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Behavior and Psychology

Television Viewing and Obesity in 300 Women:

Evaluation of the Pathways of Energy Intake
and Physical Activity
Larry A. Tucker1 and Jared M. Tucker2
We assessed the roles of energy intake and physical activity in the relationships among television (TV) viewing, body
composition, and obesity using high-quality measurement methods. Adult women (n=300) reported TV viewing
behavior, which was categorized into infrequent (1h/day), moderate (2h/day), and frequent (3h/day) viewing. Body
fat percentage (BF%) was assessed using plethysmography (Bod Pod) and BMI was calculated from height and
body weight. Energy intake and physical activity, including time spent in sedentary, moderate, and vigorous physical
activity (PA), were objectively measured using 7-day weighed food records and 7-day accelerometry, respectively. The
mean BF% of frequent TV viewers (34.66.9%) was significantly greater (F=3.9, P=0.0218) than those of moderate
(31.56.7%) and infrequent viewers (30.87.0%); however, BMI did not differ across the TV viewing groups (F=0.8,
P=0.4172). Controlling statistically for differences in age, education, time in sedentary activity, time in moderate
activity, and energy intake, considered individually, had no influence on the relationships between TV viewing and
BF%, nor TV and BMI. Moreover, the relationship between TV and BF% remained significant after adjusting for
differences in BMI (F=3.6, P=0.0276). However, adjusting for total PA reduced the relationship between TV and BF%
to nonsignificance (F=2.5, P=0.0810), as did time spent in vigorous PA (F=2.2, P=0.1307). These data suggest a
strong relationship between TV viewing and BF%. This association appears to be due, in part, to differences in total
PA, particularly vigorous PA, but not time spent in sedentary activity, moderate activity, or energy intake.
Obesity (2011) 19, 19501956. doi:10.1038/oby.2011.184

Introduction

Frequent television (TV) watching is viewed as a risk factor for

obesity in children and adults (1). Numerous studies support
this important link. Why abundant TV watching leads to
weight gain, however, is not totally clear. Research focusing on
the pathways leading from TV viewing to obesity is currently
lacking.
In 1985, Dietz and Gortmaker published the first TV and
obesity paper. They showed that for each additional hour
spent watching TV, prevalence of obesity increased by 2%
among a large sample of children (2). A wide variety of
factors were controlled statistically, including prior obesity,
race, socioeconomic status, and a variety of family variables.
However, the study did not take into account differences in
energy intake or physical activity (PA).
In 1989, Tucker and Friedman (3) conducted the first investigation linking TV viewing to obesity in men. They found a
strong doseresponse relationship. Differences in self-reported
exercise habits were controlled statistically, but energy consumption was not. The authors concluded that the TV and

obesity association was independent of differences in PA (3).

Then in 1991, Tucker and Bagwell (4) published the first study
on TV viewing and obesity in women. A significant dose
response relationship was uncovered in this investigation as
well, with self-reported exercise habits significantly attenuating the link between TV viewing and obesity.
Since the first investigations conducted more than two
decades ago, dozens of studies have established and confirmed
the connection between time spent watching TV and obesity
(1). In recent years, scientists are showing greater interest in
the behavioral factors through which TV watching seems to
cause weight gain. To date, most of the studies focusing on the
pathways explaining the TVobesity relationship have been in
children, although in 2006, Foster et al. (5) summarized several
TVobesity investigations in adults that included important
covariates. In addition, a key randomized controlled trial was
conducted recently by Otten et al. in overweight and obese
adults (6).
There are two primary pathways that could explain the link
between TV viewing and obesity. First, frequent TV viewing

1
Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA; 2Department of Health, Nutrition, and Exercise Sciences, North Dakota State
University, Fargo, NorthDakota, USA. Correspondence:Jared M. Tucker (jared.tucker@ndsu.edu)

