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A recent study, published in the journal Appetite, found that women ages 20 to 35 who watch cooking shows — and then cook from scratch — weigh more and have higher BMIs than those who simply watch (and do not cook). Are cooking shows leading us to make unhealthy meals? Lisa Gorman, RN and director of the St. Joseph Health Wellness Corner in Irvine, weighs in.
The article talks about two different kinds of people: "viewers" and "doers." In your opinion, how does simply viewing a cooking show lead to increased weight?
Nothing about the television directly forces us to gain weight, but it sure does seem to make snacking appealing. We snack in a lot of places — in the car, at the office, or even at our child’s swim practice — but nothing is quite as conducive to snacking as an evening in front of the television. When you watch food being cooked on television – or even when you see advertisements that contain food or actors holding glasses of wine — your mind creates a subconscious desire for that food. Since watching TV is not a mindful activity, people tend to act on these desires more readily. This can be a dangerous situation when all of your kitchen ingredients are just a few steps away from the living room. A snack every now and then isn’t a bad thing, but you should be mindful of what you are eating. I tell all my patients to practice mindful eating, which means separating mealtime from all other tasks and entertainment, including television. I don’t recommend eating in front of the TV, or any electronic device, for the same reasons I wouldn’t encourage people to eat lunch at their desks: When you are cognizant of what you eat and how it makes you feel, you can enjoy the food more and acknowledge when you’re full. Having a healthy and mindful meal can also keep you from over-snacking later.
This study only looks at women. Do you know of any studies where the participants were men? Or do you have any thoughts about how gender could influence the results of this study?
When you watch food being cooked on television...your mind creates a subconscious desire for that food.From my experience at the St. Joseph Health Wellness Corner in Irvine, this does not appear to be a gender-specific issue. Like women, men also struggle with non-mindful eating, and they prepare meals and watch cooking shows just like their female counterparts. A 2012 study conducted by researchers from the University of Michigan found that men watch cooking shows and read magazine articles on cooking just as much as women do. It did point out that more women cook, which may have been part of the reason that women were surveyed in the most recent study.
Given the results of this study, what are a few pieces of advice that you would give to someone who regularly watches cooking shows?
As I mentioned, mindful eating is incredibly important. Try to remove technology and other sources of entertainment from your environment, and simply take the time to relax, reflect on the day, and enjoy your plate of food. Eating meals with other people is typically OK because we tend to naturally control and portion ourselves in social situations. Another great way to avoid snacking while watching TV is to exercise. Try watching your favorite show on a treadmill by viewing it from your iPad. You can also move from the couch to the floor and practice simple exercises — like crunches or even stretches — to keep yourself from snacking.
Are there any cooking shows that you would recommend as a professional? Any that might help viewers cook and eat healthier?
I’ve been a registered nurse with a passion for nutrition for many years and I love to watch cooking shows — there are plenty of programs out there that are entertaining and have given me some great recipe ideas. But when it comes to choosing the show for you, you need to be your own referee. If a cook is using two sticks of butter to make a dish that has just four servings, it’s probably not the healthiest source of recipes. That said, you can always work to make your own healthy version of recipes you find on television. Personally, I enjoy Ellie Krieger, a nutritionist on Food Network, because she takes traditional recipes and makes them heart-healthy. Decreasing the amount of fat and sugar you use in a recipe is an easy way to decrease its overall calorie count.
Lisa Gorman, RN, is the director of the St. Joseph Health Wellness Corner in Irvine. Lisa has worked in wellness and prevention for more than 10 years, and is currently a registered nurse with 25 years of health care experience.
Kristie Collado is The Daily Meal’s Cook Editor. Follow her on Twitter @KColladoCook.
Childhood obesity linked to irregular sleep and skipping breakfast
Skipping breakfast and irregular sleep patterns have been identified as key reasons why children may become dangerously overweight in research that sheds new light on the obesity epidemic.
The study, led by academics from University College London, challenges the widely-held view that soaring childhood obesity rates are caused solely by overeating.
Lifestyle factors and the environment a child is brought up in play a significant role in their chances of becoming obese, the researchers found from examining records of the health and circumstances of children born into 19,244 families across the UK between September 2000 and January 2002.
“This study shows that disrupted routines, exemplified by irregular sleeping patterns and skipping breakfast, could influence weight gain through increased appetite and the consumption of energy-dense foods,” said Prof Yvonne Kelly, from UCL’s department of epidemiology and public health, who led the research.
Her team’s analysis of data collected by the Millennium Cohort Study showed that children who do not have a regular bedtime or who get too little sleep are at risk of gaining excess weight. Being born to a mother who smokes is another important factor in predicting whether a child will become overweight or obese, they found.
The researchers also concluded that a child’s consumption of sugary drinks or the amount of television they watch are not strong predictors of who will gain an unhealthy amount of weight. The findings are published on Friday in the American medical journal Paediatrics.
Prof Neena Modi, the president of the Royal College of Paediatrics and Child Health, said: “This paper not only highlights this point but also emphasises the multifactorial nature of obesity put simply, it isn’t just caused by eating too much. This research points to the role of environmental pressures on children’s weight such as having an irregular bedtime or insufficient sleep in other words children are very vulnerable to multiple influences.”
The study also confirms the already well-established increased risk of a child born to an overweight or obese mother ending up with excess weight themselves. But breastfeeding and the early introduction of solid food make no difference to their risk, the researchers found.
It found that 83.3% of children in the UK had a stable, non-overweight body mass index. Almost one in seven, or 13.1% and who are more likely to be girls than boys, have a moderately increasing BMI. Another 2.5% have a steeply increasing BMI. Pakistani, Black Caribbean and Black African children were more likely to belong to that group. A tiny number, 0.6%, were already obese by the age of three.
Modi backed the authors’ conclusion that greater intervention in a child’s early life is needed to try to alter their environment and reduce the chances of them becoming overweight.
“We have long drawn attention to the importance of early intervention in tackling childhood, and indeed adult, obesity. The earlier the action, the higher the chance of preventing obesity taking a hold and adversely affecting life-long health,” she said.
“To reduce the extremely worrying prevalence of child obesity and overweight, a combination of measures is required. These include support for parents before, during and after pregnancy, and education of families about the importance of leading healthy lives.
“As this paper shows, if children are set on the right trajectory early in life, they are much more likely to remain healthy as they move into adulthood. Focusing on getting it right for children will mean getting it right for adults too.”
