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. Author manuscript; available in PMC: 2020 Sep 1.
Published in final edited form as: J Acad Nutr Diet. 2019 Apr 25;119(9):1462–1469. doi: 10.1016/j.jand.2019.02.013

Watching Television while Eating: Associations with Dietary Intake and Weight Status among a Diverse Sample of Young Children

Amanda C Trofholz 1, Allan Tate 2, Katie Loth 3, Dianne Neumark-Sztainer 4, Jerica M Berge 5
PMCID: PMC6710144  NIHMSID: NIHMS1527882  PMID: 31031108

Abstract

Background

TV watching at family meals has been associated with poorer dietary quality and weight outcomes in children. Most research has been limited to family meals, overlooking the impact of TV at any meal.

Objective

This study assesses (1) how often children are eating meals at home while watching TV, (2) the association between child dietary intake while watching TV during meals eaten at home and whether an association depends on meal type (e.g., breakfast) or child race/ethnicity, and (3) if the number of meals consumed while watching TV at home is associated with overall child dietary quality or weight status.

Design

The Family Matters study utilized a cross-sectional design and was conducted between 2015–2016.

Participants/setting

Three 24-hour dietary recalls were conducted on 5–7 year-old children (n=150; 25 each of Non-Hispanic White, African American, Latino, Native American, Somali, Hmong backgrounds).

Main outcome measures

Main outcomes of this study were dietary intake at meals, overall dietary quality, and child weight status.

Statistical analysis performed

Conditional fixed effects estimators were used to address correlated error terms to model within-person variation between 1) TV and dietary intake and 2) race/ethnicity differences in child dietary outcomes.

Results

TV was watched during 30% of meals eaten at home, which differed significantly by race/ethnicity (p-value <0.001). While effect sizes were small, TV watching at meals was associated with unhealthier intake of some foods groups (e.g., increased sugar-sweetened beverages and chips/crackers, decreased fruits), dependent on the meal occasion (e.g., snacks). However, TV watching during meals at home was not significantly associated with dietary intake for other food groups. These associations did not depend on race/ethnicity. An association between number of meals consumed while watching TV with overall dietary quality or weight status was not found.

Conclusions

While more research is needed, results suggest TV watching while eating meals at home is relatively common, depends on race/ethnicity, and that TV watching at some meal occasions is associated with child intake of certain food groups, with the majority being unhealthy.

Keywords: 24-h dietary recalls, child dietary intake, television, children, meal type

Introduction

Television (TV) watching by children and adolescents has been associated with poorer dietary quality and weight outcomes in children and adolescents.1–6 A growing body of literature also demonstrates worse outcomes for children and adolescents when TV is simply present (e.g., on in the background) during family meals.7–12 Previous studies also show more negative meal-specific outcomes when TV is present at family meals, including lower family enjoyment of the meal,11,13 and serving a lower quality (e.g., less vegetables, more fast food) meal.11,14 Results regarding the presence/watching of TV at family meals and child weight status have been mixed.11,12,15

Very little is known about child dietary quality and weight-related outcomes when TV is present/being watched at eating occasions other than family meals. There appears to be only one previous study that examined diet and weight-related outcomes for children stratified by the presence of TV at any meal occasion.16 This prior study used two samples: ethnically diverse third graders and Latino fifth graders. Results found that children consumed less fast food, soda, fruit, and vegetables at meals eaten while watching TV; a significant association was not found between the amount of food eaten at meals while watching TV and child weight.16 There do not appear to be any studies exploring diet and weight-related outcomes when TV is present at specific eating occasions (i.e., breakfast, lunch, dinner, snacks). Also, as previous research has demonstrated significant differences in the eating patterns of young children by race/ethnicity,17 it is important to identify any racial/ethnic differences in dietary intake while watching TV.

Using data from three 24-hour dietary recalls from a racially/ethnically diverse and immigrant/refugee sample of children ages 5–7, this study seeks to expand the body of literature regarding TV watching at meals by answering the following questions: 1) How often are meals eaten at home while watching TV?; 2) Is TV watching associated with dietary intake and does the association depend type of meal?; 3) Is TV watching associated with dietary intake and does the association depend on child race/ethnicity?; and 4) Is the number of meals consumed while watching TV associated with child dietary quality or weight status? Given past research showing significant associations between overall TV viewing1–6 and TV watching at family meals7–12 with poorer dietary quality in children, it is hypothesized that watching TV at any eating occasion (i.e., breakfast, lunch, dinner, snack) will be associated with poorer child dietary quality and weight status both at specific meal occasions and overall.

