, SSB intake, and eating out and increases in PA would be associated with less weight gain over a 1-year period.

Section snippets

Study Population and Recruitment

Households were recruited from the community for a 1-year obesity prevention intervention trial.42 The intervention included both HH environment- and individual-level behavioral components. Recruitment sources included community libraries, worksites, schools, daycare centers, health clinics, religious institutions, park and recreation centers, grocery stores, and food co-ops. Overall, 732 inquiries were received, 289 families were eligible, and 90 HHs enrolled in the study. At 12 months, 86 HHs

Demographic and Behavioral Characteristics

Demographic and baseline behavioral characteristics of the adolescents and adults are shown in Table 1. Sixty-one percent of the 90 HHs recruited were composed of 2 adults and 2 or more children; another 21% were composed of 2 adults and 1 child. Eighteen percent of HHs were composed of single parents with 1 or more children. Table 2 shows the baseline, follow-up, and change medians for BMI and the behavioral variables. Overall, adults and adolescents were very similar in reported levels of TV

Discussion

The present study provided unique prospective data to examine longitudinal associations between energy balance behaviors and weight change among a community sample of adults and adolescents recruited from the same HH. No previous studies have prospectively examined behavior changes related to weight gain among related adults and adolescents living in the same HH. Despite low power for these secondary analyses, a clear association was observed among adolescents between reduction in TV hours and

Implications for Research and Practice

The results of the present study suggest that TV reduction may be an effective strategy to prevent excess weight gain among adolescents. Further research is needed to better understand the mechanisms by which TV reduction achieves its protective effect on BMI among youth. Clear advice to parents to limit TV among their children may be 1 powerful weight gain prevention strategy that parents can understand and implement in the home environment.

Acknowledgments

This study was supported by grant #1U54CA116849 and #R21CA137240 from the National Institutes of Health / National Cancer Institute.

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      Three studies were identified, and all used the same intervention approach which involved the implementation of a TV limiting device (French et al., 2011, 2012; Ni Mhurchu et al., 2009). The first two studies (French et al., 2011, 2012) which were evaluated as high quality interventions (see Table 3) spanned for over a year. Two of the three studies found TV limiting devices to be an effective method for reducing television time among children with medium effect sizes (French et al., 2012; Ni Mhurchu et al., 2009) and the only study that measured adults also found it to be a successful tactic for reducing TV viewing time (French et al., 2011).

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