Alison Tedstone, the chief nutritionist at Public Health England, said: “Skipping breakfast can be an indicator of a poor diet, which can predispose to weight gain. It’s important that families make health choices, including for breakfast. This is why we’re working with the food and drink industry to make the food children eat healthier, starting off with reducing some of the sugar content.”
NIH study finds heavily processed foods cause overeating and weight gain
Small-scale trial is the first randomized, controlled research of its kind.
Researchers from the National Institutes of Health Kevin D. Hall, Ph.D., center, and Stephanie Chung, M.B.B.S., right, talk with a study participant at the NIH Clinical Center. Jennifer Rymaruk, NIDDK
People eating ultra-processed foods ate more calories and gained more weight than when they ate a minimally processed diet, according to results from a National Institutes of Health study. The difference occurred even though meals provided to the volunteers in both the ultra-processed and minimally processed diets had the same number of calories and macronutrients. The results were published in Cell Metabolism.
This small-scale study of 20 adult volunteers, conducted by researchers at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), is the first randomized controlled trial examining the effects of ultra-processed foods as defined by the NOVA classification system. This system considers foods “ultra-processed” if they have ingredients predominantly found in industrial food manufacturing, such as hydrogenated oils, high-fructose corn syrup, flavoring agents, and emulsifiers.
Previous observational studies looking at large groups of people had shown associations between diets high in processed foods and health problems. But, because none of the past studies randomly assigned people to eat specific foods and then measured the results, scientists could not say for sure whether the processed foods were a problem on their own, or whether people eating them had health problems for other reasons, such as a lack of access to fresh foods.
“Though we examined a small group, results from this tightly controlled experiment showed a clear and consistent difference between the two diets,” said Kevin D. Hall, Ph.D., an NIDDK senior investigator and the study’s lead author. “This is the first study to demonstrate causality — that ultra-processed foods cause people to eat too many calories and gain weight.”
For the study, researchers admitted 20 healthy adult volunteers, 10 male and 10 female, to the NIH Clinical Center for one continuous month and, in random order for two weeks on each diet, provided them with meals made up of ultra-processed foods or meals of minimally processed foods. For example, an ultra-processed breakfast might consist of a bagel with cream cheese and turkey bacon, while the unprocessed breakfast was oatmeal with bananas, walnuts, and skim milk.
The ultra-processed and unprocessed meals had the same amounts of calories, sugars, fiber, fat, and carbohydrates, and participants could eat as much or as little as they wanted.
On the ultra-processed diet, people ate about 500 calories more per day than they did on the unprocessed diet. They also ate faster on the ultra-processed diet and gained weight, whereas they lost weight on the unprocessed diet. Participants, on average, gained 0.9 kilograms, or 2 pounds, while they were on the ultra-processed diet and lost an equivalent amount on the unprocessed diet.
Dietitians at the Clinical Center of the National Institutes of Health designed recipes to test the effects of ultra-processed and unprocessed diets on study participants. Jennifer Rymaruk, NIDDK
“We need to figure out what specific aspect of the ultra-processed foods affected people’s eating behavior and led them to gain weight,” Hall said. “The next step is to design similar studies with a reformulated ultra-processed diet to see if the changes can make the diet effect on calorie intake and body weight disappear.”
For example, slight differences in protein levels between the ultra-processed and unprocessed diets in this study could potentially explain as much as half the difference in calorie intake.
“Over time, extra calories add up, and that extra weight can lead to serious health conditions,” said NIDDK Director Griffin P. Rodgers, M.D. “Research like this is an important part of understanding the role of nutrition in health and may also help people identify foods that are both nutritious and accessible — helping people stay healthy for the long term.”
While the study reinforces the benefits of unprocessed foods, researchers note that ultra-processed foods can be difficult to restrict. “We have to be mindful that it takes more time and more money to prepare less-processed foods,” Hall said. “Just telling people to eat healthier may not be effective for some people without improved access to healthy foods.”
Support for the study primarily came from the NIDDK Division of Intramural Research.
About the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): The NIDDK, a component of the National Institutes of Health (NIH), conducts and supports research on diabetes and other endocrine and metabolic diseases digestive diseases, nutrition and obesity and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see https://www.niddk.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH&hellipTurning Discovery Into Health ®
Hall KD, et al. Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake. Cell Metabolism. May 16, 2019.
8 Conditions That Could Explain Your Sudden Weight Gain
Diet and exercise alone aren't the only things that affect the number on the scale.
You know you might put on extra pounds if you regularly skip barre class or keep selecting M&Ms when you hit up the office vending machine. But if you haven’t changed your eating and exercise habits yet the number on the scale has suddenly crept up, something more could be going on.
Carrying extra pounds isn&apost necessarily a problem, of course. But it could signal an underlying medical issue you&aposll want to address. Maybe it&aposs a hormone condition, or a mood disorder, or another factor altering your physiology without you realizing it. The only way to be 100% sure of what it means is to consult your doctor. In the meantime, consider these 8 health-related reasons that might explain why the scale has soared.
An underactive thyroid (hypothyroidism)
Aside from realizing that your jeans are more snug, have you noticed other body changes—like exhaustion, drier skin, or thinner hair? These are all signs of hypothyroidism, a condition in which the butterfly-shaped thyroid gland in your neck isn’t producing enough of thyroid hormone. Your thyroid is kind of a master gland controlling many body functions, so when it&aposs not working right, symptoms appear throughout your system.
A major function it controls is your metabolism. “Think of your body as a car. You have an engine, and the thyroid hormone maintains the idling of the engine,” Michael Nusbaum, MD, bariatric surgeon and founder of Healthy Weight Loss Centers, tells Health. “If you’re not producing enough thyroid hormone, your idle gets turned down and you’re not burning as much energy overall.” When your resting metabolism slows, it decreases the amount of calories you burn throughout the day.
One in eight women will develop a thyroid disorder during her lifetime, according to the American Thyroid Association. Dr. Nusbaum says other symptoms to look out for are muscle weakness, constantly feeling cold, bloating, and constipation. If your doctor diagnoses hypothyroidism, you’ll likely be prescribed an oral replacement for thyroid hormone that can alleviate symptoms, including weight creepage, within weeks.