Methods

Data for this study were collected as part of the Family Matters study,18 a two-phased study exploring risk and protective factors for childhood obesity disparities. Phase I of Family Matters was a cross-sectional study conducted through in-home visits in a low-income and diverse sample (n=150). Participating families were recruited between 2015–2016 from primary care clinics in the Twin Cities of Minnesota. Clinics identified 5–7 year old children (target children) with a recent well child visit. A letter was then sent to the child’s family inviting them to participate in the Family Matters study. Eligibility requirements included: having a 5–7 year old child and an additional sibling who was 2–12 years old who lived in the home full-time with the primary guardian (parent); the target child needed to be away from home during the day (e.g., school, summer camp) and needed to share at least one meal per day with the parent. To ensure equal distribution, families (n=150) were recruited across racial/ethnic groups, including twentyfive each from Non-Hispanic White, African American, Latino, Native American, Somali, Hmong households. Additionally, to ensure equal distribution of weight status, these race/ethnicity groups were stratified so that half of target children were overweight (≥85th BMI percentile) and half were normal weight (5th – 84th BMI percentile).18

At the first home visit, parents completed the consent process with research staff and gave parental consent for their children under eighteen years old to participate. Children over five years old were assented into the study. Detailed study procedures have been published elsewhere.18 All study protocols were approved by the University of Minnesota’s Institutional Review Board.

Procedures

Data were collected from participants during two home visits conducted about ten days apart. Mixed-methods data described elsewhere18 were collected (e.g., 24-hour dietary recalls, anthropometry, ecological momentary assessment, video-recorded tasks, built environment audit, home food inventory, online survey, interviews). Height and weight measurements and three 24-hour dietary recalls (two during in-home visits and one via telephone between home visits) on the target child are utilized in the current study. Participants were able to complete visits in either English, Spanish, Somali, or Hmong. If participants spoke a language other than English, they were matched with a researcher who was both bilingual and bicultural to ensure participant comfort and accurate data.

24-hour dietary recalls

Trained researchers used the 2015 Nutrition Data System for Research (NDSR) to collect three 24-hour dietary recalls on the target child.19 As young children are not considered reliable reporters of dietary intake,20,21 recalls were conducted with the parent. As the child did not always share meals with the parent (e.g., school lunch), the following strategies were used to promote complete data: 1) dietary recalls were scheduled, and parents were provided a food diary in order to record the foods and drinks consumed by the child; 2) when possible, school breakfast and lunch menus were used; 3) for school breakfast and lunch items, standard amounts (e.g., 8 fluid ounces of milk) were used, and the parent was asked to report the percentage of the food item consumed; 4) older siblings who shared the school breakfast and/or lunch were allowed to provide details when applicable. Additionally, prior to carrying out the study, Family Matters dietitians identified Hmong, Somali, and Latino foods, in coordination with community research team members from those same cultures, that might be frequently reported by participants but not found in the NDSR system. Recipes were developed for these foods using ingredients found in NDSR, and Family Matters researchers were provided training on how to enter these recipes. Recalls were conducted on nonconsecutive days; two were weekdays, and one was a weekend day. The first and third recalls were conducted at the two home visits; the second recall was conducted via telephone in the days between home visits. Staff dietitians conducted quality assurance on 100% of dietary recalls.

Measures

Meal Characteristics

Presence of TV Watching; Weekday or Weekend day Meal; Meal Type; and Meal Location: Screen time included anytime the child was watching a physical TV or TV/videos on a different screen (e.g., tablet, phone); for this study, any screen time will be referred to as “TV”. The parent was asked at each dietary recall meal, “Was the child watching TV or videos during this meal?” Each meal received a “Yes” or “No” depending on the parent’s response. Whether the recall was a weekday or weekend day was determined by the date of intake. Parents also classified each meal as a breakfast, lunch, dinner, or snack and reported where the meal was eaten (e.g. at home, at school). For the current analysis, only meals eaten at home are included.

