Pediatric Weight Management

PWM: Physical Activity and Inactivity of Youth (2006)


Lowry, R., Wechsler, H., Galuska, A., Fulton, J.E., & Kann, L. Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students:  differences by race, ethnicity, and gender.  J Sch Health 2002;72(10):413-421.

PubMed ID: 12617028
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

The purpose of this study is to extend the current literature by analyzing a nationally representative sample of US high school students to describe race, ethnic, and gender-specific differences in associations between tv viewing and being overweight, being sedentary, and eating insufficient fruits and vegetables.

Inclusion Criteria:
Three stage cluster sample design for high school students in grades 9-12. All students in selected classes were eligible to participate in the survey.
Exclusion Criteria:
Not Stated
Description of Study Protocol:

Self reported height and weight were used to calculate BMI. Three stage cluster sample design was used.  The questionnaire contained 92 items and was administered in the classroom by trained data collectors.

Statistical Analysis

Separate logistic regression models tested individual associations between tv viewing as an independent variable and the dependent variables of overweight and sedentary lifestyle controlling for demographic characteristics.

Data Collection Summary:

Dependent Variables

  • overweight, sedentary lifestyle

Independent Variables

  • tv viewing

Control Variables

  • maturation
Description of Actual Data Sample:

Initial N: The sample came from the 1999 national Youth Risk Behavior Survey (YRBS). The sample included a representative sample of 15,349 US high school students.

Attrition (final N): 15,349 US high school students.

Age: high school students


Other relevant demographics: The sample came from the 1999 national Youth Risk Behavior Survey (YRBS). 

Anthropometrics (e.g., were groups same or different on important measures)

Location: USA

Summary of Results:

TV viewing on an average school day exceeded 2 hours/day among 43% of the students; it was greater among Black (74%) and Hispanics (52%) than White (34%) students.

Overall, 11% of students were overweight, 31% of students were sedentary (ie, did not participate in moderate or vigorous physical activity at recommended levels). 

Watching television more than 2 hours/day was associated with being overweight, being sedentary, and eating insufficient fruits and vegetables among White females, and with being overweight among Hispanic females.  No significant associations were found among Black females. 

TV viewing was associated with being overweight and eating insufficient fruits and vegetables among White males.  No significant associations were found among Hispanic males.  Among Black males, tv viewing was associated with greater participation in physical activity.

Author Conclusion:

On of ten (10.8%) high school students were overweight, and associations between tv viewing and overweight were consistent whether tv viewing was modeled as an independent variable or the dependent variable. In addition, associations between tv viewing and overweight were independent of participation in moderate or vigorous physical activity and fruit and vegetable consumption. This finding may suggest tv viewing exerts its predominant influence on overweight through effects on physical activity of less than moderate to vigorous intensity.

Funding Source:
Other: no reported funding
Reviewer Comments:

These findings suggest the presence of cultural factors to consider when developing interventions to promote physical activity, healthy eating, and healthy weight through reduced tv viewing among adolescents.


Because this was part of a broad-based surveillance system, only a limited number of self-reported questionnaire items were available to measure the variable analyzed. Height and weight were self-reported.


Large nationally representative sample.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? N/A
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? Yes
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? No
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? N/A
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? N/A
  10.1. Were sources of funding and investigators' affiliations described? N/A
  10.2. Was the study free from apparent conflict of interest? N/A