Polycystic ovary syndrome (PCOS)
PCOS is another condition caused by out-of-whack hormones. This endocrine disorder is characterized by an imbalance in the sex hormones estrogen and testosterone (women produce testosterone too, though in much smaller quantities than men do). This imbalance leads to irregular periods, acne, and even facial hair growth.
This disorder, which strikes one in 10 women of childbearing age, also disrupts the way the body uses insulin—the hormone responsible for converting carbohydrates into energy, Dr. Nusbaum says. Yep, you guessed it, that means weight gain. When your body becomes insulin resistant, the sugars and starches you consume are stored as fat instead of turned into fuel, he explains.
While there’s no cure for PCOS, women who have it can manage their symptoms with lifestyle changes as well as medication. Your doctor will help you find the method that’s right for you.
Mood disorders like depression and anxiety
Dealing with anxious or sad feelings by mindlessly munching is something almost all of us do on occasion. But either of these mood disorders can make overeating a regular coping mechanism. Dr. Nusbaum gives the example of breaking open a bag of chips, and after three, four, then five handfuls, “you’re not even tasting the chips anymore, your taste buds are completely saturated with the flavor, but you’re still eating, and you’re thinking, Why am I still eating?”
Depression and anxiety can both bring on fatigue, irritability, and a lack of focus. All three can throw you off your game when you work out or lead you to ditch the gym altogether. and pretty soon, pounds pack on.
Reflect on your mood over the past few weeks. If you’ve been consistently down on yourself, on edge, disinterested in things you usually enjoy, or have had trouble sleeping, consider asking your MD for a referral to a mental health professional. A therapist can help get to the bottom of what’s going on, and with proper treatment, help you keep extra pounds at bay.
Perimenopause and menopause
How the five or so years leading up to menopause affects you partially depends on genetics, Dr. Nusbaum says. “I joke around with my patients because they’ll typically come in saying, ‘Holy crap, I’m starting to look like my mother.’” One way to get an idea of the way your body will change during perimenopause and then menopause itself is by asking your mom what changes she noticed in herself. Though your experience could be different than hers, there’s a good chance it’ll be similar—so if she began gaining weight at this point in her life, it could be the explanation for your weight change.
Once again, hormones are to blame for the extra pounds. "The rapid reduction in the amount of hormones present in your body throws you off kilter pretty quickly,” Dr. Nusbaum says. Lifestyle changes can help, so talk to your ob-gyn.
Cortisol is nicknamed the stress hormone, Diondra Atoyebi, DO, family physician at Piedmont Healthcare in Georgia, tells Health your body releases it in response to overwhelming or dangerous situations. But when your system makes too much cortisol over an extended period of time, you can develop Cushing&aposs disease. One unpleasant side effect: abnormal fatty deposits in the abdominal area and around the face.
If you’re taking long-term steroids, you’re more likely to develop Cushing&aposs disease, Dr. Atoyebi says. The condition can also be brought on by tumors on the pituitary gland in the brain, which triggers an uptick in the production and release of adrenocorticotropic hormone—the catalyst that signals the adrenal glands to produce cortisol.
Weight gain is a hallmark sign of Cushing&aposs, but other symptoms include discolored stretch marks, acne, and fragile skin. Depending on the cause, Cushing&aposs disease can be treated in a variety of ways. If you have Cushing&aposs disease, your doctor will help you determine what&aposs best.
An ovarian or uterine tumor
Earlier this month, a 53-year-old woman in Singapore had a 61-pound tumor removed from from her uterus after showing up at the hospital struggling to breathe. To grow so large, the tumor was likely developing inside her for years. It&aposs an extreme case, sure. But it shows that if left untreated, large pelvic area tumors, such as uterine or ovarian tumors, can distend the abdomen the way excess fat does and send the scale soaring. In the case of the Singaporean woman, the tumor was benign, but others can be cancerous.
In addition to weight gain, symptoms of ovarian or uterine tumors include lower back pain, vaginal bleeding, painful intercourse, and constipation. But these signs are common for other conditions as well, Dr. Nusbaum says, which is why you should always consult your doctor to confirm the root cause of the problem.
Before starting any new OTC or prescription medication, ask your doctor if extra pounds are a possible side effect. Psychiatric medications, especially for depression and bipolar disorder, commonly cause weight gain, Dr. Nusbaum says. “They act centrally on the brain, and while they intend to lower your depression, they inadvertently increase your desire to eat.”
Meds that combat high blood pressure can also cause extra poundage, Susan Besser, MD, family practitioner at Mercy Personal Physicians in Maryland, tells Health. Another culprit is taking insulin, a frustrating side effect for people who are battling diabetesuse maintaining a healthy weight is crucial to managing the disease. Staying active and sticking to a strict meal plan can help you take insulin without adding pounds.
If you rock up to work on only four hours of sleep, you&aposll probably turn to snacking to give you the energy to get through the day. Why does exhaustion trigger cravings? Dr. Besser says lack of sleep messes with your hunger-regulating hormones. Levels of ghrelin, a hormone that tells your body it&aposs time to eat, increase after a restless night. At the same time, leptin, the hormone that signals fullness, may plunge. Put the two together, and no wonder your belt feels tight.
Sleep deprivation can also affect your decision making. Let&aposs say you can eat either a banana or a cookie. When you&aposre tired, you become more impulsive, and that impulsivity can coax you into grabbing that Oreo. A 2018 study published in the American Journal of Clinical Nutrition found that getting more shuteye can mean consuming up to 10 fewer grams of sugar throughout the day. That&aposs the best reason to turn in early that we&aposve heard in a long time.
Sleep Is Integral To Weight Loss, Study Suggests
So you're eating right and exercising regularly as part of your weight-loss plan -- but are you getting your ZZs?
A new commentary from researchers at Laval University, Quebec, reveals just how big of an effect sleep has on weight -- and weight gain -- and goes into what research shows the link between the two.
"The solution is not as simple as 'eat less, move more, sleep more,'" the researchers wrote in the commentary, published in the Canadian Medical Association Journal. "However, an accumulating body of evidence suggests that sleeping habits should not be overlooked when prescribing a weight-reduction program to a patient with obesity."
In one of the studies cited in the commentary, study participants decreased the amount of calories they consumed for two weeks, and got either 5.5 hours of sleep a night, or 8.5 hours of sleep a night. By the end of the study period, the ones who got 5.5 hours of sleep a night lost less body fat than those who got 8.5 hours.
