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Adolescent health briefThe Effect of Television Viewing on Adolescents Snacking: Individual

Differences Explained by External, Restrained and Emotional Eating

Harritte M. Snoek, M.Sc.a,*, Tatjana van Strien, Ph.D.b, Jan M.A.M. Janssens, Ph.D.a, andRutger C.M.E. Engels, Ph.D.a

aBehavioural Science Institute, Radboud University Nijmegen, Nijmegen, NetherlandsbDepartment of Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands

Manuscript received April 21, 2005; manuscript accepted December 16, 2005

Abstract: In a nationwide sample of 10,087 Dutch adolescents aged 1116 years (M 13.0, SD .8), onaverage, 25% of the respondents watched more than three hours of television per day. Lowest levels

of television viewing (TVV) were found in Dutch adolescents as compared to other ethnic groups,

and in higher compared to lower educational levels. Snacking was negatively associated with

physical activity and positively associated with TVV. For both boys and girls, the positive

association between TVV and snacking was stronger in adolescents who scored high on external and

(only for boys) emotional eating, whereas restrained eating attenuated this association. 2006

Society for Adolescent Medicine. All rights reserved.

Keywords: Television; Adolescent; Overeating; Snacking; External eating; Restrained eating; Emotional eating

Ample research examined the association between chil-

drens television viewing (TVV) and weight. Cross-sec-tional studies, a few intervention studies, and recent longi-

tudinal studies [1] have shown a positive relationship

between hours of TVV and weight (increase) during child-

hood and adolescence [2]. Two primary mechanisms by

which TVV contributes to obesity have been suggested:

reduced physical activity and increased energy intake[3].

Inverse associations between TVV and physical activity

have been found[4],albeit in some studies this association

was weak or nonsignificant[2].There is also evidence that

at least part of the relationship between TVV and over-

weight is due to food intake. TVV is associated with higher

intake of energy and fat, and is assumed to promote snack-ing[5]and consumption of nutritionally poorer diets.

Two major hypotheses about the mechanism by which

TVV exactly promotes food intake are often mentioned.

First, TV is believed to provide food cues (e.g., food ad-

vertisements) that may alter the viewers food preferences

and intake. Second, weight-related messages on TV likethin idealizations and stigmatization of overweight people

as well as showing incorrect, contradictory messages of slim

actors who eat unhealthily without gaining any weight could

cause negative emotions and overeating in persons who are

preoccupied with weight. Such theories, however, assume

that people react similarly to food cues and to negative

emotions, and do not allow for individual differences in

eating behavior. The objective of the present study is to

provide a framework for explaining individual differences

in the magnitude of the association between TVV and food

intake. We discuss three major psychological theories on the

relationship between eating behavior and overweightex-ternal, restrained, and emotional eatingand subsequently

test their moderating effects on the association between

TVV and snacking.

The first theory, focusing on external eating, states that

certain people are more sensible to external food cues than

others, and that they eat in response to those stimuli, re-

gardless of their internal state of hunger and satiety [6].

TVV can provide food cues in the form of food advertise-

ments. The association between advertisement and food

*Address correspondence to: Ms. Harritte Snoek, Institute of Family

and Child Care Studies, Radboud University Nijmegen, P.O. Box 9104,

6700 HE Nijmegen, Netherlands.

E-mail address: h.snoek@bsi.ru.nl

Journal of Adolescent Health 39 (2006) 448451

1054-139X/06/$ see front matter 2006 Society for Adolescent Medicine. All rights reserved.

doi:10.1016/j.jadohealth.2005.12.020

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positively associated with snacking (r .25 for boys, and r

.21 for girls, p .001).

Adolescents who scored high on external eatingate more

snacks than those who scored low on external eating

(t(4810) 15.95 for boys, and t(5042) 19.54 for

girls,p .001). Adolescents who scored high onrestrained

eating ate fewer snacks than those who scored low onrestraint eating (t(4799) 9.94 for boys, and t(5039)

9.58 for girls, p .001). Adolescents who scored high on

emotional eating ate more snacks than those who scored

low on emotional eating (t(4798) 7.16 for boys, and

t(5035) 11.59 for girls, p .001) (Table 2).

