Report: You Are What You Watch

Melissa Musiker is a registered dietician and a member of APCO’s Washington, D.C., health policy team.

Earlier this week, the American Academy of Pediatrics (AAP) released a policy statement on “Children, Adolescents, Obesity, and the Media.” According to the AAP, obesity represents a “clear and present danger to the health of children and adolescents.” The statement claims that “most researchers now agree that the evidence linking excessive TV-viewing and obesity is persuasive,” with dozens of longitudinal and correlational studies documenting a connection.

According to the AAP, watching TV contributes to obesity by increasing sedentary activity and displacing more physical pursuits; encouraging unhealthy eating practices learned from both the programming and the advertisements for unhealthy foods; increasing snacking behavior while viewing; and interfering with normal sleep patterns.

The AAP recommends that pediatricians counsel parents and caregivers at well-child visits about age-appropriate screen time, nutrition education and parental monitoring of TV viewing and internet usage, and reminds pediatricians that screen time is associated is associated with increased stress and decreased sleep, lifestyle factors highly correlated with obesity. They also encourage pediatricians to engage in their community by helping implement education programs to “immunize young people against harmful media effects.”

Finally, the AAP statement outlines significant public policy interventions, most notably a ban on “junk-food” advertising during children’s programming, in interactive digital media (such as advergaming on company websites) and in paid product placements in movies. AAP also wants FTC to have the authority to tightly regulate children’s advertising, asks Congress to fund additional media research and suggests the White House should encourage the production of websites and video games promoting healthy foods.

Based on their recommendations, it is clear that the AAP feels that existing self-regulatory activities to limit food advertising to children are ineffective and that foods advertised to children are unhealthy. Notably, the AAP does not recognize the 2005 IOM report, “Food Marketing to Children and Youth: Threat or Opportunity,” which found that “there is presently insufficient causal evidence that links advertising directly with childhood obesity and that would support a ban on all food advertising directed to children.” They do not appear to see a role for industry self-regulatory activities.

There is little debate that all children and adolescents would benefit from decreased screen time, but the issue is much more complex than what kids are watching or eating. In the public health community, TV time is used as a proxy indicator for assessing parenting style. Successful interventions must be more holistic and based on modifying parenting style rather than focusing on nutrition or physical activity in isolation. All the factors described above are strongly and independently associated with increased risk of obesity.

It is appropriate for the AAP to recommend that their members counsel parents on the importance of this replacing screen time with other activities. It is likely, however, that the press and advocacy groups will focus on the provocative marketing ban language in the statement as opposed to the common-sense behavioral and parenting interventions with a firm foundation in consensus science that would benefit children and their families more broadly.