And in another study explored in the commentary, 123 overweight or obese adults went on a calorie-restricted diet for 17 weeks. Just like the other study, the amount of sleep they got was linked with how much weight they actually lost by the end of the study period.
The researchers said there should be further studies to see what activities people do during their waking hours -- like watching TV in the morning -- that could instead be spent sleeping.
"New studies provide evidence that insufficient sleep enhances hedonic stimulus processing in the brain underlying the drive to consume food thus, insufficient sleep results in increased food intake," the researchers wrote in the commentary.
Along these lines, a recent study presented at a meeting of the American Heart Association earlier this year showed that sleep deprivation could spur a person to eat more. HuffPost's Catherine Pearson reported that one group in the study, who were only permitted to get two-thirds their normal amount of sleep a night, ate more than 500 more calories each day compared with those in the other group in the study who were able to get full nights' sleep.
And sleep may not just be linked with weight by potentially increasing the urge to eat -- another study, published earlier this year in the journal SLEEP, showed that sleep could also impact our genes' influence on weight.
"The longer you sleep, the less important genetics become in determining what you weigh," study researcher Dr. Nathaniel Watson, co-director of the University of Washington Sleep Disorders Center, earlier explained to HuffPost. "Does this mean you can sleep yourself thin? Probably not. But you can sleep yourself to a point where environmental factors, like diet and activity, are more important in determining your body weight than genetics."
Why people become overweight
Everyone knows some people who can eat ice cream, cake, and whatever else they want and still not gain weight. At the other extreme are people who seem to gain weight no matter how little they eat. Why? What are the causes of obesity? What allows one person to remain thin without effort but demands that another struggle to avoid gaining weight or regaining the pounds he or she has lost previously?
On a very simple level, your weight depends on the number of calories you consume, how many of those calories you store, and how many you burn up. But each of these factors is influenced by a combination of genes and environment. Both can affect your physiology (such as how fast you burn calories) as well as your behavior (the types of foods you choose to eat, for instance). The interplay between all these factors begins at the moment of your conception and continues throughout your life.
The calorie equation
The balance of calories stored and burned depends on your genetic makeup, your level of physical activity, and your resting energy expenditure (the number of calories your body burns while at rest). If you consistently burn all of the calories that you consume in the course of a day, you will maintain your weight. If you consume more energy (calories) than you expend, you will gain weight.
Excess calories are stored throughout your body as fat. Your body stores this fat within specialized fat cells (adipose tissue) — either by enlarging fat cells, which are always present in the body, or by creating more of them. If you decrease your food intake and consume fewer calories than you burn up, or if you exercise more and burn up more calories, your body will reduce some of your fat stores. When this happens, fat cells shrink, along with your waistline.
To date, more than 400 different genes have been implicated in the causes of overweight or obesity, although only a handful appear to be major players. Genes contribute to the causes of obesity in many ways, by affecting appetite, satiety (the sense of fullness), metabolism, food cravings, body-fat distribution, and the tendency to use eating as a way to cope with stress.
The strength of the genetic influence on weight disorders varies quite a bit from person to person. Research suggests that for some people, genes account for just 25% of the predisposition to be overweight, while for others the genetic influence is as high as 70% to 80%. Having a rough idea of how large a role genes play in your weight may be helpful in terms of treating your weight problems.
How much of your weight depends on your genes?
Genes are probably a significant contributor to your obesity if you have most or all of the following characteristics:
- You have been overweight for much of your life.
- One or both of your parents or several other blood relatives are significantly overweight. If both of your parents have obesity, your likelihood of developing obesity is as high as 80%.
- You can't lose weight even when you increase your physical activity and stick to a low-calorie diet for many months.
Genes are probably a lower contributor for you if you have most or all of the following characteristics:
- You are strongly influenced by the availability of food.
- You are moderately overweight, but you can lose weight when you follow a reasonable diet and exercise program.
- You regain lost weight during the holiday season, after changing your eating or exercise habits, or at times when you experience psychological or social problems.
These circumstances suggest that you have a genetic predisposition to be heavy, but it's not so great that you can't overcome it with some effort.
At the other end of the spectrum, you can assume that your genetic predisposition to obesity is modest if your weight is normal and doesn't increase even when you regularly indulge in high-calorie foods and rarely exercise.
People with only a moderate genetic predisposition to be overweight have a good chance of losing weight on their own by eating fewer calories and getting more vigorous exercise more often. These people are more likely to be able to maintain this lower weight.
What are thrifty genes?
When the prey escaped or the crops failed, how did our ancestors survive? Those who could store body fat to live off during the lean times lived, and those who couldn't, perished. This evolutionary adaptation explains why most modern humans — about 85% of us — carry so-called thrifty genes, which help us conserve energy and store fat. Today, of course, these thrifty genes are a curse rather than a blessing. Not only is food readily available to us nearly around the clock, we don't even have to hunt or harvest it!
In contrast, people with a strong genetic predisposition to obesity may not be able to lose weight with the usual forms of diet and exercise therapy. Even if they lose weight, they are less likely to maintain the weight loss. For people with a very strong genetic predisposition, sheer willpower is ineffective in counteracting their tendency to be overweight. Typically, these people can maintain weight loss only under a doctor's guidance. They are also the most likely to require weight-loss drugs or surgery.
The prevalence of obesity among adults in the United States has been rising since the 1970s. Genes alone cannot possibly explain such a rapid rise. Although the genetic predisposition to be overweight varies widely from person to person, the rise in body mass index appears to be nearly universal, cutting across all demographic groups. These findings underscore the importance of changes in our environment that contribute to the epidemic of overweight and obesity.
Environmental causes of obesity
Genetic factors are the forces inside you that help you gain weight and stay overweight environmental factors are the outside forces that contribute to these problems. They encompass anything in our environment that makes us more likely to eat too much or exercise too little. Taken together, experts think that environmental factors are the driving force for the causes of obesity and its dramatic rise.
Environmental influences come into play very early, even before you're born. Researchers sometimes call these in-utero exposures "fetal programming." Babies of mothers who smoked during pregnancy are more likely to become overweight than those whose mothers didn't smoke. The same is true for babies born to mothers who had diabetes. Researchers believe these conditions may somehow alter the growing baby's metabolism in ways that show up later in life.
After birth, babies who are breast-fed for more than three months are less likely to have obesity as adolescents compared with infants who are breast-fed for less than three months.