Food and Nutrient Categories

NDSR combines foods eaten into food subgroups (e.g., dark green vegetables, whole grain crackers). Similar subgroups were combined to create an overall category. For example, sweetened coffees, fruit drinks, soft drinks, teas, and waters were combined to create a sugar-sweetened beverages (SSB) category. NDSR also compiles nutrient data (e.g., Sodium). Both food subgroups and nutrient data are available at a meal level. Healthy Eating Index-2010 (HEI) scores were calculated and included all meals eaten by the child over 3 days (i.e., not just the meals eaten at home).22,23

Anthropometry

Child height and weight was completed by trained staff members. Height was assessed to the closest 0.1 cm using a Seca 217 stadiometer; weight was assessed to the closest 0.1 kg using a calibrated Seca 869 scale. Both measurements were taken twice and then averaged, and measurements needed to agree to less than 0.5 cm for height and 0.5 kg for weight. If the measurements did not agree within the standard of error, a third measurement was taken; the calculated height and/or weight was the mean of the two closest measurements. The measured heights and weights were used to calculate body mass index (BMI) percentile values using the CDC calculator.24

Statistical Analysis

Data visualization procedures and cross-tabulations were used to evaluate modeling assumptions and identify any missing data. Unless otherwise noted, the two-sided type I error rate was set to the 0.05 alpha level. Additionally, while there were 150 participants (25 per racial/ethnic group), analysis was conducted at the meal level, which allowed for the utilization of 1,435 meal occasions. Data management and analysis was performed in Stata 15SE (College Station, TX).25

Research question 1

Descriptive statistics were computed to examine the frequency of TV watching at meals and the prevalence of TV at weekend and weekday meal occasions. A subpopulation analysis was performed to examine race/ethnicity differences in TV watching by meal occasion. Logit models with participant random intercepts to deal with correlated errors were fit to determine if the prevalence of TV watching differed overall for race/ethnicity subpopulations; post-hoc pairwise comparisons were computed at a two-sided 0.01 alpha level to examine how each subpopulation differed compared to each other. Similar analyses (set at 0.05 alpha level) were conducted to evaluate if the presence of TV at meals differed by weekend or weekday.

Research question 2

A conditional fixed-effects estimator was used for linear regression models applying robust standard errors to examine if the relationship between TV watching and dietary intake depended on the type of meal occasion. This model uses within-participant variation (i.e., compares an individual’s dietary intake when they are watching TV versus when they are not watching TV) to explain how the outcome varies for time-variant predictors while accounting for correlated errors due to repeated measures.26 In the interaction model, the primary outcome was a continuous variable for dietary intake (servings) at the meal, the independent predictor was a dichotomous variable for whether or not the child was watching TV, and the third interaction term was the meal type/occasion (i.e., breakfast, lunch, dinner, or snack occasion). Stratum-specific (meal type/occasion), marginal effects by the four meal type levels were calculated for all statistically significant interaction terms (p<0.05). A control for the day of the meal occasion was included in all models.

Research question 3

Between-group race/ethnicity (independent predictor) differences in dietary intake (dependent variable) were examined with conditional fixed effects estimators. A control for the day of the meal occasion was included in all models.

Research question 4

A cross-sectional analysis was conducted to examine the relationship between the prevalence of TV at meals (independent predictor) and child weight status, BMI percentile, and HEI scores. This score was calculated by averaging the dietary recall intake data, computing scores for each adequacy and moderation component, and summing the component scores to compute individual HEI-2010 scores.

Results

As this study aimed to investigate meals where the parent(s) would have the most influence, only those meals eaten at home were utilized. For ease of the reader, the remainder of the manuscript will only refer to “meals” rather than clarifying that these were meals eaten at home.

How often are meals eaten at home while watching TV?

Overall, parents reported that children watched TV at 30% of meals (n=430) (Table 1). Children watched TV the most at snacking meals (37%) and the least at breakfast meals (22%). There were significant differences in the prevalence of TV watching by children observed across race/ethnicity groups. African American children watched TV at meals significantly more (57% of all meals) than nearly all other race/ethnicity groups, and Somali children watched TV significantly less than most other race/ethnicity groups (9% of all meals).

