INTRODUCTION
Television viewing has been associated with childhood obe-
sity in several epidemiologic studies (1). In a clinical trial, thirdand fourth-grade children who received intervention to reduce television viewing had lower body mass index (BMI; in kg/m2) values, tricep skinfold thicknesses, waist circumferences, and waist-to-hip ratios than did control subjects (2). Children who received the television-reduction intervention reduced the number of meals consumed during television viewing, and a trend toward lower intakes of high-fat foods was observed. Two of the hypothesized mechanisms through which television viewing is thought to promote childhood obesity are increased dietary intake from eating during viewing and eating highly advertised foods (1). Several studies provided ecologic evidence in support of these mechanisms. First, increased television viewing has been associated with increased energy intake (3–5). Adolescents whoreportedwatchingmoretelevisionalsoreportedeatingmore high-fat foods (6) and fast food, drinking more soft drinks, and consuming fewer fruits and vegetables (4). Likewise, in households in which the television is on during meals, children consume more red meat, pizza, snack foods, and soda and fewer fruits and vegetables (7). Second, several content analyses of children’s television programs showed that foods, especially high-fat or high-sugar foods, are frequently advertised on children’s television programs (8–11). Furthermore, an experiment conducted with preschool children showed that only a brief exposure to food advertisements embedded within children’s programming resulted in the children choosing the advertised brand of food over a similar unadvertised product (12). Prior studies of the effects of food advertising on older children’s food choices showed similar effects (13, 14).
Most previous epidemiologic research investigating the relation between television viewing and dietary intake has relied on separate reports of daily television viewing practices and dietary intake.Dataonwhatchildrenactuallyeatduringtelevisionviewing are lacking. Therefore, during 24-h dietary recalls, we collected data on the activities that children participated in while they ate each meal or snack. We used these data to describe the amount and types of foods consumed during television viewing, to examine the association between these types of foods and children’s BMI, and to compare the types of foods that children consumedwhenthetelevisionwasonwiththetypesoffoodsthat they consumed when the television was off.