Childhood habits often stick with people for the rest of their lives. Kids who drink sugary sodas and eat high-calorie, processed foods develop a taste for these products and continue eating them as adults, which tends to promote weight gain. Likewise, kids who watch television and play video games instead of being active may be programming themselves for a sedentary future.
Many features of modern life promote weight gain. In short, today's "obesogenic" environment encourages us to eat more and exercise less. And there's growing evidence that broader aspects of the way we live — such as how much we sleep, our stress levels, and other psychological factors — can affect weight as well.
The food factor as one of the causes of obesity
According to the Centers for Disease Control and Prevention (CDC), Americans are eating more calories on average than they did in the 1970s. Between 1971 and 2000, the average man added 168 calories to his daily fare, while the average woman added 335 calories a day. What's driving this trend? Experts say it's a combination of increased availability, bigger portions, and more high-calorie foods.
Practically everywhere we go — shopping centers, sports stadiums, movie theaters — food is readily available. You can buy snacks or meals at roadside rest stops, 24-hour convenience stores, even gyms and health clubs. Americans are spending far more on foods eaten out of the home: In 1970, we spent 27% of our food budget on away-from-home food by 2006, that percentage had risen to 46%.
In the 1950s, fast-food restaurants offered one portion size. Today, portion sizes have ballooned, a trend that has spilled over into many other foods, from cookies and popcorn to sandwiches and steaks. A typical serving of French fries from McDonald's contains three times more calories than when the franchise began. A single "super-sized" meal may contain 1,500–2,000 calories — all the calories that most people need for an entire day. And research shows that people will often eat what's in front of them, even if they're already full. Not surprisingly, we're also eating more high-calorie foods (especially salty snacks, soft drinks, and pizza), which are much more readily available than lower-calorie choices like salads and whole fruits. Fat isn't necessarily the problem in fact, research shows that the fat content of our diet has actually gone down since the early 1980s. But many low-fat foods are very high in calories because they contain large amounts of sugar to improve their taste and palatability. In fact, many low-fat foods are actually higher in calories than foods that are not low fat.
The exercise equation
The government's current recommendations for exercise call for an hour of moderate to vigorous exercise a day. But fewer than 25% of Americans meet that goal.
Our daily lives don't offer many opportunities for activity. Children don't exercise as much in school, often because of cutbacks in physical education classes. Many people drive to work and spend much of the day sitting at a computer terminal. Because we work long hours, we have trouble finding the time to go to the gym, play a sport, or exercise in other ways.
Instead of walking to local shops and toting shopping bags, we drive to one-stop megastores, where we park close to the entrance, wheel our purchases in a shopping cart, and drive home. The widespread use of vacuum cleaners, dishwashers, leaf blowers, and a host of other appliances takes nearly all the physical effort out of daily chores and can contribute as one of the causes of obesity.
The trouble with TV: Sedentary snacking
The average American watches about four hours of television per day, a habit that's been linked to overweight or obesity in a number of studies. Data from the National Health and Nutrition Examination Survey, a long-term study monitoring the health of American adults, revealed that people with overweight and obesity spend more time watching television and playing video games than people of normal weight. Watching television more than two hours a day also raises the risk of overweight in children, even in those as young as three years old.
Part of the problem may be that people are watching television instead of exercising or doing other activities that burn more calories (watching TV burns only slightly more calories than sleeping, and less than other sedentary pursuits such as sewing or reading). But food advertisements also may play a significant role. The average hour-long TV show features about 11 food and beverage commercials, which encourage people to eat. And studies show that eating food in front of the TV stimulates people to eat more calories, and particularly more calories from fat. In fact, a study that limited the amount of TV kids watched demonstrated that this practice helped them lose weight — but not because they became more active when they weren't watching TV. The difference was that the children ate more snacks when they were watching television than when doing other activities, even sedentary ones.
Stress and related issues
Obesity experts now believe that a number of different aspects of American society may conspire to promote weight gain. Stress is a common thread intertwining these factors. For example, these days it's commonplace to work long hours and take shorter or less frequent vacations. In many families, both parents work, which makes it harder to find time for families to shop, prepare, and eat healthy foods together. Round-the-clock TV news means we hear more frequent reports of child abductions and random violent acts. This does more than increase stress levels it also makes parents more reluctant to allow children to ride their bikes to the park to play. Parents end up driving kids to play dates and structured activities, which means less activity for the kids and more stress for parents. Time pressures — whether for school, work, or family obligations — often lead people to eat on the run and to sacrifice sleep, both of which can contribute to weight gain.
Some researchers also think that the very act of eating irregularly and on the run may be another one of the causes of obesity. Neurological evidence indicates that the brain's biological clock — the pacemaker that controls numerous other daily rhythms in our bodies — may also help to regulate hunger and satiety signals. Ideally, these signals should keep our weight steady. They should prompt us to eat when our body fat falls below a certain level or when we need more body fat (during pregnancy, for example), and they should tell us when we feel satiated and should stop eating. Close connections between the brain's pacemaker and the appetite control center in the hypothalamus suggest that hunger and satiety are affected by temporal cues. Irregular eating patterns may disrupt the effectiveness of these cues in a way that promotes obesity.
Similarly, research shows that the less you sleep, the more likely you are to gain weight. Lack of sufficient sleep tends to disrupt hormones that control hunger and appetite and could be another one of the causes of obesity. In a 2004 study of more than 1,000 volunteers, researchers found that people who slept less than eight hours a night had higher levels of body fat than those who slept more, and the people who slept the fewest hours weighed the most.
Stress and lack of sleep are closely connected to psychological well-being, which can also affect diet and appetite, as anyone who's ever gorged on cookies or potato chips when feeling anxious or sad can attest. Studies have demonstrated that some people eat more when affected by depression, anxiety, or other emotional disorders. In turn, overweight and obesity themselves can promote emotional disorders: If you repeatedly try to lose weight and fail, or if you succeed in losing weight only to gain it all back, the struggle can cause tremendous frustration over time, which can cause or worsen anxiety and depression. A cycle develops that leads to greater and greater obesity, associated with increasingly severe emotional difficulties.
