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Katie Sprague
Draft 3

Cover Letter

In this paper I tried to make all of the suggested corrections and expand on my
topics. I also tried to improve my conclusion by connecting with another

classmates topic and relating it to my topic.


I found my core ideas and references by searching in PubMed for studies relating

to adolescent behavior and the impact of social media.


I think my successes in turning the second draft into a final paper were making all
the suggested corrections, I felt more prepared in adding to the paper and was
more confident when writing this draft. I found it difficult to finish the conclusion

and add in the connection, but I feel that I met the criteria and was successful.
I think my paper meets the criteria shown in the grading rubric.
I proofread my submission by reading it aloud to myself twice and having two of

my roommates read it as well.


Additional comment: in my second draft you had a question about the figure on
page 11, asking to double check the reference to see if the model was tested with
path analysis. The study did not test the entire path in that model; only the
exposure to TV food advertising leading to increased consumption of those foods

and increased BMI. http://dx.doi.org/10.1016/j.amepre.2013.06.011


Plagiarism statement: I, Kathleen Sprague, state that the work completed in this
paper is my own and all sources have been properly cited to give credit where it is
due.

Exploring the Influence of Media on


Adolescent/Young Adult Overweight and Obesity
Status

Kathleen Sprague
DIET 3231W

I.

Introduction:

Obesity is a worldwide issue that has more than doubled in the last 30 years. This major
health concern is caused by chronic energy intake that exceeds energy output. In 2014 there were
42 million children (under the age of 5) who were overweight or obese, which joins over 2
billion adults (18 or over) worldwide who were overweight or obese (World Health Organization
2016). Children and adolescents who are overweight and obese are more likely to develop
conditions such as diabetes or cardiovascular disease at an earlier age (WHO 2016). Overweight
or obesity status is preventable and reversible. Actions should be taken to intervene, especially
during the critical growth period of adolescence, to help combat the problem of overweight and
obesity status throughout the world.
In this modern age of increasing technology individuals are inundated by the media,
especially adolescents and young adults. In 2013, the Pew Research Center (PRC) released a fact
sheet (Teens and Technology 2013) stating that of young adults ages 12-17, 93% had access to a
computer, and 78% owned a cell phone (47% of which were smartphones) (Madden, et al). The
PRC is a fact tank which gathers information through demographic research, public polling,
content analysis, and more. PRCs purpose is to release information to the public about the
attitudes, behaviors and trends in the country without bias. Through these methods, the PRC also
found that young adults averaged between 112-133 hours of video viewing time per month
which is about 3-4 hours each day. Additionally, the data suggested that increased media usage
has been associated with increased adolescent obesity rates. It is subsequently associated with
decreased physical activity and poor diets including higher fat diets, more soda consumption and
low fruit and vegetable intake. These data suggest that obesity throughout adolescence and
young adulthood may be greatly increased by media usage during these years.

Thus, this paper will discuss the effects of the media, especially social media, on
adolescent/young adult overweight and obesity status. The years of adolescence and young
adulthood, specifically ages 12-25, are critical in establishing healthy dietary and physical
activity behaviors as lifelong habits. The paper will present research showing that adolescents are
likely to have unhealthy dietary and physical activity behaviors. The question of interest is if
media in the form of smartphone Apps, Facebook, Twitter, text messaging, web pages and TV
commercials can exert a positive or negative influence on adolescents dietary and physical
activity behaviors. Furthermore, the question remains if interventions for adolescents that use
technologies and social media encourage healthy dietary and physical activity habits. That is, can
the use of health conscious media such as smartphone apps, Facebook pages, Twitter, web pages,
text messaging and TV promote healthy dietary and physical activity behaviors? These
interventions should be tested to determine if health-promoting social media is beneficial at the
individual level, group level, or both. More randomized control trials (RCT) should test the
effects of these social media interventions to determine the success rate of decreasing adolescent
obesity. If the social media interventions are proven to be successful, then policy makers should
consider implementing these programs into schools (elementary, middle and high school),
universities and the workplace to help monitor and mandate healthy dietary and physical activity
behaviors throughout the years of adolescence and young adulthood.
To address the hypothesis this paper will explore the extent to which adolescent/young adult
dietary and physical activity behaviors deviate from the recommendations, and the extent to
which media is able to influence adolescent/young adult behaviors. Furthermore, it will delve
into potential roles that media plays in decreasing or limiting the overweight and obesity status in
young adults/adolescents as well as negative roles and influences the media has had in this same

area. Finally, the paper will discuss interventions needed to increase the positive influence of
media on adolescent/young adult overweight and obesity status, and minimize the negative
influences.
Topics:
II.