Received 1 September 2010; accepted 19 May 2011; published online 30 June 2011. doi:10.1038/oby.2011.184
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may lead to obesity through increased energy intake. For example, TV watching may trigger energy intake because hands are
free and little else is happening. Excess intake may also occur
outside of TV watching due to TV advertisements for foods
high in sugar and fat. Second, frequent TV viewing may lead to
obesity through decreased energy expenditure (i.e., increased
sedentary living and/or decreased PA). Frequent TV watching could increase time spent sitting and could also displace
exercise because of the lack of time. Further, reduced energy
expenditure could occur because TV viewing reduces arousal
and energy levels so that adults are less likely to go out and
exercise after a long bout of TV watching. Other potential confounders, such as sleep deprivation due to excess TV viewing,
and the fact that frequent TV viewing may reflect a generally
unhealthy lifestyle, could also explain why frequent TV watchers tend to be more obese than their counterparts.
Although the pathways through which excess TV watching
leading to obesity remain under-studied, especially in adults,
other significant problems handicap research in this area. First,
most research investigating the TVobesity association has
defined obesity using body weight or BMI. Actual measurement
of body fat percentage (BF%) has been rare. In addition,
studies examining the role of energy intake have typically
employed measurement methods, such as food frequency
questionnaires, that produce only rough estimates of energy
intake. Lastly, projects including assessment of PA have often
used self-report questionnaires, which are less accurate than
objective measures. To date, evaluation of the roles of energy
consumption and PA in the TVobesity association using highquality objective measurement methods has been limited.
Although there are many studies verifying the link between
TV viewing and obesity, far fewer have simultaneously and
accurately studied the extent to which energy intake and PA
act as mediators in the TVobesity relationship. Hence, the
purpose of the present study was to ascertain the mediating
roles of energy intake and PA, including sedentary, moderate,
and vigorous PA, in the relationship between TV viewing and
BMI and BF%, using high-quality measurement methods.
A secondary objective was to evaluate the influence of other
potentially confounding factors, namely age and education
level. A third aim was to determine the extent to which
frequent TV viewing influences the prevalence of overweight
and obesity, defined using BMI and BF%.
Methods and Procedures
The current study used a cross-sectional design to assess the relationship
between TV viewing, BMI, and BF%, and potential mediating variables.
Participants included middle-aged women who were recruited through
emails, flyers, and newspaper advertisements. Women who were
pregnant, current smokers, or chronically ill, were excluded from the
study. Of the 312 women who met the inclusion criteria and participated
in the data collection, 300 had complete data and were used in the
analyses. All study procedures were approved by the Universitys IRB.
Eligible participants were instructed regarding study procedures
and signed an informed consent document. A questionnaire was then
administered which assessed demographic characteristics and TV viewing behavior. Upon completion, participants changed into a standard
one-piece swimsuit and BF% was estimated using the Bod Pod. While
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in the swimsuit, height and weight were also assessed. Before leaving,
trained research staff instructed participants regarding how to wear the
accelerometer, and plastic food models were used to teach participants
about weighing and recording their food so they could keep accurate
records for the next 7 days. After the 7 days, participants returned to the
lab to return the accelerometer and the food diary and to be weighed a
second time while wearing the standard swimsuit.
Instruments and measurement methods
Physical activity. PA was objectively assessed using Actigraph 7164
accelerometers, previously named CSA accelerometers (Health One
Technology, Fort Walton Beach, FL). The Actigraph is a uniaxial accelerometer that filters out accelerations outside of the potential range
for human movement, such as riding in a vehicle (7). The Actigraph
is the most widely used accelerometer for field-based research (8) and
has been well-validated, especially in adults (913). As with all lifestylerelated assessments, a limitation of using accelerometers to measure
daily activity is that wearing the monitor can influence behavior, motivating some individuals to increase their activity. However, this extra
motivation is usually short-lived. Hence, participants were asked to
wear the monitors continuously for 7 days, except during water-based
activities (e.g., swimming or bathing). Participants were instructed to
wear the accelerometer on the left hip at the height of the umbilicus
using the adjustable waistband provided.
Nonwear time was defined as a 10min string of consecutive zeros.
Upon return, monitors were downloaded and manually checked for
compliance. Participants were required to wear the monitor for at least
12h per day to be considered a valid wear-day. Those with inadequate
wear time on a given day were asked to rewear the monitor on the same
day(s) of the week as the noncompliant day(s). Subjects with fewer than
12h of wear time for any of the 7 days, who were not willing to rewear
the accelerometer, were excluded from the study (n=6). Mean wear time
from 7 am to 10 pm (a 15h period) across the 7 days was 13.9h (93%
wear-time compliance).
Accelerometer activity counts for each participant were collapsed into
10min intervals. Ten-minute epochs were employed based on recommendations from the American College of Sports Medicine (ACSM) that PA
can be accumulated in 10min bouts (14). Over the course of the 7 days,
each participant had 144 10-min bouts per day, a total of 1,008 bouts, from
which counts were summed to index total PA.
Time spent engaged in sedentary behaviors, such as sitting, reading,
computer use, standing, and similar passive activities, including TV
watching, was also assessed using the accelerometer. Based on pilot data
and previous research, a cut-point of 10,000 activity counts per 10-min
period was used (1517). Similarly, minutes engaged in activities requiring moderate exertion, such as walking or house work, were assessed
using a cut-point of 30,00049,999 counts per 10-min bout (1517), and
a cut-point of 50,000 counts was used to represent vigorous PA, such as
jogging and aerobic dancing (1517).

