This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (590)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Obesity  • Randomized Controlled Trial  • Humanities  • Medicine and the Media  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Controlled Trial

Thomas N. Robinson, MD, MPH

JAMA. 1999;282:1561-1567.

Context  Some observational studies have found an association between television viewing and child and adolescent adiposity.

Objective  To assess the effects of reducing television, videotape, and video game use on changes in adiposity, physical activity, and dietary intake.

Design  Randomized controlled school-based trial conducted from September 1996 to April 1997.

Setting  Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif.

Participants  Of 198 third- and fourth-grade students, who were given parental consent to participate, 192 students (mean age, 8.9 years) completed the study.

Intervention  Children in 1 elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use.

Main Outcome Measures  Changes in measures of height, weight, triceps skinfold thickness, waist and hip circumferences, and cardiorespiratory fitness; self-reported media use, physical activity, and dietary behaviors; and parental report of child and family behaviors. The primary outcome measure was body mass index, calculated as weight in kilograms divided by the square of height in meters.

Results  Compared with controls, children in the intervention group had statistically significant relative decreases in body mass index (intervention vs control change: 18.38 to 18.67 kg/m² vs 18.10 to 18.81 kg/m², respectively; adjusted difference -0.45 kg/m² [95% confidence interval {CI}, -0.73 to -0.17]; P=.002), triceps skinfold thickness (intervention vs control change: 14.55 to 15.47 mm vs 13.97 to 16.46 mm, respectively; adjusted difference, -1.47 mm [95% CI, -2.41 to -0.54]; P=.002), waist circumference (intervention vs control change: 60.48 to 63.57 cm vs 59.51 to 64.73 cm, respectively; adjusted difference, -2.30 cm [95% CI, -3.27 to -1.33]; P<.001), and waist-to-hip ratio (intervention vs control change: 0.83 to 0.83 vs 0.82 to 0.84, respectively; adjusted difference, -0.02 [95% CI, -0.03 to -0.01]; P<.001). Relative to controls, intervention group changes were accompanied by statistically significant decreases in children's reported television viewing and meals eaten in front of the television. There were no statistically significant differences between groups for changes in high-fat food intake, moderate-to-vigorous physical activity, and cardiorespiratory fitness.

Conclusions  Reducing television, videotape, and video game use may be a promising, population-based approach to prevent childhood obesity.

Author Affiliation: Departments of Pediatrics and Medicine, Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

October 27, 1999
JAMA. 1999;282(16):1593-1594.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

After-school program to reduce obesity in minority children: a pilot study
Madsen et al.
J Child Health Care 2009;13:333-346.
ABSTRACT  

Perinatal risk factors for childhood obesity and metabolic dysregulation
Catalano et al.
Am. J. Clin. Nutr. 2009;90:1303-1313.
ABSTRACT | FULL TEXT  

Obesity in the Transition to Adulthood: Predictions Across Race/Ethnicity, Immigrant Generation, and Sex
Harris et al.
Arch Pediatr Adolesc Med 2009;163:1022-1028.
ABSTRACT | FULL TEXT  

The CHEER Study to Reduce BMI in Elementary School Students: A School-Based, Parent-Directed Study in Framingham, Massachusetts
Resnick et al.
The Journal of School Nursing 2009;25:361-372.
ABSTRACT | FULL TEXT  

Relation Between Socioeconomic Status and Body Mass Index: Evidence of an Indirect Path via Television Use
Morgenstern et al.
Arch Pediatr Adolesc Med 2009;163:731-738.
ABSTRACT | FULL TEXT  

By how much would limiting TV food advertising reduce childhood obesity?
Veerman et al.
Eur J Public Health 2009;19:365-369.
ABSTRACT | FULL TEXT  

Early Child Care and Adiposity at Ages 1 and 3 Years
Benjamin et al.
Pediatrics 2009;124:555-562.
ABSTRACT | FULL TEXT  

