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

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

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

4. Theories of distraction 4 Institute for Translational Sciences 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

5. Engagement 5 Institute for Translational Sciences 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

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

7. Transportation 7 Institute for Translational Sciences 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

8. 5 Institute for Translational Sciences 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

9. 5 Institute for Translational Sciences

10. 10 Institute for Translational Sciences Transportation

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

12. Distraction and energy expenditure 12 Institute for Translational Sciences 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!

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

14. Department Name Goes Here 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 14

15. Department Name Goes Here Snacks and beverages Snacks Doritos M & Ms Trail mix Baked Lays Beverages Coke Mountain Dew Diet Coke Water 15

16. Department Name Goes Here 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 16

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 17

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 18

19. Department Name Goes Here Participant characteristics 62% White, 17% Black, 14% Asian, 7% Other, 8% Hispanic 63% normal weight, 26% overweight, 11% obese TV (N = 40) VG (N = 40) Motion (N = 40) Total (N = 120) Age (years)24.6 (4.7)23.6 (4.2)24.0 (4.4)24.1 (4.4) Height (cm)171.1 (9.0)171.8 (11.1)170.1 (9.3)171.0 (9.8) Weight (kg)72.6 (17.1)72.0 (16.0)70.0 (10.9)71.5 (14.8) BMI (kg/m 2 )24.7 (4.6)24.3 (4.0)24.3 (4.2)24.4 (4.1) 19

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

21. PRESENCE 2 energy intake 21 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? 22 Institute for Translational Sciences 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?

23. Department Name Goes Here Gender differences: TV genres 23

24. Department Name Goes Here Gender differences: VG genres 24

25. Department Name Goes Here Gender differences: Motion VG genres 25

26. Take-home messages 26 Institute for Translational Sciences 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! 

27. Paper 2: a review of eating studies 27 Institute for Translational Sciences 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

28. Distraction 28 Institute for Translational Sciences 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

29. Physiologic food regulation 29 Institute for Translational Sciences 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

30. Conditioned cues 30 Institute for Translational Sciences 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

31. Memory 31 Institute for Translational Sciences 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

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

33. Take-home messages 33 Institute for Translational Sciences 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

34. Thoughts for discussion 34 Institute for Translational Sciences 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?

35. Acknowledgements and thanks 35 Institute for Translational Sciences 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