Adolescents have unhealthy dietary and physical activity behaviors deviate from
the recommendations.

The 2013 United States Youth Risk Behavior Survey (YRBSS) shows that 14% of all high
school students in the US are overweight or obese (CDC.gov), meaning their BMI is equal to or
above the 85th percentile for their gender and age category (Figure 1). The YRBSS is done every
2 years and the surveys representative samples of 9th 12th grade students in public and private
schools throughout the U.S. The YRBSS has surveyed and collected data from over 2.6 million
high school students from the years 1991 2013. It includes national, state, territorial, tribal
government and school-based surveys conducted by the departments of health and education.
Also from the year 2013, the YRBSS collected data showing that adolescents have dietary habits
that deviate from the recommendation. Fourteen percent of this population did not eat breakfast
during the seven days before the survey was conducted and 7% of this population did not eat
vegetables during this same time frame before the survey was conducted. Additionally, 15% of
all US high school students reported not engaging in at least 60 minutes of physical activity
during the seven days before the survey was conducted. Similarly, 46% of high school students
did not play at least one sport. These data support the claim that adolescents have physical
activity behaviors that deviate from the recommended amount of 60 minutes per day. Having
unhealthy dietary and physical activity behaviors in adolescence are consistent with the high
levels of overweight status and obesity seen in this cohort of adolescents.

Figure 1 shows the percentage of males in high school that are obese (16.6%) compared
to the percentage of females in high school that are obese in the US (10.9%) (top panel) and
percentages of high school males (16.5%) compared to females in the US that are overweight
(16.6%) (bottom panel) (CDC.gov).
In addition to the information displayed about overweight and obesity status in Figure 1 from
the YRBSS, the National Health and Nutrition Examination Survey (2009-2010) reports that 1/3
of adolescents are considered overweight and 1 in 6 adolescents are considered obese
(NHANES). NHANES also shows that physical activity declines with age in adolescence; 42%
of children ages 6-11 get the recommended 60 minutes of physical activity per day, while only
8% of adolescents ages 12-15 and 7.6% of adolescents ages 16-19 reach this same goal.
In summary, the YRBSS and NHANES data suggests that adolescents are an at-risk
population for overweight and obesity status. Although there are many different factors that

could be contributing to this risk, media (specifically social media) could hold a large influence.
Adolescent behaviors, including dietary and physical activity behaviors, are influenced by social
media usage.
III.

Adolescent behaviors are influenced by the media.

In our modern world media plays a large role in everyday life, especially in the lives of
adolescents and young adults. It is possible that the increased exposure to media and social
media usage during adolescence and young adulthood has the ability to shape and influence
behaviors. In this section I explored the influence of media on adolescent behavior through
PubMed searches including the terms adolescents OR young adults, social media OR
television OR TV, overweight OR obesity, smartphone OR cellphone, and usage OR
impact. From these results I chose the studies with information most relevant to my hypothesis.
I looked for those with statistical evidence as well a variety of types of studies to help portray the
impact of the media on the lives of adolescents/young adults.
The Pews Research Center Teen Fact Sheet (PRCTFS) (ages 12-17) shows that as of
September 2012 47% of all teens with cell phones own a smartphone, meaning they have access
to internet, social media and Apps (PRCTFS). The Pews Research Center conducts nationally
representative surveys of the general public. The surveys are conducted in person, over the phone
(both landline and cellphone), through the internet, or with paper questionnaires. The PRCTFS
used the internet to survey 802 adolescents ages 12-17. Of the teens surveyed from PRCTFS,
74% access the internet using their mobile device and 25% report using mostly their cell phone
to access the internet. Additionally, 81% of teens who are online use some type of social media.
As of 2012, 94% of teens have Facebook profiles/accounts and 58% of all teens have previously
downloaded Apps to their smart phones (Teen Fact Sheet). This information shows that a large