Factors associated with television viewing time in toddlers and preschoolers in Greece: the GENESIS study
Kourlaba et al.
J Public Health (Oxf) 2009;31:222-230.
ABSTRACT | FULL TEXT  

Television Viewing and Symptoms of Inattention and Hyperactivity Across Time: The Importance of Research Questions
Stevens et al.
Journal of Early Intervention 2009;31:215-226.
ABSTRACT  

Increased television viewing is associated with elevated body fatness but not with lower total energy expenditure in children
Jackson et al.
Am. J. Clin. Nutr. 2009;89:1031-1036.
ABSTRACT | FULL TEXT  

Dutch Obesity Intervention in Teenagers: Effectiveness of a School-Based Program on Body Composition and Behavior
Singh et al.
Arch Pediatr Adolesc Med 2009;163:309-317.
ABSTRACT | FULL TEXT  

Implementing American Heart Association Pediatric and Adult Nutrition Guidelines: A Scientific Statement From the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disease in the Young, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research
Gidding et al.
Circulation 2009;119:1161-1175.
FULL TEXT  

Television Viewing in Infancy and Child Cognition at 3 Years of Age in a US Cohort
Schmidt et al.
Pediatrics 2009;123:e370-e375.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT  

Prevention in the first place: schools a setting for action on physical inactivity
Naylor and McKay
Br. J. Sports. Med. 2009;43:10-13.
ABSTRACT | FULL TEXT  

Effect of a family-based intervention on electronic media use and body composition among boys aged 8--11 years: a pilot study
Todd et al.
J Child Health Care 2008;12:344-358.
ABSTRACT  

Behavioral Interventions to Prevent Childhood Obesity: A Systematic Review and Metaanalyses of Randomized Trials
Kamath et al.
J. Clin. Endocrinol. Metab. 2008;93:4606-4615.
ABSTRACT | FULL TEXT  

Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
August et al.
J. Clin. Endocrinol. Metab. 2008;93:4576-4599.
ABSTRACT | FULL TEXT  

Preventing childhood obesity: the sentinel site for obesity prevention in Victoria, Australia
Bell et al.
HEALTH PROMOT INT 2008;23:328-336.
ABSTRACT | FULL TEXT  

Reducing overweight and obesity: closing the gap between primary care and public health
Anderson
Fam Pract 2008;25:i10-i16.
ABSTRACT | FULL TEXT  

A Public Health Approach to Winning the War Against Cancer
Frieden et al.
The Oncologist 2008;13:1306-1313.
ABSTRACT | FULL TEXT  

Perception, Intention, and Action in Adolescent Obesity
Bittner Fagan et al.
J Am Board Fam Med 2008;21:555-561.
ABSTRACT | FULL TEXT  

A National Longitudinal Study of the Association Between Hours of TV Viewing and the Trajectory of BMI Growth Among US Children
Danner
J Pediatr Psychol 2008;33:1100-1107.
ABSTRACT | FULL TEXT  

Physically Active Video Gaming: An Effective Strategy for Obesity Prevention?
Pate
Arch Pediatr Adolesc Med 2008;162:895-896.
FULL TEXT  

Population-Based Prevention of Obesity: The Need for Comprehensive Promotion of Healthful Eating, Physical Activity, and Energy Balance: A Scientific Statement From American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (Formerly the Expert Panel on Population and Prevention Science)
Kumanyika et al.
Circulation 2008;118:428-464.
ABSTRACT | FULL TEXT  

Why Young Adults Hold the Key to Assessing the Obesity Epidemic in Children
Lee
Arch Pediatr Adolesc Med 2008;162:682-687.
ABSTRACT | FULL TEXT  

A Review of TV Viewing and Its Association With Health Outcomes in Adults
Williams et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:250-259.
ABSTRACT  

Risk factors associated with obesity in children of different racial backgrounds
Urrutia-Rojas et al.
Health Education Journal 2008;67:121-133.
ABSTRACT  