Table 1:

Percentage of Breakfast, Lunch, Dinner, Snack, and All Meals Eaten by 5–7 Year Old Children (n=150, 25 each of African American, Non-Hispanic White, Somali, Hmong, Latino, Native American) While Watching TV between 2015–2016, Stratified by Race/Ethnicity and Day of the Week

Meals by Race/Ethnicitya
Breakfast Lunch Snack Dinner All Meals
TV not present (n (%)) TV present (n (%)) p-value Total Meals TV not present (n (%)) TV present (n (%)) p-value Total Meals TV not present (n (%)) TV present (n (%)) p-value Total Meals TV not present (n (%)) TV present (n (%)) p-value Total Meals TV not present (n (%)) TV present (n (%)) p-value Total Meals
Overall Sample (n=150) 252 (78%) 70 (22%) 0.001 322 120 (70%) 51 (30%) 0.028 171 347 (63%) 204 (37%) <0.001 551 286 (73%) 105 (27%) <0.001 391 1005 (70%) 430 (30%) <0.001 1435
African American (n=25) 21 (49%) 22 (51%)y 43 9 (33%) 18 (67%)y 27 35 (39%) 54 (61%)z 89 33 (48%) 36 (52%)y 69 98 (43%) 130 (57%)z 228
Non-Hispanic White (n=25) 56 (93%) 4 (7%)w 60 19 (90%) 2 (10%)wx 21 71 (71%) 29 (29%)wxy 100 50 (78%) 14 (22%)x 64 196 (80%) 49 (20%)wx 245
Somali (n=25) 63 (89%) 8 (11%)wx 71 45 (96%) 2 (4%)w 47 71 (86%) 12 (14%)w 83 70 (96%) 3 (4%)w 73 249 (91%) 25 (9%)w 274
Hmong (n=25) 34 (68%) 16 (32%)xy 50 10 (37%) 17 (63%)y 27 38 (49%) 40 (51%)yz 78 36 (58%) 26 (42%)xy 62 118 (54%) 99 (46%)yz 217
Latino (n=25) 42 (88%) 6 (13%)wx 48 22 (85%) 4 (15%)wx 26 72 (73%) 27 (27%)wx 99 50 (85%) 9 (15%)wx 59 186 (80%) 46 (20%)wx 232
Native American (n=25) 36 (72%) 14 (28%)xy 50 15 (65%) 8 (35%)xy 23 60 (59%) 42 (41%)xyz 102 47 (73%) 17 (27%)xy 64 158 (66%) 81 (34%)xy 239
Weekday and Weekend Day Mealsb
Weekend 99 (75%) 33 (25%) 0.148 132 68 (69%) 30 (31%) 0.637 98 124 (60%) 83 (40%) 0.013 207 99 (78%) 28 (22%) 0.123 127 390 (69%) 174 (31%) 0.035 564
Weekday 153 (81%) 37 (19%) 190 52 (71%) 21 (29%) 73 223 (65%) 121 (35%) 344 187 (71%) 77 (29%) 264 615 (71%) 256 (29%) 871
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Bolded p-values indicate statistical significance at p <0.05.

a:

Different letters (w, x, y, z) indicate statistically significant differences in TV viewing at meals between racial/ethnic groups. Significance level was adjusted to a 0.01 alpha level to account for multiple testing.

b:

For weekday and weekend day meals, a significance level at the 0.05 alpha level was retained.

Is TV watching associated with dietary intake and does this association depend on type of meal?

The association between TV watching while eating a meal and dietary intake was dependent on the type of meal occasion (i.e., breakfast, lunch, dinner, snack) for four food categories: SSB, fruit, whole grains, and chips/crackers (Table 2). For example, when TV was being watched at a family dinner meal, children had 0.12 higher servings (CI: 0.01, 0.24) of SSBs at that specific meal.