Body fat percentage. BF% was estimated objectively via air displacement plethysmography using the Bod Pod (Life Measurements Instruments, Concord, CA). The Bod Pod has been shown to provide valid
BF% estimates among female adults when compared to dual-energy
X-ray absorptiometry (18,19). Participants were asked to void and
change into a standard swimsuit and swim cap, after which duplicate
BF% measures were taken. If necessary, additional measures were taken
until two estimates were within one percentage point of each other, after
which the average of these measures was used to indicate BF%. For 75%
of the subjects, only two Bod Pod measurements were taken.
BMI. BMI was computed as weight (kg) height (m)2. Height was measured using a wall-mounted stadiometer to the nearest 0.1cm and weight
was assessed using a calibrated, electronic scale, accurate to within
0.05kg. Because body weight can vary from week to week, it was assessed
twice, once when participants came for their initial visit and again when
they returned 8 days later to return the accelerometer and the 7-day food
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record. During each weight assessment, subjects wore a standard, labissued swimsuit. Two body weights were collected so that the average
could be used, affording a more reliable index of body weight.
Energy intake. Energy intake was assessed using 7-day weighed food
records. This assessment method provides the benefit of capturing
dietary patterns on both weekdays and weekends, which shorter assessments often neglect (20,21). In addition, 7-day records eliminate the
need for participants to recall foods and portion sizes (20).
Participants were strongly encouraged to avoid changing their eating
patterns and to not lose weight during the week of dietary assessment.
Further, subjects were called twice during the week of recording and
encouraged to eat normally, to not under-eat or under-report, and to
wear the accelerometer at all times. In addition, subjects who did not
report consuming at least 130% of their resting metabolic rate (estimated
using the Ravussin metabolism formula) (22) were required to repeat
their diet recording for another 7 days.
Participants were trained using printed instructions and plastic food
models to weigh and record everything they ate. All food and beverages
were weighed in grams using an Ohaus 2000 electronic scale (Florham
Park, NJ), and recorded along with a description of the food. Returned
logs were checked for detail and accuracy and then analyzed by a registered dietician using ESHA Research software (Salem, OR).
Questionnaire. Participants completed a questionnaire that assessed
demographic characteristics as well as TV viewing behavior. The specific question used to index TV watching was How many hours do you
spend watching TV and videos per day or week? This question has
been employed in several other published investigations (3,4,23,24).
Possible responses were: (a) <4h per week, (b) 46h per week, (c) 1h
per day, (d) 2h per day, (e) 3h per day, (f) 4h per day, (g) 56h per day,
(h)7 or more hours per day.
Beyond face validity, concurrent validity has been established for this
TV viewing measure, given its statistically significant associations with
obesity in men (3), obesity in women (4), measured physical fitness in
adults (23), and physical fitness and obesity in adolescents (24). Moreover, in the present investigation, concurrent validity was further established, given TV viewing was strongly related to time spent in sedentary
behaviors (F=3.4, P=0.0338) and was inversely related to vigorous PA
(F=6.4, P=0.0019).
Participants were divided into three categories based on the amount
of time they reported watching TV per day, as used in other studies
(3,4,23,24)-infrequent viewers: 1h or less/day, moderate viewers: 2h/
day, and frequent viewers: 3h or more per day.
Data analysis
All analyses were performed using SAS software (version 9.1,
SAS Institute, Cary, NC). Mean BMI and levels of BF% were each