Relationship between screen time and metabolic syndrome in adolescents
Mark and Janssen
J Public Health (Oxf) 2008;30:153-160.
ABSTRACT | FULL TEXT  

Clinical Profile of the Overweight Child in the New Millennium
Carvalho et al.
CLIN PEDIATR 2008;47:476-482.
ABSTRACT  

Randomised controlled trial adapting US school obesity prevention to England
Kipping et al.
Arch. Dis. Child. 2008;93:469-473.
ABSTRACT | FULL TEXT  

Watching Social Science: The Debate About the Effects of Exposure to Televised Violence on Aggressive Behavior
Glymour et al.
American Behavioral Scientist 2008;51:1231-1259.
ABSTRACT  

Characteristics Associated With Older Adolescents Who Have a Television in Their Bedrooms
Barr-Anderson et al.
Pediatrics 2008;121:718-724.
ABSTRACT | FULL TEXT  

Childhood Obesity Prevention Programs: How Do They Affect Eating Pathology and Other Psychological Measures?
Carter and Bulik
Psychosom. Med. 2008;70:363-371.
ABSTRACT | FULL TEXT  

A Policy-Based School Intervention to Prevent Overweight and Obesity
Foster et al.
Pediatrics 2008;121:e794-e802.
ABSTRACT | FULL TEXT  

Public Health Interventions for Addressing Childhood Overweight: Analysis of the Business Case
Finkelstein and Trogdon
AJPH 2008;98:411-415.
ABSTRACT | FULL TEXT  

Team Sports for Overweight Children: The Stanford Sports to Prevent Obesity Randomized Trial (SPORT)
Weintraub et al.
Arch Pediatr Adolesc Med 2008;162:232-237.
ABSTRACT | FULL TEXT  

A Randomized Trial of the Effects of Reducing Television Viewing and Computer Use on Body Mass Index in Young Children
Epstein et al.
Arch Pediatr Adolesc Med 2008;162:239-245.
ABSTRACT | FULL TEXT  

Innovations to Reduce Television and ComputerTime and Obesity in Childhood
Gortmaker
Arch Pediatr Adolesc Med 2008;162:283-284.
FULL TEXT  

Themed Review: Clinical Interventions to Promote Physical Activity in Youth
Meriwether et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:7-25.
ABSTRACT  

The choice of cutoffs for obesity and the effect of those values on risk factor estimation
Toschke et al.
Am. J. Clin. Nutr. 2008;87:292-294.
ABSTRACT | FULL TEXT  

Children, Television Viewing, and Weight Status: Summary and Recommendations from an Expert Panel Meeting
Jordan and Robinson
The ANNALS of the American Academy of Political and Social Science 2008;615:119-132.
ABSTRACT  

Peer Influence on Children's Physical Activity: An Experience Sampling Study
Salvy et al.
J Pediatr Psychol 2008;33:39-49.
ABSTRACT | FULL TEXT  

Special Article: Physical Activity, Physical Fitness, and Cardiovascular Risk Factors in Childhood
Gidding
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:499-505.
ABSTRACT  

Physical activity for the prevention and management of youth-onset type 2 diabetes mellitus: focus on cardiovascular complications
Mcgavock et al.
Diabetes and Vascular Disease Research 2007;4:305-310.
ABSTRACT  

Targeting obesity to reduce the risk for type 2 diabetes and other co-morbidities in African American youth: a review of the literature and recommendations for prevention
Nwobu and Johnson
Diabetes and Vascular Disease Research 2007;4:311-319.
ABSTRACT  

The status of health-promoting schools in Hong Kong and implications for further development
Lee et al.
HEALTH PROMOT INT 2007;22:316-326.
ABSTRACT | FULL TEXT  

Assessment of Child and Adolescent Overweight and Obesity
Krebs et al.
Pediatrics 2007;120:S193-S228.
ABSTRACT | FULL TEXT  