Significant main effects on snacking were found for the

three eating behaviors, as well as significant TVV eating

behavior interactions on snacking for TVV external eat-

ing (p .01 for boys and p .01 for girls), TVV

restrained eating (p .03 for boys and .02 for girls), and

TVV emotional eating (p .01 for boys).

Discussion

This study provides tentative evidence that external, re-strained and emotional eating might play a role in the

association between TVV and snacking, confirming our

hypothesis that high external and emotional eaters had

stronger associations between TVV and snacking. Interest-

ingly, the interaction between TVV, emotional eating and

snacking was only significant for boys; these sex differences

need further investigation. Possibly, in certain people both

heavy TVV and emotional eating might be the conse-

Table 1

Television viewing per group of subjects

% n Television viewing (%) Statistics

1 hour 13 hours 3 hours

Gender

Boys 49 4712 22 54 24 2

(2, n

9658)

1.16,Girls 51 4946 22 53 25 p .56

Age (years)

1112 29 2760 26 55 19 2 (6, n 9652) 131.82,

13 47 4506 21 55 24 p .001

14 22 2092 18 51 31

15 3 294 19 43 38

Educational levela

Lower level education 54 5224 20 48 32 2 (2, n 9600) 347.81,

Higher level education 46 4376 24 60 16 p .001

Ethnicityb

Dutch 81 7710 23 55 22 2 (8, n 9493) 123.89,

Surinam/Antillean 4 372 12 46 42 p .001

Moroccan 1 107 17 48 35

Turkish 3 326 15 49 36

Other 10 978 20 51 29

a Lower-level education (LWOO, VMBO; preparatory college for vocational training) and higher level education (HAVO, VWO; preparatory school for

college or university).b Ethnicity was determined by the native country of the parents.

Table 2

Average number of snacks per day per group of subjects sorted by score on eating behavior and hours TV watched per day (mean [ SD])

Score on eating behavior Boys television viewing* Girls television viewing*

3 hours n 3516 3 hours n 1116 3 hours n 3675 3 hours n 1223

External eating*

Below median 1.98 (1.10) 2.42 (1.35) 1.75 (0.93) 2.09 (1.18)

Above median 2.47 (1.30) 3.16 (1.47) 2.29 (1.16) 2.81 (1.33)

Restraint eating*

Below median 2.36 (1.27) 3.06 (1.50) 2.12 (1.13) 2.71 (1.36)

Above median 2.03 (1.14) 2.55 (1.37) 1.83 (0.98) 2.24 (1.22)

Emotional eating*

Below median 2.09 (1.18) 2.58 (1.44) 1.83 (0.98) 2.23 (1.26)

Above median 2.31 (1.25) 3.03 (1.46) 2.16 (1.13) 2.68 (1.32)

Total 2.20 (1.22) 2.83 (1.47) 1.99 (1.08) 2.47 (1.31)

* Groups differ significantly in snack consumption (p .001) (one-way Anova).

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quences of inadequacy in dealing with negative emotions

[16], a mechanism that might differ between men and

women. Opposite to our prediction, restrained eating atten-

uated the association between TVV and snacking. Perhaps

TVV and accompanying thin idealizing messages do not

always lead to negative emotions and disinhibition, but have

also shown inspiring effects in restrained eaters[12].Suchmechanisms should preferably be studied in real-life set-

tings and over longer time periods.

Snacking was measured with a questionnaire instead of

dietary food intake measurements, and therefore does not

allow for conclusions about nutrient intake. We also cannot

rule out the possible effect of socially desirable answers on

dieting and snacking. A strength of this study is that it

covers a large sample and substantial proportions of ethnic

minorities and lower education-level groups. Although the

data are cross-sectional and no causal inferences from the

results can be drawn, they indicate that studying eating

behavior in other designs, where snacking during TVV ismeasured, can provide more insight into the mechanisms

that underlie the association between TVV and food intake

in adolescents.

Acknowledgment

Rutger Engels was supported by a fellowship of the

Dutch Organization of Scientific Research during the prep-

aration of this manuscript. We thank Roy Otten and

Monique van de Ven for their work during the preparation

of this study and during the data collection, and Hedwig

Lahnstein for text revisions.

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