Table 2:

Association Between TV Watching and Dietary Intake at Breakfast, Lunch, Dinner, Snacks, and All Meals for 5–7 Year Old Children (n=150, 25 each of African American, Non-Hispanic White, Somali, Hmong, Latino, Native American) between 2015–2016, Stratified by Meal Type (N=1,435 meal occasions)

TV at Meals Association with Dietary Intake (95% CI) (reference: No TV) a p-value Breakfasta,b Lunch a,b Snacks a,b Dinner a,b Interaction p-value
Interaction Models by Meal Occasion
 Dietary Intake (servings)
Sugar Sweetened Beverage −0.06 (−0.13, 0.01) 0.05 (−0.08, 0.17) 0.04 (−0.04, 0.11) 0.12 (0.01, 0.24) 0.013
Fruit −0.04 (−0.15, 0.06) 0.01 (−0.16, 0.19) −0.14 (−0.27, 0.00) 0.10 (0.01, 0.2) 0.028
Whole Grains −0.12 (−0.32, 0.08) −0.09 (−0.25, 0.07) 0.21 (0.10, 0.31) −0.02 (−0.19, 0.15) 0.001
Chips/Crackers −0.02 (−0.10, 0.05) −0.04 (−0.16, 0.08) 0.12 (0.01, 0.24) −0.08 (−0.17, 0.01) 0.015
Non-Interaction Models
Added Sugars (grams) 0.92 (−0.95, 2.78) 0.334
Sodium (milligrams) 14.15 (−58.58, 86.89) 0.701
Baked Goods 0.02 (−0.03, 0.07) 0.454
Candy −0.01 (−0.04, 0.02) 0.409
Vegetable −0.03 (−0.10, 0.04) 0.431
French Fries −0.01 (−0.03, 0.01) 0.204
Dairy −0.05 (−0.12, 0.01) 0.101
Energy (kilocalories) −4.10 (−30.28, 22.09) 0.758
100% juice −0.02 (−0.08, 0.03) 0.416
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a:

All models are adjusted for whether the meal occasion was on a weekday or a weekend. Values shown are beta coefficients.

b:

Note: The frequency of each meal type was examined, and on average participants reported 0.77 breakfasts, 0.53 lunches, 1.3 snacks, and 0.86 dinners per day in the home (i.e., not at school or at restaurants).

Interpretation Example: The relationship between TV watching during meals and child dietary intake of SSB, fruit, whole grains, and chips/crackers depended on the type of meal occasion (P-interaction < 0.05). All other TV and dietary associations were not modified by the type of meal occasion; coefficients and 0.05 alpha levels are presented for the non-interaction models. For example, TV watching was not associated with increased or decreased intake of added sugars,

Is TV watching associated with dietary intake and does this association depend on child race/ethnicity?

The association between dietary intake at meals and TV watching did not depend on race/ethnicity. Data not shown.

Is the number of meals consumed while watching TV associated with poorer dietary quality or weight status?

There were no significant associations between the number of meals a child ate while watching TV with either overall dietary quality (HEI-2010 score), child BMI percentile, or weight status (i.e., nonoverweight or overweight) (Table 3 on-line only).

Discussion

The aim of the current study was to examine if there was an association between watching TV during specific weekday/weekend meal occasions (e.g., breakfast, lunch, dinner, snacks) and child dietary quality and weight, and to examine whether an association depended on meal type or child race/ethnicity. Associations between TV watching at all meals and child overall dietary quality and weight status were also examined.

Overall, children in this study ate 30% of their meals while watching TV. There were also significant racial/ethnic differences in the prevalence of TV watching at meal occasions. For example, African American children watched TV at 57% of all home meals. While there is some research evaluating the frequency of TV watching at family meals,9,13,27 there does not appear to be any research that has examined TV watching at all types of eating occasions, particularly by day of the week and/or race/ethnicity.

Interaction models indicated that TV watching at meals may be associated with some change in dietary intake. For example, while the effect of TV on these food categories was small, watching TV at dinner was significantly associated with increased intake of fruit and SSB. Watching TV at snacks was significantly associated with increased intake of chips/crackers and whole grains. Further investigation is needed to explore whether consumed whole grains were healthy (e.g., brown rice) or less healthy (e.g., tortilla chips). Children in this study consumed 1.3 average snacks per day, but only 0.77 breakfasts and 0.86 dinners. Given the possibility for many snacking occasions throughout the day, and the synergistic relationship with TV watching and less healthful intake (i.e., chips/crackers, possible less healthy whole grain items (e.g., cereal bars)) found in the current study, snacking appears to be a natural intervention point to potentially change child health behaviors, however future research is needed before utilizing snacking as an intervention target.”. Future research should investigate who prepares snack foods. For example, a previous qualitative study of parents of 2–18 year olds, found that children who made their own meals without parent involvement generally made quick foods that tended to be more unhealthy (e.g., hot dogs).28

However, while interaction models indicated that dietary intake for certain food groups depended on meal type, dietary intake of most food groups was not impacted by the presence of TV, and there were no significant differences by race/ethnicity. Additionally, there were not significant associations between increased TV watching at meals with the child’s overall dietary quality (HEI-2010 score) or weight status. This is somewhat surprising given past research demonstrating worse dietary and weight outcomes for children and adolescents with increased TV watching at family meals.7–12 Future research needs to evaluate why TV watching at family meals may be associated with worse outcomes (e.g., lower dietary quality and increased weight status), while TV watching at all meals is not. Additionally, study results regarding the prevalence of TV watching during meals were similar to previous research examining children’s hours of daily leisure screen time. For example, previous research found that African American children had the highest hours of leisure screen time per day (5.6 hours/day), which was significantly higher than Somali children’s daily hours of screen time (2.3 hours/day). (Berge, 2019, unpublished data.) If African American children are frequently watching TV, the content they watch specifically during meals (e.g., advertisements)29,30 may not be associated with their dietary quality.

There are both strengths and limitations of the current study. One strength of this study was the use of a substantial number of meal occasions (N=1,435), which allows the extraction of variation within participants and provided the opportunity to examine TV watching with dietary outcomes at an overall, day, and meal level. This study was also strengthened by a racially/ethnically diverse sample. One limitation of the study was that there are additional meal variables (e.g., who was present at the meal, meal atmosphere) that may impact child dietary intake which were not available for this study. Parent recall of TV watching and child dietary intake may be misreported. Dietary recalls were scheduled, and therefore, may not reflect usual intake. However, if recall bias is non-differential, then it is likely that these findings are conservative estimates of the impact of TV on child dietary intake. In addition, it is not known what media content the child was consuming at meals or for how long they were watching the content. Another limitation of the study is that the sample included only children with siblings; results may not generalize to children living in homes without siblings. Future research should investigate whether there are differences in dietary quality depending on the type of media used (e.g., TV, tablet), the length of watching, or the advertisement content of the media at any meal.

Conclusions

Study results showed that children are frequently watching TV while consuming meals at home, and there are significant racial/ethnic differences in the percentage of meals consumed while watching TV. With some exceptions (i.e., sugar-sweetened beverages, chips/crackers, fruits, whole grains), dietary intake was not associated with TV watching during meals. While more research is needed, results suggest that TV watching at some meal occasions is associated with child intake of certain food groups, with the majority being unhealthy.

Supplementary Material

1

Research Snapshot.

Research Question

How often do children eat meals at home while watching TV? What is the association between watching TV during home meals and child dietary intake, and does an association depend on meal type or child race/ethnicity?

Key Findings

Results from 24-hour dietary recalls found that children watched TV at 30% of all home meals, with significant differences by child race/ethnicity. TV watching was significantly associated with more unhealthy intake of some foods (e.g., chips/crackers) at some meal types (e.g., snacks), but was not significantly associated with intake of other foods (e.g., baked goods), nor were there differences found by race/ethnicity.

Acknowledgments

Financial support: Research is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute, the National Institute of Child Health and Human Development or the National Institutes of Health.

Footnotes

Conflict of Interest: There are no conflicts of interests to report.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Contributor Information

Amanda C. Trofholz, research associate, Division of Family Medicine and Community Health, University of Minnesota, Minneapolis.

Allan Tate, graduate research assistant, Division of Family Medicine and Community Health, University of Minnesota, Minneapolis.

Katie Loth, assistant professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.

Dianne Neumark-Sztainer, professor, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.

Jerica M. Berge, associate professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.

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