c ompared across the TV categories using regression analysis and the

GLM (General Linear Model) procedure. To examine the influence
of specific potential confounding factors on the TV viewing and
body composition associations, including age, education, sedentary
time, moderate PA, vigorous PA, and energy intake, considered individually and collectively, partial correlations were calculated using
the GLM procedure. Mean BF% and BMI, adjusted for differences
in the potential confounders, were computed using the least-squares
means procedure. In addition, to determine the relationship between
TV viewing, treated as a categorical variable (frequent, moderate,
infrequent), and obesity, also treated as a categorical variable (Obese:
35% body fat; not obese: <35% body fat), 2 was employed. The traditional cut-point of 25kg/m2 was used to index overweight/obesity
when BMI was used as the outcome variable. To estimate the probability that frequent TV viewers were more likely to be obese (using
BF%) or overweight/obese (using BMI) than moderate or infrequent
viewers, with and without potential confounders, odds ratios were
generated using logistic regression.
Results

A total of 300 women participated in the present study. Subjects

were middle-aged (40.2 3.0 years), primarily white, nonHispanic (~ 90%), employed part-time or full-time (~60%),
married (~80%), with at least some college education (~50%).
Means, standard deviations, minimum and maximum scores,
and quartile values are shown in Table1.
BF% and BMI were strongly correlated (r=0.72, P < 0.0001),
as were total activity counts and time engaged in vigorous
PA (r=0.62, P < 0.0001). Total PA and sedentary time were
inversely related (r=0.21, P=0.0002), as were vigorous PA
and sedentary time (r=0.16, P=0.0045).
As shown in Table2, with no variables controlled statistically, mean BF% differed significantly across the three TV
viewing categories (F=3.9, P=0.0218). Specifically, frequent
viewers (34.66.9%) had significantly higher BF% than moderate (31.5 6.7%) and infrequent viewers (30.8 7.0%).
Statistically controlling for differences in age, education, BMI,
energy intake, sedentary pursuits, and moderate PA, considered individually, had no mediating influence on the relationship between TV viewing and BF% (Table2). However,
after adjusting individually for differences in total PA (F=2.5,
P=0.0810) or vigorous PA (F=2.2, P=0.1363), BF% no longer
differed significantly across the TV groups.

Table 1Description information for all participants (n=300)

Variables

Mean

s.d.

Min

25th Percentile

50th Percentile

75th Percentile

Max

Age (years)

40.2

3.0

34

38

40

43

46

Weight (kg)

65.6

9.9

42.1

58.4

64.5

71.7

95.5

BMI

23.7

3.3

15.8

21.1

23.5

25.8

32.1

Body fat (%)

31.4

6.9

14.6

26.5

31.8

36.7

44.8

Energy intake (kcal/day)

2,055

317

1,448

1,826

2,010

2,237

3,495

Total PA (counts/week)a

2,753

837

828

2,123

2,707

3,210

6,642

Vigorous PA (min/week)

34.7

65.6

40

420

Moderate PA (min/week)

48.5

58.1

30

70

330

Sedentary time (min/week)

7,547

825

4,390

7,265

7,720

8,135

8,820

Average activity counts for 1 week measured objectively using accelerometers, divided by 1,000.
Min, minimum or lowest score for each variable; Max, maximum score for each variable.
a

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Table 2Differences in body fat percentage and BMI across television viewing categories before and after controlling for potential
confounders
Television viewing category
Infrequent viewing
Key variable
Variable Controlled

Moderate viewing

(n=183)

Frequent viewing

(n=89)

(n=28)

Mean

s.d.

Mean

s.d.

Mean

s.d.

