Healthy Food & Healthy Living by Dr. Ayala

Does Instagram make kids overeat?

Can you imagine photography-free dining? It isn’t easy. I’d bet that the food-photo to phone-call ratio on many teens’ smartphones favors food images. Food dominates much of social media; we are fed with food images as often as mama bird shares real food with her newly hatched chicks.

And while so many of us document our meals and snacks for a multitude of unclear reasons, there are professionals making a living off their stylized, gorgeous photos. Food manufactures and brands seek influencers with engaging content in order to reach their fanbase. Products are integrated into the feed of influencers in a way that makes it hard to discern that’s marketing and what’s content.

It’s already established that ads on TV and other traditional media affect kids’ food choices, and play a part in the obesity epidemic.

Instagram marketing may have just the same effect.

First with your eyes, then with your mouth

A new study in Pediatrics examined the effect of Instagram influencer marketing. 178 British kids, aged 9-11 years were randomly assigned to one of three influencer-marketing conditions: healthy food images, unhealthy food images, or non-food images as the control.

The influencers were a 26-year-old female video blogger and a 23 year-old male YouTube video blogger with millions of followers and subscribers. Each child was exposed to both the male and the female influencer, and was shown mock, photo-edited images that looked like a real Instagram feed with 6 images, 3 test ones, and 3 fillers. Test images had the celebrity holding an unhealthy snack – cookies – or healthy snacks – a banana – or a branded control that isn’t food – sneakers.

After looking at the images the kids were treated to snacks. They could choose from jelly candy, chocolate buttons, carrots or grapes, and eat as much as they wanted.

Exposure to marketing affected the kids’ immediate intake:

Kids shown the unhealthy Instagram feed consumed 26 percent more calories overall than those shown no food, and 15 percent more than those shown healthy foods.

Kids shown the unhealthy Instagram feed consumed 32 percent more calories from unhealthy snacks than those shown no food (control), and 20 percent more than those shown healthy foods.

Could Instagram make you overeat?

I think that nobody will be surprised to learn that marketing a product increases its sales – why else would brands invest money in it?

But another growing concern is just the sheer abundance of junk food offline and online, because junk food marketing, we’re learning, not only lifts the sales of the advertised brand: it has an overall effect of making us eat more.

Junk food abundance, both in real life – offered wherever kids go, sold in every corner, vended from machines placed strategically – and in images, may be central to our obesogenic environment.

It turns out that just having appetizing food around, even in a picture, might push kids to eat just a little bit more. And years of just an extra half cookie can be enough to launch a kid into overweight or obesity.

As kids shift their media consumption towards mobile and social media it’s imperative that we learn how new technologies and content impact their habits and health.

Dr. Ayala

Does online food shopping promote healthy eating?

One of the things I like about grocery shopping is meeting people I know and chatting with the cashier. I dread the Silicon Valley world in which Monica realizes that she’s the only person in the supermarket buying things for herself – the rest are professionals fulfilling online orders. But still, the fourth or fifth message from Whole Foods finally got through my barriers. Incentives and insistence made me place an order.

My first inclination was to avoid ordering fresh produce, which I usually decide upon only after seeing what’s good right now, and then I’m not shy about looking through the pile for the best looking, least bruised apples and the perkiest kale. But the whole point was testing the fresh produce, so I did order some greens and fruit.

As promised, my package arrived within the two-hour window, nicely packed. The produce quality was fine.

Just like me, at least on that busy Thursday, many people are trying online grocery shopping. According to a Nielsen survey 50 percent of American shoppers currently order groceries online, and they predict that 70 percent of consumers will be doing it by 2024.

How is this shift going to impact eating habits?

Clicking for groceries: the good and the bad

A new study in Public Health Nutrition gathered all the relevant research papers published in the past 10 years to see what research can teach us about the potential of advancing health through online shopping. There were 24 studies that met the inclusion criteria. Here are some of the findings:

The authors find several potential positives:

Fewer impulse purchases: Most supermarkets are designed to maximize impulse purchases, and the items that are placed to tempt us as we walk around and linger around the cashier tend to be the less healthy ones. The studies found that the online shopping environment, at least for now, makes it easier to avoid tempting unhealthy foods, and people report they buy more of what they ‘need’, less of what they ‘want’, and fewer ‘vices’.

Online displays can help with healthy decisions: Six studies that focused on advancing healthier decisions in online selections found that the first screen the shoppers see is the most powerful tool to influence their purchase decisions. People don’t look at nutrition information much – even when they’re trying to lose weight or have allergies. The ability to shape that first screen, perhaps even according to the consumer’s needs and preferences, can help shape healthier habits.

