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Background and Methods: The prevalence of obesity among children and adolescents has increased, and television viewing has been suggested as a cause. We examined the relation between hours of television viewed and the prevalence of overweight in 1990, and the incidence and remission of overweight from 1986 to 1990 in a nationally representative cohort of 746 youths aged 10 to 15 years in 1990 whose mothers were 25 to 32 years old. Overweight was defined as a body mass index higher than the 85th percentile for age and gender., Results: We observed a strong dose-response relationship between the prevalence of overweight in 1990 and hours of television viewed. The odds of being overweight were 4.6 (95% confidence interval, 2.2 to 9.6) times greater for youth watching more than 5 hours of television per day compared with those watching 0 to 2 hours. When adjustments were made for previous overweight (in 1986), baseline maternal overweight, socioeconomic status, household structure, ethnicity, and maternal and child aptitude test scores, results were similar (odds ratio, 5.3; 95% confidence interval, 2.3 to 12.1). We also found significant relations between television viewing and increased incidence and decreased remission of overweight during this 4-year period, adjusted for baseline covariates. The adjusted odds of incidence were 8.3 (95% confidence interval, 2.6 to 26.5) times greater for youth watching more than 5 hours of television per day compared with those watching for 0 to 2 hours. Estimates of attributable risk indicate that more than 60% of overweight incidence in this population can be linked to excess television viewing time., Conclusion: Television viewing affects overweight among youth, and reductions in viewing time could help prevent this increasingly common chronic health condition.

As we have indicated, children's television has either a documented or probable effect on a variety of health-related behaviors in children and adolescents in the United States. Studies of cognitive development indicate that television provides a stimulus for learning and that children learn from television. The adverse effects of television appear related to both the time spent watching television and the content of the programs that are viewed. The reviewed observations suggest that a variety of initiatives are warranted to alter the time children spend watching television, the content of programs, and the types of programs for children and adolescents that are produced and broadcast. These initiatives require the development of effective techniques and materials for counseling parents, as well as continued political and legislative activities at the local and national level. We must promote the conviction that time spent in activities other than television viewing will provide our children with the values necessary to understand and interact with an increasingly complex world. Effective governmental action on behalf of children to change television will require a reaffirmation and enforcement of the Public Interest Standard. For half a century, the broadcast media have been licensed to use the airwaves in the public interest. The diversity and magnitude of the adverse effects of television on the health of children strongly suggest that the use of television has not been in the public interest. Although cable television offers multiple alternatives, less than 60% of American households receive cable. Broadcast television still represents the only alternative for 40% of American children. Substantial regulatory change by the current administration is unlikely. Therefore, legislative activity to mandate broadcast practices responsive to the needs of children appears the most appropriate national approach.

The association of television viewing and obesity in data collected during cycles II and III of the National Health Examination Survey was examined. Cycle II examined 6,965 children aged 6 to 11 years and cycle III examined 6,671 children aged 12 to 17 years. Included in the cycle III sample were 2,153 subjects previously studied during cycle II. These surveys, therefore, provided two cross-sectional samples and one prospective sample. In all three samples, significant associations of the time spent watching television and the prevalence of obesity were observed. In 12- to 17-year-old adolescents, the prevalence of obesity increased by 2% for each additional hour of television viewed. The associations persisted when controlled for prior obesity, region, season, population density, race, socioeconomic class, and a variety of other family variables. The consistency, temporal sequence, strength, and specificity of the associations suggest that television viewing may cause obesity in at least some children and adolescents. The potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis.