Effects of screen time behaviors on food and beverage intake

1. Effects of screen time behaviors on food and beverage intake Elizabeth J. Lyons, PhD, MPH June 13, 2014 Institute for Translational Sciences

2. Presentation overview Background • Theories of distraction • Media and distraction • Distraction and energy expenditure Paper 1: Secondary data analysis Paper 2: Review Thoughts for discussion Institute for Translational Sciences

3. Why might TV  eating? • Priming • Associative learning • Distraction from satiety cues & dietary restraint • Greater cognitive load overwhelms self-regulatory capacity Institute for Translational Sciences

4. Theories of distraction • Interdisciplinary, messy definitions • Presence/immersion/engagement/transportation… • Used synonymously • Sometimes have specific definitions • Example: immersion refers to the capacity of the hardware to produce presence • …except when it doesn’t Institute for Translational Sciences

5. Engagement According to the Temple group, a more surface level of mental immersion • According to others, a broader category that includes flow and presence A measure of attentional allocation Occurs when perception is directed towards a technologically mediated world, away from the physical world Institute for Translational Sciences

6. Presence • Sense of “being there” • Perceptual illusion of non-mediation • Sometimes specified as spatial presence Institute for Translational Sciences

7. Transportation • Specific to narratives • Absorption in a storyline • Attentional allocation + imagery and feelings associated with a story • Requires active participation to imagine story • Likely to produce a greater cognitive load Institute for Translational Sciences

8. Specific to narratives • Absorption in a storyline • Attentional allocation + imagery and feelings associated with a story • Requires active participation to imagine story • Likely to produce a greater cognitive load Institute for Translational Sciences

9. Institute for Translational Sciences

10. Transportation Institute for Translational Sciences

11. Distraction and media: predictors • Better graphics • Better sound • First-person point of view • Better, more immersive equipment (larger, more pixels, etc.) • Haptic feedback • Character identification Institute for Translational Sciences

12. Distraction and energy expenditure • Distract from emotions of pain & fatigue • Distract from unpleasant physiological sensations • Appears to be more useful for MVPA than PA than approaches/exceeds the ventilatory threshold • It’s pretty hard to ignore bodily cues at that point! Institute for Translational Sciences

13. Distraction and energy intake • We’ll get to this in paper 2… Institute for Translational Sciences

14. Paper 1: The PRESENCE 2 study • Addressed both sides of energy balance • 120 participants (60 female) randomized to • TV watching • Traditional video gaming • Motion-controlled video gaming • 1 hour with access to snacks, beverages • Choice of content in each group • Fasted 2 hours

15. Snacks and beverages • Snacks • Doritos • M & Ms • Trail mix • Baked Lays • Beverages • Coke • Mountain Dew • Diet Coke • Water

16. Measures • SenseWear Pro Armband • Accelerometry • Galvanic skin response • Estimates MET values • Tanita food scale • Measures to nearest gram • Weighed containers before and after study period

17. TV group • Netflix instant streaming • 100s of TV shows available • No commercials • Most popular shows • 30 Rock (5) • The Office (5) • Weeds (3) • Dexter (3) Institute for Translational Sciences

18. Video game groups • Traditional • 10 games • Playstation 3 • Rated at least 75 on Metacritic • No more than 2 per genre • Motion-controlled • 10 games • Wii and Xbox 360 • Included motions • Throwing • Punching • Hitting Institute for Translational Sciences

19. Participant characteristics 62% White, 17% Black, 14% Asian, 7% Other, 8% Hispanic 63% normal weight, 26% overweight, 11% obese

20. Energy expenditure a b P < .001; Trend toward difference between VG and TV, P = .069; Gender effect P < .001

21. PRESENCE 2 energy intake Institute for Translational Sciences P = .065; likelihood of eating 500 kcals or more TV vs. motion, OR = 3.2 (1.2 – 8.4)

22. But why? • Tested presence, engagement, and narrative transportation • Only narrative transportation mediated the effect of TV on energy intake • Other potential predictors/moderators? • Gender? • Type of show/game? Institute for Translational Sciences

23. Gender differences: TV genres

24. Gender differences: VG genres

25. Gender differences: Motion VG genres

26. Take-home messages Screen-based behaviors affect eating • TV and sedentary video gaming worse than motion-controlled gaming What you watch/play impacts how much you eat Greater distraction/cognitive load is likely worse for you • But more fun!  Institute for Translational Sciences

27. Paper 2: a review of eating studies Possible reasons for screen effects on energy intake: • Distraction/attentional allocation • Interruption of physiologic food regulation • Screen-based activities as conditioned cues to eat • Memory • Stress-induced reward system Institute for Translational Sciences

28. Distraction Distract from • Restriction (self-regulation, self-control) • Satiety signals • As you eat, your body attempts habituation to food stimuli •  ending the meal, eventually • Slows rate of habituation to satiety cues • Keep eating Continuous TV > 1.5 minute TV clips • Meaningful vs. meaningless distraction Institute for Translational Sciences

29. Physiologic food regulation Interrupt not just mental processes related to intake regulation • Decrease ability of a glucose preload to decrease intake • Overrides physiological signals …Basically the same thing as the last one Institute for Translational Sciences

30. Conditioned cues • TV always paired with food  TV is associated with food • Superbowl = junk food, etc. • Can be specific to type of food and type of activity Institute for Translational Sciences

31. Memory Amnesiacs will eat a second meal • Remembering a recent meal will decrease intake Impairs ability to accurately estimate food intake • Which then leads to greater intake later, since memory of intake is impaired This, too, is ultimately due to distraction Institute for Translational Sciences

32. Stress-induced reward system Games are stressful & biologically demanding • Even sedentary games increase heart rate, etc. Eating feels pleasurable, reduces stress •  people eat when stressed Institute for Translational Sciences

33. Take-home messages Basically, distraction is the key ingredient in most of these • Distraction from cognitive or behavioral cues • Distraction from physiological signals • Distraction leading to poor memory for meal Stress and cues likely also contribute This is all excluding clear influence of food ads Institute for Translational Sciences

34. Thoughts for discussion • Variance was a huge issue in PRESENCE 2. What other variables are likely to be contributing to this variance? • Gender is clearly a moderator. What other moderators could plausibly exist? • What do you think is the most important mechanism by which distraction affects intake? Institute for Translational Sciences

35. Acknowledgements and thanks • Funding • NIH BIRCWH K12 (K12HD05023) • NIH CTSA (UL1RR029876) • NIH Pepper OAIC (P30AG024832) • AHA (13BGIA17110021) • Current mentors & collaborators • Tom Baranowski (BCM) • Karen Basen-Engquist (MDA) • Abbey Berenson • Jim Goodwin • Koyya Lewis • Eloisa Martinez • Ken Ottenbacher • Jennifer Rowland • Elena Volpi Institute for Translational Sciences