30.8a

31.5a

6.7

34.6b

6.9

3.9

0.0218

(23.5)

3.3

(23.8)

3.3

(24.3)

3.0

Body fat percentage

(BMI)
None
Age
Education
BMI or BF%
Energy intake

0.8

0.4172

30.8a

31.5a

34.6b

3.8

0.0241

(23.5)

(23.8)

(24.3)

0.8

0.4411

30.5a

31.3a

34.5b

4.0

0.0193

(23.7)

(24.1)

(24.4)

0.7

0.4985

31.0a

31.3a

33.0b

3.6

0.0279

(23.7)

(23.8)

(23.2)

30.7

31.6

34.5

(23.5)
Total physical activity
Vigorous PA
Moderate PA
Sedentary time
All covariates*

(23.9)

0.6

0.5275

3.8

0.0226

(24.2)

1.1

0.3428

31.0

31.3

34.0

2.5

0.0810

(23.5)

(23.8)

(24.3)

0.7

0.5151

31.1

31.1

33.7

2.2

0.1363

(23.6)

(23.7)

24.1

0.3

0.7255

30.7

31.5

34.7

4.0

0.0200

(23.5)

(23.8)

(24.3)

0.9

0.4205

30.8a

31.5a

34.5b

3.5

0.0312

(23.5)

(23.8)

(24.3)

0.7

0.4821

30.7a

30.5a

32.9b

3.3

0.0393

(24.0)

(24.2)

(23.4)

1.7

0.1861

Means on the same row as a potential confounding variable are statistically adjusted for that variable. For each row, means on the top reflect body fat percentages and
means on the bottom in parentheses reflect BMI.
Means on the same row with different superscripts are significantly different (P < 0.05).
Infrequent viewing included women who watched less than 1h of TV per day. Moderate viewing included those who watched 12h per day, and frequent viewing
included those who watched 3h or more per day of television.
Total PA, total physical activity counts accumulated over the 7 consecutive days of monitoring. For the relationship between TV viewing and body fat percentage, BMI
was controlled, and for the association between TV watching and BMI, body fat percentage (BF%) was controlled.
*When controlling for All Covariates, total PA was controlled, but not the other PA variables. Replacing total PA with all of the other PA variables and sedentary time,
along with the other covariates, resulted in F=3.5, P=0.0330 for body fat percentage and F=1.9, P=0.1456 for BMI.

Unlike BF%, BMI did not differ significantly across the TV

viewing groups, without (F=0.8, P=0.4172) and with control of the potential confounders, considered individually and
together (F=1.7, P=0.1861), as displayed in Table2.
Table3 shows the relationships between each of the potential confounding variables and TV viewing. Specifically, age,
energy intake, time in moderate PA, and education, were
not related to TV viewing status. However, total PA counts
(F=3.6, P=0.0278), time spent in sedentary behavior (F=3.4,
P=0.0338), and time in vigorous PA (F=6.4, P=0.0019), differed significantly across the three TV categories.
Overall, 103 of the participants (34%) had body fat levels of
35% or higher and were labeled, obese. Across the three TV
viewing groups, 30.6% of infrequent viewers were obese (BF%
35%), whereas 33.7% of moderate viewers were obese, and
60.7% of frequent viewers were obese (2=9.8, P=0.0075).
obesity | VOLUME 19 NUMBER 10 | OCTOBER 2011

Compared to frequent TV watchers, moderate viewers had

0.33 times the odds of being obese (P=0.0114), and infrequent viewers had 0.29 times the likelihood of being obese
(P=0.0019), as shown in Figure1. With moderate and infrequent viewers combined, the odds of being obese were 0.30
times that of frequent watchers (P=0.0020).
In total, 99 women (33%) had BMI levels of 25 or higher
and were labeled, overweight/obese. Using BMI instead of
BF%, the prevalence of overweight/obesity (BMI 25.0kg/
m2) did not differ across the three TV viewing groups.
Specifically, 30.1% of Infrequent viewers had elevated BMI
levels, whereas 34.8% of moderate viewers and 46.4% of
Frequent viewers had BMI levels 25.0 (2=3.1, P=0.2084).
None of the odds ratios comparing the BMI levels of infrequent, moderate, and frequent TV viewers were statistically
significant.
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Table 3Differences in the potential confounding variables across the television viewing categories
Television viewing category
Infrequent viewing

Moderate viewing

(n=183)
Variable

Mean

Frequent viewing

(n=89)
s.d.

Mean

(n=28)
s.d.

Mean

s.d.