percentage of teens have constant access to social media and Apps through their smartphones,
and most are using Facebook. Since teens are likely to have smartphones with Apps and access
to social media, it is possible that social media would be an effective way to achieve behavior
change in the adolescent/young adult population.
Adolescent health behaviors are influenced by the amount of time spent using screen-based
media (SBM) according to findings from The Health Behavior in School-Aged Children (HBSC)
cross-sectional study completed by nationally-representative samples of children in the US and
Canada (ages 12-18) (Iannotti, et al). The HBSC study used standardized methods and surveyed
adolescents across more than 40 countries and regions. The survey asked adolescents how many
hours during the weekdays and weekends were spent using a computer during free time and
watching television. The survey also asked about the adolescents physical activity habits,
perceived health status, health complaints, tobacco use, alcohol use and more.
From the analysis greater use of SBM was related to lower levels of physical activity in both
the US and Canada. Increased SBM use also was related to a decrease in physical health status,
and decreased perceived quality of life and quality of family relationships. However, children
who reported greater time on SBM also felt more satisfied with the quality of peer relationships.
In both countries, increased SBM use was related to increased health complaints, cigarette
smoking, alcohol usage (including having been drunk), and physical aggression. An increase in
physical activity was consistently related to an increase in positive health indicators such as
decreased tobacco use and cigarette smoking as well as less health complaints. These findings
indicate that SBM use increases negative health behaviors in adolescents and decreases positive
health behaviors, including physical health status, quality of life and quality of family
relationships.

According to an observational study, numerous Korean adolescents considered themselves to


be addicted to their smartphone devices (Kwon, et al). This study was conducted with 559
students (343 boys and 197 girls) ages 13-15 in Kangwon, South Korea. From April to May of
2013, the students completed a questionnaire assessing their smartphone usage. Participants were
asked questions about what their quality of life would be like without their smartphone, how
often they think about their smartphone, if they miss important events due to smartphone usage,
if they consider themselves to be addicted to their smartphone, and more. From descriptive
statistics, 24.8% of the students considered themselves to be addicted to their smartphone, 57.8%
did not consider themselves to be a smartphone addict, and 17.4% were unsure. Even though
more than half of the adolescents did not consider themselves to be smartphone addicts, the
results of all the participants combined showed that ~3 hours were spent using smartphones
during the weekdays, and ~4 hours were spent using smartphones on the weekends. This
suggests that all of the participants were still reporting high usage of their smartphone devices
regardless of if they qualified themselves as smartphone addicts. (Kwon, et al). Despite the
limitation of the sample by the study, these results indicate that adolescents put a considerable
value on their smartphone devices and that these devices are an integral part of adolescent life.
In summary, the data provided from the PRCTFS, the HBSC, and the observational study
done by Kwon, et al supports the claim that the media is able to influence adolescent and young
adult behaviors (specifically health behaviors). Not only is there increased access to and usage of
media and social media, but there is also increased significance and value that adolescents and
young adults place on their social media devices. Based on this information, there is a possibility
that the media is able to impact health behaviors of adolescents/young adults in a way that
contributes to increased overweight and obesity status. Health professionals would benefit from

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using the information provided from these studies to increase the usage of social media and
smartphones to encourage healthy behaviors in adolescents.
IV.

The media can have a negative impact on the overweight/obesity status of


adolescents.

This section will discuss the possible negative influences that the media can have on
increasing obesity in adolescents and young adults. These data were found through PubMed
searches including the terms adolescents OR young adults, social media OR media OR
television OR TV, overweight OR obesity. From these searches, the studies I chose were
those with information that was pertinent to my hypothesis. I also looked for studies that were
randomized, conducted with a large population and had few limitations in order to provide the
most reliable results.
A randomized telephone survey combined with a randomized web based survey found that
increased exposure to television fast food advertisements lead to an increase in participant
obesity (McClure, et al). The study was conducted with 3342 participants ages 15-23 in the US
showing an association between fast food advertisements on TV and adiposity. The participants
viewed a random subset of 20 advertisements of national fast food restaurants that had been aired
on TV the previous year. The participants were asked whether they had seen the advertisement
before and whether or not they liked it; based on their answers, the advertisements were given a
receptivity score. These participants also were asked to self-report their heights and weights for
calculation of BMI. Based on the analysis, each 1-point increase in the TV advertisements
receptivity score increased the odds of young adult/adolescent obesity by 19%. These results
show a direct association between fast food advertising on TV and risk of adolescent/young adult
obesity. The association was independent of time spent watching TV, and instead related to the

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specific food messages viewed during that time. Overall, this study suggests that TV-fast food
advertising may be playing a large role in contributing to adolescent/young adult obesity rates as
shown by the model in in Figure 2.

