Elsevier

Appetite

Volume 77, 1 June 2014, Pages 13-18
Appetite

Research report
Comparative effects of TV watching, recreational computer use, and sedentary video game play on spontaneous energy intake in male children. A randomised crossover trial

https://doi.org/10.1016/j.appet.2014.02.008Get rights and content

Highlights

  • Screen-based activities increase dietary intake in the absence of TV advertising

  • Studies have focused on the effects of TV rather than computer and video games

  • Limited data on comparative effects of different screens on acute dietary intake

  • Energy intake greater during TV watching than computer use

  • No difference in energy intake between computer use and video game play

Abstract

To compare the effects of three screen-based sedentary behaviours on acute energy intake (EI) in children. Normal-weight males aged 9–13 years participated in a randomised crossover trial conducted in a laboratory setting between November 2012 and February 2013 in Auckland, New Zealand. EI during an ad libitum meal was compared for three 1-hour conditions: (1) television (TV) watching, (2) sedentary video game (VG) play, and (3) recreational computer use. The primary endpoint was total EI from food and drink. Mixed regression models were used to evaluate the treatment conditions adjusting for age, BMI, and appetite at baseline. A total of 20 participants were randomised and all completed the three conditions. Total EI from food and drink in the TV, computer, and VG conditions was estimated at 820 (SE 73.15), 685 (SE 73.33), and 696 (SE 73.16) kcal, respectively, with EI being significantly greater in the TV versus computer condition (+135; P = 0.04), a trend towards greater intake in the TV versus VG condition (+124; P = 0.06), but not significantly different between the computer and VG conditions (−10; P = 0.87). TV watching was associated with greater EI compared with computer use, and a trend towards greater EI compared with VG play.

Introduction

In New Zealand (NZ), around one-third of children are overweight or obese (Ministry of Health, 2012). The cause and effect model for overweight and obesity (Hummel, Wittig, Schneider, Gebhardt, & Hoffmann, 2013) identifies two direct factors influencing bodyweight: energy balance and biology. Almost all indirect factors in the model act via the energy balance pathway. One such indirect factor is sedentary behaviour, defined as any waking behaviour conducted in a sitting or reclined position and characterised by low energy expenditure (i.e. ≤1.5 METS) (Sedentary Behaviour Research Network, 2012).

Much of the literature linking sedentary time and increased bodyweight has used television (TV) watching as a proxy measure for sedentary behaviour (Tremblay et al., 2011). Indeed, health risks in children appear to be linked with self-reported measures of screen-based sedentary behaviours, including TV watching, recreational computer use, and sedentary video game (VG) play (Carson & Janssen, 2011; Mark & Janssen, 2008). However, evidence suggests that accelerometer-measured patterns of sedentary time are not associated with health risk in children and youth (Colley et al., 2013). It is therefore proposed that screen time may have a negative impact on health, while other sedentary behaviours, such as reading a book, may be neutral or have a positive impact (Colley et al., 2013).

A number of mechanisms have been proposed to explain the positive association between screen time and bodyweight, including decreased resting metabolic rate (Dietz & Gortmaker, 1985; Salmon, Bauman, Crawford, Timperio, & Owen, 2000) and displacement of physical activity (Jenvey, 2007). However, there is growing evidence to suggest that the relationship is best explained by the effects on dietary intake (Jackson, Djafarian, Stewart, & Speakman, 2009), via either advertising effects (Institute of Medicine Committee on Food Marketing and the Diets of Children and Youth, 2006; Lobstein & Dibb, 2005), or other non-advertising mechanisms, such as distraction (Bellissimo, Pencharz, Thomas, & Anderson, 2007; Hetherington, Anderson, Norton, & Newson, 2006; Temple, Giacomelli, Kent, Roemmich, & Epstein, 2007). These non-advertising effects may be of particular importance, given recent increases in both accessibility to competing screen-based activities, which may draw attention away from TV food advertising (Schmitt, Woolf, & Anderson, 2003), and availability of advertising free TV content, due to either online streaming or time-shifted TV viewing (Carlson, 2006).

A number of studies have investigated the non-advertising effects of screen time on dietary intake. According to a Canadian population-based survey in children (Liang, Kuhle, & Veugelers, 2009), eating dinner in front of the TV was negatively associated with diet quality and positively associated with bodyweight, independent of overall time spent watching TV. Furthermore, results from a recent systematic review of laboratory-based studies showed that exposure to screens in the absence of advertising consistently increased acute energy intake (EI) compared with controls who were not exposed to screens (Marsh, Mhurchu, & Maddison, 2013). However, the majority of the studies focused on TV watching and no studies were identified that investigated the effects of recreational computer use. Only one study assessed the comparative effects of different screen-based activities (Lyons, Tate, Ward, & Wang, 2012).

As such, research is needed to assess the comparative effects of popular screen-based sedentary behaviours on EI. ESSAY (Effects of Screen-based Sedentary Activities on energY intake) was a crossover trial designed to investigate the effects of three common screen-based sedentary behaviours, watching TV, recreational computer use, and sedentary VG play, on EI in boys aged 9–13 years.

Section snippets

Study design

ESSAY was a laboratory based, randomised, crossover trial. Eligible participants were healthy, normal-weight (5th percentile to less than 85th percentile) males aged 9–13 years who were able to provide written informed consent, could understand and adhere to the study protocol, and had fasted for at least 1 hour prior to attending the study clinic. Due to the exploratory nature of this study, and previous research suggesting the possibility of a more complex relationship between screen exposure

Participant characteristics

A total of 20 participants were recruited and completed the 3 conditions. Demographic characteristics of participants are presented in Table 1. Dinner and snacks were the meals most frequently reported to be eaten in front of a screen within the previous week. Participants had a mean age of 11.3 years, BMI of 17.8 kg/m2, were in the 57th percentile for age, and had a mean baseline VAS appetite score of 56 mm. The majority of participants were NZ European (65%).

Primary outcome

Total EI overall (food + drink)

Main findings

We found that in normal-weight males aged 9–13 years, TV watching was associated with significantly greater acute EI overall compared with recreational computer use. We also observed a trend towards significantly greater EI for TV watching when compared with sedentary VG play. We found no evidence for a difference in EI between computer use and sedentary VG play. Watching TV while eating was also associated with greater EI from all food (high + low energy density foods) compared with sedentary

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      However, our results are inconsistent with an RCT demonstrating reductions in BMI following an intervention to decrease computer time among overweight children aged 4–7 years (Epstein et al., 2008). A possible explanation for why energy intake, and more specifically carbohydrate consumption, did not mediate the relationship between recreational computer use and BMI in our sample may be supported by the recent finding that energy intake from soda was significantly lower during recreational computer use when compared to TV viewing (Marsh, Ni Mhurchu, Jiang, & Maddison, 2014). In addition, computer use may engage the hands and mind in a manner that limits energy intake when compared with TV viewing or video gaming.

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    Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12612001103853.

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