Age (years)

40.1

3.0

40.4

3.0

40.3

2.7

0.3

0.7267

Energy intake (kcal/day)

2,068

331

2,014

260

2,095

378

1.1

0.3244

Total PA (counts/week)

2,850

915

2,640

684

2,477

638

3.6

0.0278

Vigorous PA (min/week)

45.0

76.6

21.6

41.7

0.9

21.7

6.4

0.0019

Moderate PA (min/week)

48.2

55.9

45.7

55.9

58.6

78.0

0.5

0.5942

844

7,574

853

7,909

443

3.4

0.0338

Sedentary time (min/week)

7,478

a,b

Means on the same row with different superscripts are significantly different (P < 0.05).
For the television viewing categories, infrequent viewing included women who watched 1h of TV per day. Moderate viewing included those who watched ~2h per day,
and frequent viewing included those who watched 3h or more per day of television.
2 analysis showed that education, a categorical variable, was not related to TV viewing status (2=9.1, P=0.1683).
Vigorous PA, minutes spent in vigorous physical activity, expressed in minutes per week.
1.2
1.0 1.0

Odds ratio

0.8
0.62

0.6
0.4

0.50

* 0.29

BF% (>35%)
BMI (>25)

*0.33

0.2
0
Infrequent
viewers
1 h/day

Moderate
viewers
2 h/day

Frequent
viewers
3 h/day

Figure 1 Odds of being obese according to body fat percentage and

overweight/obese according to BMI across levels of television viewing.
*Indicates a statistically significant odds ratio (P < 0.05). BF%, body fat
percentage.

Discussion

Results of the present investigation indicate that frequent

TV viewers tend to have significantly higher levels of body
fat and obesity than women who watch TV moderately or
infrequently. Adjusting for differences in age, education, time
engaged in sedentary behaviors, time in moderate activity, and
energy intake seems to have minimal effect on the association.
However, when adjustments are made for differences in total
PA, or time spent in vigorous PA, the TV and BF% relationship is nullified. In short, it appears that women who watch TV
frequently do not have more body fat because of differences
in age, education, sedentary behavior, moderate PA, or energy
intake than women who watch less TV. Rather, this difference
in body fat appears to be due, in part, to lower levels of total
PA, and particularly less vigorous PA.
Using time engaged in sedentary behaviors as a guide, frequent viewers participated in sedentary activities about 5 h
more per week than moderate watchers, and 7h more per week
than infrequent viewers (Table3). Further, infrequent viewers
spent about 24 more minutes per week engaged in vigorous PA
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compared to moderate viewers, and about 44 more minutes