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The relationship between screen media exposure and obesity has been widely studied. Starting in the mid-1980s, 1 many epidemiologic studies have revealed associations between screen time and obesity. 2 For example, in 1 longitudinal cohort study of a nationally representative sample of US 10- to 15-year-olds, there was a strong dose-response relationship between the number of hours per day children viewed television and the prevalence of overweight, and as much as 60% of the 4-year incidence of overweight was estimated to be attributable to excess television viewing. 3 Longer-term cohort studies have revealed that more television viewing during childhood predicts overweight and obesity in adulthood. 4, 5 In a longitudinal study in New Zealand, up to 17% of the overweight prevalence observed at 26 years of age was estimated to be attributable to viewing Ϣ hours of television per day on weekdays during childhood and adolescence. 5 Observational studies have also revealed that greater screen time is associated with cardiometabolic risk factors more broadly, including hypertension, elevated cholesterol levels, insulin resistance, elevated inflammation, and the metabolic syndrome. 2
Observational research is limited in its ability to demonstrate cause and effect relationships, and not all epidemiologic studies find significant associations between screen time and obesity in children. However, null results (those that are not statistically significant) do not indicate that a relationship does not exist. Observational studies are susceptible to errors in measuring screen time and the accompanying loss of statistical power and potential bias introduced. There have now been a number of experimental research studies in which screen media exposure was manipulated to test this relationship, demonstrating evidence of a cause and effect link between screen media exposure and excess weight gain in children.
Experimental Studies of Reducing Screen Time
A number of rigorous experimental trials tested the effects of reducing children’s screen media exposure on weight gain. 6 The first to address screen time exclusively was a 7-month, school-based randomized controlled trial among third and fourth grade children from 2 California schools. 7 One school was randomly selected to receive an 18-lesson, multiple-component screen-time reduction curriculum delivered by the regular classroom teachers, and it included behavior change skills, an electronic television time manager, and educational parent newsletters. The intervention targeted reducing time spent watching television, playing sedentary video games, and using computers. The other school received no intervention. Both schools received the same measures at the beginning and end of the school year. Over the 7 months of the trial, children in the school that received the screen-time reduction curriculum significantly reduced their television viewing, video game use, and number of meals eaten in front of the television. Intervention participants also significantly slowed their gain in BMI, triceps skinfold thickness, waist circumference, and waist-to-hip ratio compared with the children in the control school. In a subsequent 2-year trial, 70 4- to 7-year-olds and their families were randomly assigned to either receive a screen-time reduction intervention that involved installing an electronic television time manager in their home or a control parenting intervention. 8 Compared with controls, children in the screen-time reduction group had significant decreases in television viewing and computer use, energy intake, and age- and sex-adjusted BMI that persisted for 2 years. An analysis of possible mediators suggested that the effects of reduced screen time on changes in BMI were associated with reductions in dietary energy intake but not increased physical activity measured by accelerometry. These studies that focused solely on reducing screen media exposure are also joined by other experimental studies of reducing screen time along with changes in diet, physical activity, and other obesity risk behaviors that have produced reduced obesity and weight gain or obesity compared with controls. 7 Together these studies demonstrate a direct cause and effect relationship between screen media viewing and weight gain and demonstrate that reducing screen media time results in less BMI gain in children.
How Does Screen Media Exposure Lead to Obesity?
A number of possible mechanisms are thought to explain the effects of screen media exposure on obesity. 2, 9 These include displacing physical activity, increasing energy intake from eating while viewing and/or the effects of advertising, and reducing sleep.
Although it is often assumed that screen media time displaces time spent being more physically active, epidemiologic studies have only inconsistently revealed cross-sectional or prospective associations between screen time and less physical activity. This may be because of the difficulties in validly measuring both screen media exposure and physical activity. Experimental studies of reducing screen time have generally revealed only small if any measurable increases in physical activity. 6 This suggests that displacement of physical activity may not be a strong link between screen time and obesity.
In contrast, much more evidence supports screen media effects on energy intake as the prominent mechanism linking screen time and obesity in children. Epidemiologic studies reveal that children who consume more screen media also consume fewer fruits and vegetables and more energy-dense snacks, energy-dense drinks and fast food, receive a higher percentage of their energy from fats, and have a higher total energy intake. 10, 11 Laboratory-based experimental studies have revealed that screen media exposure can lead to incremental energy consumption without increased feelings of hunger or compensation by lower intake during the rest of the day. 12 Screen-time reduction interventions also have documented reductions in dietary intake compared with controls. 7, 8
Eating while viewing is one important way that screen media exposure increases children’s energy intake. Studies have revealed that children consume a large proportion of their daily calories and meals while watching screen media. In 1 study, up to a third of daily energy intake and half of children’s meals were consumed in front of a screen. 13 Some of this effect may be because of the large amount of time spent with screens, the types of high-energy foods and beverages that are consumed while viewing, media acting as a trigger or prompt to eating, media extending the duration of eating, or media distracting from or obscuring feelings of fullness or satiety. 14
Food advertising is another explanation for the link between screen media exposure and excess energy consumption. 15 According to the Federal Trade Commission, food and beverage companies spent $1.8 billion on marketing to children and adolescents in the United States in 2009. 16 It is estimated that in 2014, 2- to 11-year-olds and 12- to 17-year-olds saw an average of 12.8 and 15.2 food, beverage, and restaurant advertisements per day on television, respectively. 17 In addition, youth are now exposed to marketing in new media, including food company-sponsored websites, apps, and advergames as well as in advertising on third-party children’s websites and marketing via mobile devices and social media. 16 This new marketing is engaging and often disguised as entertainment or messages from friends, making it more difficult for children, even older children, to recognize its persuasive intent. 18 Research shows that food advertising impacts children’s food preference and food intake. 15 Again, the strongest evidence comes from experimental studies. For example, randomized controlled trials of food commercials embedded in animated programs revealed that advertising increases automatic eating for foods not being advertised, 19 and even a single 30-second commercial impacts brand preferences. 20 In addition, a randomized controlled trial also revealed that fast food branding altered young children’s actual taste perceptions in side-by-side taste tests. 21
Inadequate sleep is another likely mechanism linking screen media exposure, excess energy consumption, and obesity. A recent systematic literature review of screen time and sleep found that over 90% of the studies demonstrated positive associations between screen time and adverse sleep, usually measured by later bedtimes and less total sleep time. 22 Sleep deprivation has been associated with increased obesity and weight gain among children, most consistently among those between ages 3 and 7. 23, 24 At least 3 possible mechanisms have been suggested: sleep deprivation causes changes in the appetite-regulating hormones ghrelin and leptin to increase hunger and decrease satiety, short sleep duration can affect children’s choices to consume more calories and fewer nutritionally-dense foods, and shorter sleep duration may lead to increased snacking and eating outside of normal mealtimes, including during the night. 23
You always eat out for lunch
If your lunch break is consistently you running out to a local spot or out the door to meet a delivery guy, then chances are you're eating up more calories, salt, and sugar than if you just ate a lunch from home. Restaurant options are often spiked with diet-destroying sauces and belly-bloating sodium. And when you eat out, you often say "yes" to more than you need. And your local place is just as to blame as the McDonald's down the block. A study published in the Journal of the American Academy of Nutrition and Dietetics found that restaurant food is as caloric as fast-food. Researchers found that 92% of meals gathered from both large-chain and local restaurants three cities contained on average 1,205 calories—nearly 60% of the FDA's daily recommended intake of 2,000.