Figure 2
A theoretical model of TV food advertising receptivity and obesity (McClure et al). The figure
suggests the routes in which TV time and TV food advertising can lead to obesity.
Additionally, a cross-sectional study conducted by the International Study of Asthma and
Allergies in Childhood (ISAAC) was consistent with the flowchart shown above in Figure 2. The
study suggests that adolescents with high TV viewing time are likely to have increased BMIs.
The information for this study was gathered from ISAAC Phase 3 which was originally
conducted to explore the prevalence of allergies, asthma, eczema and more in adolescents and
teens. However, this survey also asked participants about their TV viewing habits and their
BMIs. ISAAC is a multicenter, multicountry, multiphase, cross-sectional study. It surveyed
207,673 adolescents from 37 countries. The results of the study showed that adolescents
watching TV for longer periods of time had higher BMIs. There was a 10-27% increased risk of
being overweight or obese in adolescents watching 1-3 hours of TV per day, and there was a 45%
increased risk of being overweight or obese for females watching 5 or more hours per day.

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Additionally, the study showed that 52% of adolescents surveyed watched 3 or more hours of TV
per day.
Although both studies correspond with the flowchart depicted in Figure 2, the study
conducted by Braithwaite, et al differed from the study conducted by McClure, et al in that it did
not survey the dietary habits of the participants or the content of the television programs/
commercials that they viewed. Instead, Braithwaite, et als study focused on the time adolescents
spent watching TV and being sedentary. Therefore, rather than TV time leading to viewing fast
food commercials and consuming these fast food choices, this study starts with TV viewing,
leads to increased sedentary behavior, an energy imbalance and finally increased overweight and
obesity status. Both of these studies follow the flowchart in Figure 2 to show the different ways
in which media in the form of watching TV can lead to increased overweight and obesity status
in adolescents and young adults.
V.

The media can have a positive impact on the overweight/obesity status of


adolescents.

This section will discuss the ways in which media usage may be able to decrease overweight
and obesity status in adolescents and young adults. To find original research, PubMed was
searched using key terms such as adolescents, Facebook, smartphone OR smartphone
applications, social media, text messaging, overweight OR obese OR obesity. From these
searches, studies that were the most relevant to my hypothesis were reviewed. In addition studies
that covered a wide population and those that tested different types and forms of social media
also were examined.

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The use of a Facebook page along with text messaging interventions proved to be a
successful weight loss tool for young adults, according to a RCT at a large urban university in
the US (Napolitano et al). There were 52 racially diverse college student participants (86%
female) with BMI that range from 26 to 36. The students were split up into three trial groups.
One group was assigned to a Facebook intervention (n=17), which was a private Facebook page
including polls, healthy eating and physical activity event invitations (such as fitness classes,
local farmers markets and more), group postings, social support, and healthy lifestyle
encouragement. The Facebook Plus group (n=18) gained access to a private Facebook group that
contained all of the same content as the Facebook page assigned to the first group but also
included personalized weight loss goals, tips on self-monitoring, and were assigned a buddy in
the group. This group also received text messages which were designed to give feedback,
encourage, and reinforce the healthy behavior and weight loss goals. These messages were being
sent to the participant each day and were interactive. The third group (n=17) was a wait list
control group which received no treatment.
From measured weights at 4 weeks and then again at 8 weeks, the Facebook Plus group had
significantly greater weight loss at 8 weeks than the control and regular Facebook group. There
were no significant weight loss differences between the Facebook and control groups. Both in the
Facebook and Facebook Plus groups of the participants liked study related posts on the
Facebook pages. However in the Facebook group, only 41.2% of participants posted or
commented on content on the Facebook page whereas 77.8% of Facebook Plus members
commented or posted on their Facebook page. Additionally, of the participants in the Facebook
and Facebook plus groups 97% reported finding the program helpful, 81.3% reported that the
videos and handouts were helpful and 100% of the participants would recommend these

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programs to others (Napolitano, et al). Overall, this study suggests that interventions combining
multiple forms of social media (Facebook and text messaging) may be beneficial in controlling
adolescent overweight/obesity status.
In addition to the study conducted by Napolitano, et al on the effects of multiple combined
social media techniques to help combat adolescent/young adult obesity, Merchant, et al also
proposed a larger study of overweight/obese college students. The results of this study did not
find that social media alone was enough to results in weight loss (Merchant, et al). Both studies
concluded that Facebook alone was not able to cause a behavior change leading to weight loss in
adolescents/young adults.
A RCT was conducted, suggesting that overweight/obese college students are willing to use
and interact with a weight loss Facebook page program, but the social media interactions did not
lead to behavior change and weight loss in these individuals (Merchant, et al). This study was
done across three Southern California universities including 404 overweight/obese college
students who were selected to participate in a 24-month long weight loss program delivered
through Facebook. Each intervention member (202 students) had to like the Facebook page
where a health coach (RD) would post 3-4 times per day. The study then measured how many
times each member would engage with the Facebook page either through a like or a comment
or an individual post. The results show that 72% of all posts to the page were engaged with at
least once, however the amount of engagements decreased substantially over time. This decrease
in post interactions could be due to 40% of the intervention participants reporting that they often
read the posts but did not directly interact with them. Overall, this study showed that
overweight/obese college students will interact and engage with a Facebook oriented weight loss