per week than frequent watchers (Table3). Differences in sedentary activity did not influence the association between TV
viewing and BF%, however.
Although BF% differed significantly across the TV viewing
groups, BMI levels did not differ significantly across the TV
categories. Furthermore, differences in BF% across the TV
groups remained significant, even after adjusting for differences
in BMI, suggesting that women who watch TV frequently have
more adipose tissue, given the same body weight and height,
(i.e., BMI) than women who watch less TV. Evidently, BF% is
a more sensitive body composition measurement than BMI,
especially when comparing women who engage in different
amounts of TV watching.
In 2006, Foster et al. published a literature review regarding
TV watching and obesity in adults (5). A total of 13 studies
cited by Foster included some measurement of exercise or PA,
although none assessed movement objectively and few examined the TV and obesity association after adjusting for differences in PA (3,4,2536).
In adults, the influence of PA on the relationship between TV
viewing and obesity has typically been nonsignificant. Using a
sample of Australian adults, Cleland et al. (37) concluded that
women watching >3h of TV per day have more abdominal obesity compared to women viewing <1h per day. However, adjusting
for differences in leisure time PA had little effect on the results.
Similarly, in another adult study, Salmon et al. (30) noted that
the relationship between TV time and BMI was independent of
PA levels. In addition, using data from the Nurses Health Study,
Hu et al. (35) determined that the association between TV and
obesity was independent of exercise levels. Lastly, using data
from the National Weight Registry, Raynor etal. (38) reported
that adults who have lost substantial amounts of body weight
tend to watch significantly less TV than typical adults. However,
they concluded that the association between TV viewing and
weight gain was independent of PA levels.
It is unclear why several investigations using adult participants have concluded that differences in PA have little effect
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on the relationship between TV watching and obesity, while
the present study showed the opposite result. It is likely that
the methods employed to measure PA across studies played
a role. In each of the investigations noted above, activity was
assessed using a questionnaire. Self-reported information,
especially about PA habits, often reflects wishful thinking and
good intentions as well as levels of physical exertion (39,40). In
the present investigation, PA was evaluated using 7-day accelerometry. Because accelerometers measure PA objectively and
with greater accuracy and reliability than self-reported measures (41), differences in findings could be explained by this
factor alone.
In addition to differences in PA measurement methods,
virtually all TV and obesity studies to date have focused on
body weight or BMI to index obesity rather than actual BF%.
Although body weight and BMI are related significantly to adiposity, differences are real and meaningful. These differences
could also explain the inconsistent findings among studies
regarding TV viewing, obesity, and PA.
In a recent randomized controlled trial of TV viewing in
adults, Otten et al. (6) found a meaningful connection between
changes in TV viewing and changes in energy expenditure, as
is consistent with the findings of the present study. Specifically,
subjects in the treatment group were required to reduce TV
watching time by 50%. Results showed that energy expenditure
increased as a result of decreased TV watching, confirming the
inverse relationship between TV watching and PA, and the
potential mediating role of PA in the TVadiposity association
in adults revealed in the present study.
The extent to which differences in energy consumption
influence the relationship between TV viewing and obesity
has been studied sparingly. However, Epstein (42) recently
conducted a randomized controlled trial over 2 years using
70 children. The treatment group was required to reduce
TV viewing and computer use by 50%. Results showed that
zBMI was decreased more in the treatment group compared
to controls. Moreover, changes in zBMI were more related to
changes in energy intake than to changes in PA (42), unlike in
the current investigation. Furthermore, in a series of studies of
children directed by Epstein and published by Temple et al.,
results showed that watching TV may disrupt habituation to
food cues, thereby increasing motivation to eat and to consume
energy (43), unlike in the current study of adult women, where
frequent TV viewing was not associated with increased energy
intake, nor did kcal consumption modify the TVobesity
relationship.
The two principal pathways by which TV watching may
influence overweight and obesity are PA and diet. To reduce
measurement error in this investigation, accelerometry and
7-day weighed diet records were used. A common concern
about 7-day weighed food records stems from the increased
risk that subjects will eat less and/or under-report their food
intake. In the present study, it appears that the multiple precautions employed to minimize under-reporting and undereating, discussed in the Methods and Procedures section, were
successful. Mean energy intake for the sample was 2055317
obesity | VOLUME 19 NUMBER 10 | OCTOBER 2011

kcal per day, which is substantially higher than the average

energy intake for women 4059 years old (mean=1,828 kcal
per day; median=1,695 kcal per day) reported for a national
sample of adult women in NHANES (44).
In addition, average resting metabolic rate for the present
sample was 1,364105 kcal, estimated using Ravussins formula, based on fat free mass (22). Using a PAL (PA level) of
1.5 and a resting metabolic rate of 1,364 kcal, total daily energy
expenditure for this sample was estimated to be 2,046 kcal per
day (1,364 1.5=2,046), a difference of less than 10 kcal from
the actual energy intake derived from the 7-day food records
(2,055317 kcal). A PAL of 1.5 represents a Low Active lifestyle according to the Institute of Medicine (45). Low Active
is the PAL category between Sedentary and Active.
The present study was not without limitations. First, the design
of the study was cross-sectional. As a result, temporality was
an issue and cause-and-effect conclusions are not warranted.
Second, subjects were all middle-aged, nonsmokers, female, and
most were white, non-Hispanic. Hence, the findings cannot be
generalized beyond populations with similar characteristics.
In conclusion, according to the findings of the present study,
frequent TV viewing is closely associated with increased levels
of body fat and obesity in middle-aged women, but not with
BMI. The relationship between TV watching and BF% does
not appear to be a function of differences in energy intake,
nor time involved in sedentary or moderate intensity activity.
However, when differences in objectively measured total PA
are controlled statistically, or adjustments are made for differences in vigorous PA, the positive association between TV and
obesity is eliminated. Hence, the relationship between frequent
TV viewing and obesity in women seems to be partly a function of differences in PA, not dietary intake.
Acknowledgments
The authors wish to thank Travis Peterson, Bruce Bailey, James LeCheminant,
and Lance Davidson for their help supervising the data collection and the
participants, who willingly gave significant time and effort to make this
research possible. This study was funded through an internal University
grant.

Disclosure
The authors declared no conflict of interest.
2011 The Obesity Society

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