Eat This! Tip:
To stay away from those unwanted calories, brown bag it. With these 25 Super-Healthy Lunches Under 400 Calories you're set to make an awesome week's worth of lunches.
7 Weird Things That Might Be Widening Your Waist
You can work out like a champ, eat virtuously, and get sound sleep but still stay thick around the middle. Blame some newly discovered triggers that undermine your slim-down efforts by making you pack on the belly flab. Take note, and trim down.
Living on a Busy Street
Regular exposure to traffic noise makes you 29 percent more likely to have a bigger waistline, according to findings in Occupational & Environmental Medicine. (That risk escalates further if you&aposre constantly hearing planes, trains, and automobiles.) (Read more: Living Near Traffic Noise Linked to Higher BMI.) Other research found that such noise may spike your cortisol, a hormone associated with ab fat. Three suggestions for you: Drown out the noise by playing soothing music (studies revealed that such tunes lower cortisol levels), muffle the clamor with a background- noise machine, or pop in noise-canceling earbuds when you need to focus.
Your Diet Soda Habit
Ironically, people who sip the no-cal stuff in an effort to cut calories are actually more likely to gain belly fat. Diet soda drinkers who averaged about a can and a half a day packed 3.2 inches onto their waistlines over the course of nine and a half years, while regular soda drinkers gained less than an inch, a recent study at the University of Texas Health Science Center found. One reason is that artificial sweeteners prevent the brain from registering satiety, thus increasing cravings for sweets, so you end up eating more, says study author Helen Hazuda, Ph.D. If you can&apost give up the bubbles, switch to naturally flavored calorie-free seltzers, which are made without any sweeteners (snapping open the can and sipping the slightly tangy carbonated drink can mimic the diet soda experience), or for your caffeine fix, go for unsweetened coffee or tea, Hazuda suggests.
Brown University researchers found that people who were able to focus their thoughts on the present carried about a pound less of belly fat, on average, than those who weren&apost as mindful. The scientists speculate that because mindful people are able to view their feelings more objectively, they have greater power to overcome urges-for example, resisting a second drink at happy hour in favor of pushing it in an a.m. Spinning class. Cultivate your focus by meditating, practicing yoga, or engaging in endurance exercise, such as going for a long run or bike ride, which encourages you to constantly monitor your pace, the way your body is moving, and how you&aposre feeling, says study author Eric Loucks, Ph.D. (Did you know Multitasking with Technology Can Rewire Your Brain?)
Skimping on Calcium
Fifty-seven percent of women are falling short on the recommended daily allowance of calcium, and it may be showing in their waist measurements. Dairy, which is rich in calcium, can help flatten your belly, a study published in the journal Nutrients found. When subjects ate three daily servings of milk-based products for 12 weeks, they lost about 2.2 pounds more belly fat than those who consumed less of the same stuff. That&aposs because foods loaded with calcium better suppress a type of hormone that promotes fat storage, the researchers speculate. Aim to eat three servings a day of high-calcium foods like milk, yogurt, cheese, broccoli, kale, and tofu.
The longer you travel to your job, the wider your waistline, according to a study of almost 4,300 workers conducted at Washington University. The top reason? A longer trip means less time to work out. You may not be able to change how you get to the office, but you can build activity into your commute by parking a mile or two from your workplace or train stop and walking, biking, or running the rest of the way. Or join a gym that&aposs on your route and keep clothes and sneakers in the car so you can pop in on your way home, suggests sport psychologist Amanda Visek, Ph.D. (One woman shares: "How (and Why) I Run Commute to Work.")
Tossing and Turning
Tons of studies have shown that sleep deprivation can increase cortisol levels. But a new German study found that the quality of your sleep matters too and that people who don&apost sleep soundly have more fat. "Waking up in the middle of the night as a result of things like snoring, nightmares, restlessness, or a baby crying happens commonly actually, we&aposre wired to naturally wake up a few times," says José Colón, M.D., the author of The Sleep Diet. "But if you wake up and immediately start panicking about falling back asleep, that can raise cortisol levels." Dr. Colón suggests turning your alarm clock over so you don&apost fixate on the time. Sometimes circumstances prevent you from getting seven to eight consecutive hours of sleep. Sleeping in blocks of three or four hours, however, is still restorative.
Watching food TV
OK, so it&aposs no surprise that young women who watch more than three hours of TV a day have significantly more belly fat than those who watch an hour or less a day-lying on the couch with your hand in a bag of pretzels isn&apost exactly a recipe for weight loss. Researchers found that tuning in to cooking programs also boosts your risk of gaining weight. People who watch food TV and cook the featured dishes weigh 10 pounds more than people who find recipes elsewhere. (Yep, Food Network Is Making You Fat.)
Binge-watching: Impacting mental and physical health
The concept of watching television has transitioned significantly since the last decade. Traditional television scheduling made viewers stick to the timings of television programming, subjected them to commercials, and made them wait for their favourite shows or films for days or weeks (1). In this digital era, the methods and speed of watching television series have undergone significant changes. On-demand television and online streaming services (e.g., Netflix, Amazon, Disney, Fox, Hulu, when only limited to legal downloading platforms) have gained immense success in recent years by eliminating the restrictions of time and place (2).
Binge-watching (defined as watching between two and six episodes of a TV show in one sitting) has quickly become a common practice among the audience population in this context, most of whom report this as their preferred means of consuming TV entertainment. More precisely, this is an option to spend an evening or a weekend glued to the television, indulged in the consumption of several episodes or even in a single sitting of a whole season of TV shows. Between 2011 and 2015, the prevalence of binge-watching grew to gradually become a standard form of consuming TV series among the general public (3). As of the third quarter of 2020, Netflix had 190 million paying subscribers worldwide. This number grew exponentially, from 5 million in 2012 to more than 190 million in 2020 (4).