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program, however it is unclear whether or not these interactions lead to behavior change or
weight loss.
Although a Facebook group intervention may not lead to weight loss or a decrease in
adolescent/young adult obesity status, it did suggest that the adolescent/young adult population is
willing to interact with and participate in a group targeting weight loss and healthy behaviors.
There was more success in behavior change and weight loss while using multiple social media
outlets based on the Facebook Plus group shown in Napolitano et als study. This suggests that
participating in multiple social media interventions at the same time may increase the chances of
changing health behaviors leading to weight loss and ultimately lowering the rates of
adolescent/young adult overweight and obesity status.
VI.

Interventions and Connections

The information explored in this paper strongly suggests that media (specifically social
media) influences the overweight and obesity status of adolescents/young adults. Interventions
would need to occur at multiple levels in order to result in behavior change. I would suggest
intervening by conducting more RCTs testing the use of interactive social media programs on
adolescents to assess whether they truly can change behavior and result in lower BMIs for this
age group. These trials should be done in multiple ways; they should test if social media
interventions are effective at the individual or group level, or at both levels.
However, interventions should not simply be focused on adolescents and social media. It may
be beneficial to enact change within a younger population as well, focusing on other technology
usage besides the ones addressed in this paper. For example, a RCT in Auckland New Zealand
concluded that active video games have an effect on BMI and body composition in obese and

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overweight children (ages 10-14) when compared to sedentary video games (Maddison, et al).
The RCT studied 322 obese children who were currently users of sedentary video games. The
participants were randomly assigned a new active video game or were chosen to have no change
to their current video game (staying sedentary). At 12 and 24 weeks the participants had their
weight, height, and waist circumference measured as well as a bioelectrical impendence analysis
and physical fitness test. The results of the study showed that there was a small, but statistically
significant change in BMI over the 6 months (0.24) for the children that were assigned to the
intervention (active video game) group. Furthermore, the results showed that there was a small
difference in fat percentage for the intervention group.
The study suggests that active video games may be another way to decrease childhood and
teenager overweight/obesity status. More RCT should be conducted to validate the effects that
active video games have on decreasing childhood obesity, and they should test if these effects are
consistent with adolescents as well. If more research is done, interventions would include using
active video games as a way to increase physical activity in the suggested age groups, and
subsequently decrease the amount of childhood/adolescent overweight and obesity status.
Overall, obesity status cannot be combatted by only intervening with media and social media.
Additionally, it cannot be overcome by just focusing on adolescents or young adults. Successful
interventions may include increasing technologies such as active video games for children and
young adolescents to increase physical activity and reduce obesity at a younger age.
Interventions may be more effective if they combine technologies, media and social media to
cause positive behavior change at multiple levels. Programs could include active video games as
well as active computer games, interactive TV shows, and activity based Facebook and text
messaging programs. If these programs are tested and proven to be successful, then interventions

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at the policy maker level should be considered. For example, these successful combined social
media and technology programs should be implemented into middle and high schools, and well
as university curriculums to help mandate healthy dietary and physical activity behaviors for
these age groups.
VII.

Conclusion

This paper explored the possible negative and positive effects that media (specifically social
media) can have on the overweight and obesity status of young adults and adolescents. The
media usage explored in this paper was television time, computer time, Facebook usage,
webpage usage, and smartphone usage. Overall, the research shows that young adults and
adolescents participate in high usage of media and social media, and their daily behaviors are
influenced by this usage. The data also shows that media has the ability to exert both positive and
negative influences on adolescent and young adult overweight and obesity status. In some ways
media usage has been shown to cause increased sedentary behaviors and increased poor dietary
choices leading to increased BMI. On the other hand, social media tactics such as interactive
Facebook pages, webpages and text messages through smartphones were shown to be effective
programs in decreasing BMI in adolescents and young adults. However, the data presented
addressing the positive influences media has on adolescent overweight and obesity status was
less conclusive and expansive than the data addressing the negative effects of the media on
adolescent obesity status.
Overall, the data collected was found to support my hypothesis that the media, specifically
social media, is able to influence dietary and physical activity behaviors of adolescents and
young adults leading to increased overweight and obesity status. If steps are taken to increase the

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positive influences of the media and decrease the negative then it will be possible to lower the
amount of overweight and obese adolescents and young adults.

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