Recommendations for Prevention of Childhood Obesity
Davis et al.
Pediatrics 2007;120:S229-S253.
ABSTRACT | FULL TEXT  

Recommendations for Treatment of Child and Adolescent Overweight and Obesity
Spear et al.
Pediatrics 2007;120:S254-S288.
ABSTRACT | FULL TEXT  

Violent Television Viewing During Preschool Is Associated With Antisocial Behavior During School Age
Christakis and Zimmerman
Pediatrics 2007;120:993-999.
ABSTRACT | FULL TEXT  

Making a difference: the clinical research programme for children
Smyth
Arch. Dis. Child. 2007;92:835-837.
FULL TEXT  

Tioga County Fit for Life: A Primary Obesity Prevention Project
Gombosi et al.
CLIN PEDIATR 2007;46:592-600.
ABSTRACT  

Safe Play Spaces To Promote Physical Activity in Inner-City Children: Results from a Pilot Study of an Environmental Intervention
Farley et al.
AJPH 2007;97:1625-1631.
ABSTRACT | FULL TEXT  

Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth: A Scientific Statement From the American Heart Association Committee on Atherosclerosis, Hypertension, and Obesity in Youth of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and Metabolism
Hayman et al.
Circulation 2007;116:344-357.
FULL TEXT  

Promoting Physical Activity Participation among Children and Adolescents
Salmon et al.
Epidemiol Rev 2007;0:mxm010v1.
ABSTRACT | FULL TEXT  

Evidence-Based Practice Guideline: Increasing Physical Activity in Schools--Kindergarten Through 8th Grade
Bagby and Adams
The Journal of School Nursing 2007;23:137-143.
ABSTRACT | FULL TEXT  

Persistence of Overweight among Young Children Living in Low Income Communities in Ontario
Evers et al.
J. Am. Coll. Nutr. 2007;26:219-224.
ABSTRACT | FULL TEXT  

Strong Association Between Time Watching Television and Blood Glucose Control in Children and Adolescents With Type 1 Diabetes
Margeirsdottir et al.
Diabetes Care 2007;30:1567-1570.
ABSTRACT | FULL TEXT  

Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health
McCrindle et al.
Arch. Dis. Child. 2007;92:509-514.
ABSTRACT | FULL TEXT  

State of the Art Reviews: Changing and Adhering to Lifestyle Changes: What Are the Keys?
Harris et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:214-219.
ABSTRACT  

Office-Based Motivational Interviewing to Prevent Childhood Obesity: A Feasibility Study
Schwartz et al.
Arch Pediatr Adolesc Med 2007;161:495-501.
ABSTRACT | FULL TEXT  

Childhood Overweight: Parental Perceptions and Readiness for Change
Howard
The Journal of School Nursing 2007;23:73-79.
ABSTRACT | FULL TEXT  

From Tastes Great to Cool: Children's Food Marketing and the Rise of the Symbolic
Schor and Ford
J Law Med Ethics 2007;35:10-21.
 

Addressing the Epidemic of Childhood Obesity Through School-Based Interventions: What Has Been Done and Where Do We Go From Here?
Peterson and Fox
J Law Med Ethics 2007;35:113-130.
 

Television watching increases motivated responding for food and energy intake in children
Temple et al.
Am. J. Clin. Nutr. 2007;85:355-361.
ABSTRACT | FULL TEXT  

Longitudinal Relationship Between Television Viewing and Leisure-Time Physical Activity During Adolescence
Taveras et al.
Pediatrics 2007;119:e314-e319.
ABSTRACT | FULL TEXT  

Emergence of Sex Differences in Prevalence of High Systolic Blood Pressure: Analysis of a Longitudinal Adolescent Cohort
Dasgupta et al.
Circulation 2006;114:2663-2670.
ABSTRACT | FULL TEXT  