People with binge-watching habits sometimes watch several episodes in one go. Also, when an online streaming service simultaneously released all episodes of a season, it prompted widespread “marathon-viewing” sessions among the 18-34 age group who initially binge-watched and then took to social media to share their (apparently positive reviews of such shows. Given this reality, the Tele-industry spends on web series that force people to binge-watch and sometimes all episodes of a particular web series season are released simultaneously to encourage this activity (5).
Impact of binge-watching on Mental health
Binge-watching has undeniably become the norm and engaging way for the contemporary audience to consume media content, such as television shows. This phenomenon has been observed since 2013, but research is still sparse on its psychological conditions, such as personality characteristics and motivational and emotional mechanisms. The likelihood of developing signs of behavioural addiction is the main risk behind repetitive binge-watching behaviour. Recent literature points out that excessive forms of binge-watching could be equivalent to behavioural addictions such as video games/internet addiction or problematic use of social media. This highly immersive behaviour offers instant pleasure and can therefore contribute to the loss of self-control and spending far more time watching television shows than the individual intended initially (3).
Research also shows the association between sedentary behaviour of this sort and neglect of work or social relationships, lack of sleep, procrastination at bedtime, overweight as well as an increase in unhealthy consumption of food (3).The correlation of binge-watching with mood disturbances, sleep disturbances, fatigue, and self-regulation deficiency is confirmed by existing evidence (5). As a sedentary pattern of behaviour, binge-watching is also linked to unhealthy food intake and decreased physical activity, especially among young people.
Other hazardous health consequences due to binge-watching impacting physical health
Instead of going out and becoming physically active, more and more people choose to stay indoors and watch television. Reduced sleep quality, daytime fatigue and insomnia are correlated with binge-watching frequency, with cognitive pre-sleep arousal mediating these relationships, whereas a balanced diet is negatively associated with overall binge-watching (6). Also, research has shown that watching a lot of television raises the risk of obesity by 23% (7). Another reason for the increased risk of weight gain is that watching series for a long time is often linked to the consumption of unhealthy food, implying that people are more likely to consume food that is high in fat and carbohydrates (8). The increased risk of type 2 diabetes, fatal or non-fatal cardiovascular disease and all-cause mortality has also been shown to be consistently related to a longer span of TV viewing time (9). As binge-watching rates increased, questions about physical inactivity resulting in health risks is emerging at an exponential rate.
Binge-watching during the era of COVID-19
People all around the globe, of all age groups, are experiencing anxiety and mental breakdown during the COVID-19 lockdown phase. Such a situation provides a perfect scenario for engaging in online games and watching television as people experience days of loneliness at home. In-home environments, as leisure outlets, are restricted, and internet/TV is easily accessible, readily available, and of course, affordable it can lead to binge-watching. There seems to be an uptick in binge-watching in the new COVID-19 pandemic situation with a global lockdown state, as individuals have nothing to do (5). During this pandemic, as the sources of entertainment and social interaction has reduced, people all around the globe began to concentrate on the readily accessible modes of entertainment in their home settings. The psychological motivation found for binge-watching is to pass the time and avoid boredom, reduce stress, and overcome loneliness.
An online survey conducted in the general population of four Southeast Asian countries (Bangladesh, India, Indonesia & Nepal) indicates that during the lockdown period, there is a substantial increase in binge-watching with an increase in an average time of 3-5 hours and 5+ hours of binge-watching. This study also revealed that often binge-watching causes significant sleep disturbance, disrupt work completion, and causes conflicts with others.
Therefore, it can be concluded that following back-to-back episodes of a particular show may stimulate the brain, and consequently, interferes with one`s ability to sleep. Other adverse effects on health include depression and anxiety, spinal issues, lack of oxygen, lack of physical activity, and a bigger waistline (10). These effects are the leading risk factors for heart disease and stroke. Limiting binge activity may be beneficial for individuals, as per current evidence, and may also prevent the development of lifestyle-related disorders.
- Umesh S, Bose S. Binge-Watching: A Matter of Concern? Indian J Psychol Med. 201941(2):182–4.
- Flayelle M, Maurage P, Karila L, Vögele C, Billieux J. Overcoming the unitary exploration of binge-watching: A cluster analytical approach. J Behav Addict. 2019 Sep 18(3):586–602.
- Starosta JA, Izydorczyk B. Understanding the Phenomenon of Binge-Watching—A Systematic Review. Int J Environ Res Public Health [Internet]. 2020 Jun [cited 2020 Nov 17]17(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344932/
- Netflix: number of subscribers worldwide 2020 [Internet]. Statista. [cited 2020 Nov 17]. Available from: https://www.statista.com/statistics/250934/quarterly-number-of-netflix-streaming-subscribers-worldwide/
- Dixit A, Marthoenis M, Arafat SMY, Sharma P, Kar SK. Binge watching behavior during COVID 19 pandemic: A cross-sectional, cross-national online survey. Psychiatry Res. 2020 Jul289:113089.
- Flayelle M, Maurage P, Di Lorenzo KR, Vögele C, Gainsbury SM, Billieux J. Binge-Watching: What Do we Know So Far? A First Systematic Review of the Evidence. Curr Addict Rep. 2020 Mar 17(1):44–60.
- Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003 Apr 9289(14):1785–91.
- (13) (PDF) Overcoming the unitary exploration of binge-watching: A cluster analytical approach [Internet]. [cited 2020 Nov 17]. Available from: https://www.researchgate.net/publication/335589973_Overcoming_the_unitary_exploration_of_binge-watching_A_cluster_analytical_approach
- Grøntved A, Hu FB. Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality A Meta-analysis. JAMA. 2011 Jun 15305(23):2448–55.
- Binge Watching | Northwestern Medicine [Internet]. [cited 2020 Nov 17]. Available from: https://www.nm.org/healthbeat/healthy-tips/emotional-health/binge-watching
Dr Swati Sapna is a dental surgeon and currently a postgraduate student pursuing Masters of Public Health (Epidemiology) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.
Upasna Gaba is a pharmacist and currently a postgraduate student pursuing Masters of Public Health (Health Policy) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.