Physical activity to prevent obesity in young children: Authors' reply
Reilly et al.
BMJ 2006;333:1171-1172.
FULL TEXT  

Interventions to promote young people's physical activity: Issues, implications and recommendations for practice
Cale and Harris
Health Education Journal 2006;65:320-337.
ABSTRACT  

Taking part counts: adolescents' experiences of the transition from inactivity to active participation in school-based physical education
Brooks and Magnusson
Health Educ Res 2006;21:872-883.
ABSTRACT | FULL TEXT  

Prevention of obesity and eating disorders: a consideration of shared risk factors
Haines and Neumark-Sztainer
Health Educ Res 2006;21:770-782.
ABSTRACT | FULL TEXT  

Effects of a Life Skills Intervention for Increasing Physical Activity in Adolescent Girls
Young et al.
Arch Pediatr Adolesc Med 2006;160:1255-1261.
ABSTRACT | FULL TEXT  

Longitudinal and Secular Trends in Physical Activity and Sedentary Behavior During Adolescence
Nelson et al.
Pediatrics 2006;118:e1627-e1634.
ABSTRACT | FULL TEXT  

Estimating the Energy Gap Among US Children: A Counterfactual Approach
Wang et al.
Pediatrics 2006;118:e1721-e1733.
ABSTRACT | FULL TEXT  

Physical activity to prevent obesity in young children: cluster randomised controlled trial
Reilly et al.
BMJ 2006;333:1041-1041.
ABSTRACT | FULL TEXT  

Reducing Children's Television-Viewing Time: A Qualitative Study of Parents and Their Children
Jordan et al.
Pediatrics 2006;118:e1303-e1310.
ABSTRACT | FULL TEXT  

Food cravings, ethnicity and other factors related to eating out.
Siwik and Senf
J. Am. Coll. Nutr. 2006;25:382-388.
ABSTRACT | FULL TEXT  

Promoting Physical Activity in Children and Youth: A Leadership Role for Schools: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in Collaboration With the Councils on Cardiovascular Disease in the Young and Cardiovascular Nursing
Pate et al.
Circulation 2006;114:1214-1224.
FULL TEXT  

Improving Pediatric Prevention via the Internet: A Randomized, Controlled Trial
Christakis et al.
Pediatrics 2006;118:1157-1166.
ABSTRACT | FULL TEXT  

Media and Child Health: Pediatric Care and Anticipatory Guidance for the Information Age.
Schmidt and Rich
Pediatr. Rev. 2006;27:289-298.
FULL TEXT  

What Constitutes Successful Weight Management in Adolescents?
Dietz
ANN INTERN MED 2006;145:145-146.
FULL TEXT  

Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial
Goldfield et al.
Pediatrics 2006;118:e157-e166.
ABSTRACT | FULL TEXT  

Obesity in childhood and adolescence: evidence based clinical and public health perspectives.
Reilly
Postgrad. Med. J. 2006;82:429-437.
ABSTRACT | FULL TEXT  

Translational Research in Childhood Obesity Prevention
Reynolds and Spruijt-Metz
Eval Health Prof 2006;29:219-245.
ABSTRACT  

The APPLE project: An investigation of the barriers and promoters of healthy eating and physical activity in New Zealand children aged 5-12 years
Williden et al.
Health Education Journal 2006;65:135-148.
ABSTRACT  

Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity
Council on Sports Medicine and Fitness and Council
Pediatrics 2006;117:1834-1842.
ABSTRACT | FULL TEXT  

Does Children's Screen Time Predict Requests for Advertised Products?: Cross-sectional and Prospective Analyses
Chamberlain et al.
Arch Pediatr Adolesc Med 2006;160:363-368.
ABSTRACT | FULL TEXT  

Television Viewing and Risk of Sexual Initiation by Young Adolescents
Ashby et al.
Arch Pediatr Adolesc Med 2006;160:375-380.
ABSTRACT | FULL TEXT