Addressing food deserts: Online grocery shopping can be an option for people in rural and urban food deserts, as well as for people with limited mobility, due to disability or lack of transportation. The online space can provide access to healthy foods when the local environment doesn’t.

There are several potential downsides that the studies demonstrate:

Fresh aversion: People reported that they’re less likely to buy perishables and fresh produce online.

Inequality in access persists: Areas not well served by brick-and-mortar grocery stores also see shipping and delivery that’s more limited and more expensive. People with low income also may not have Internet access, credit cards, and online grocery shopping doesn’t currently accept SNAP and WIC benefits (nutrition assistance programs).

Bottom line

Whether we like it or not, online grocery shopping, the final online frontier, is being conquered. It can never replace touching the vegetables, finding inspiration in produce section and meeting farmers at the farmers’ market. And we didn’t even get into the environmental pros and cons of deliveries – these are complex and the net effect will depend on efficiencies and optimization.

On the other hand, as this study shows, online grocery shopping makes sticking to your list easier, it can advance better food choices if done right, it can save time, maybe save money, and it can provide access to healthy ingredients when access is limited.

Are you a fan?

Dr. Ayala

Does electronic media make kids fat?

Why are today’s kids so much heavier than kids of previous generations?

The classic answer is that kids today are taking in more calories and spending less energy: They spend less time playing outdoors and have stopped working on the farm and doing chores – but hey, haven’t they stopped doing that a long time ago?

The energy expenditure side of the equation is the pet project of fast-food and junk-food makers.  Oh, if we could only give kids another hour of gym! If only kids could balance their ravenous appetite for snacks with a little more outdoor play we wouldn’t have to voice the unthinkable “eat less” advice.

But the numbers just don’t add up.  In order to eat like the TV ads suggest kids would have to increase physical activity to what amounts to no time left for homework or sleep.

I’d like to take an honest look at how sedentary activities really affect kids’ waistlines. 

An article in Obesity Reviews looked at the current trends of childhood pastimes, and how those affect not only energy expenditure, but also energy consumption.  Let’s take a look:

TV viewing

Kids watch many hours of TV and high rates of TV viewing are correlated with obesity.  While sitting on a comfy couch is super sedentary, watching TV has many other effects on energy balance. 

20-25 percent of daily calories are consumed in front of the TV.  This distracted eating increases intake of calorie-dense food (i.e. highly processed foods with lots of calories).

A study showed that 36 percent more pizza and 71 percent more mac&cheese were consumed when eaten in front of the TV, compared to meals eaten without the TV on.

For many people TV watching is associated with snacking.  They’ll munch while watching whether hungry or not, and if they ever forget to bring the munchies, an ad – so many of the TV ads are for junk-food -- will no doubt remind them that something is amiss.

Video games

Video and computer games fill many hours in the average kid’s day.   Video games are relatively new, and their effect on obesity has been studied less extensively than that of TV's, but observational studies show a connection, and a recent study showed obesity and overweight doubling for every extra hour spent playing electronic games.

Again we can argue that (non-active) video games are pretty sedentary, but the studies show that playing video games makes kids eat more.  Just like TV, video gaming leads to eating, the reflexive non-hunger kind of eating.

And don’t forget advertisers target video gamers on these platforms, too.

A single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.

Sleep

Who wants to sleep when there’s so much to do?  The presence of electronic devices such as a computer, TV or smart phone in the bedroom has been shown to delay sleep.

It seems counterintuitive, but shorter sleep duration is associated with increased risk of obesity.  It might be that being awake at night gives opportunity for late-night snacking; it might be that fatigue leads to inactivity the next day; and maybe lack of sleep messes up our hunger and appetite regulation.

We’re sleeping less – studies show that sleep has gone down by more than an hour over the past decades – and since sleep isn’t a waste of time, the barriers to sleep (many of them electronic) are hurting our health.

Media consumption begets food consumption

A recent Kaiser Family Foundation study showed that 8-18 year-olds devote an average of 7½ hours (!) to using entertainment media in a typical day.  Much of that time is spent media multitasking -- using more than one medium at a time. From what we learn from other studies we know that much of our kids’ multitasked media time also involves another added and almost automatic activity: snacking. 

Much more significant than the low energy expenditure toll of media consumption is its pairing with distracted eating.

Victorian ladies weren’t known for their workouts.  But they didn’t snack while embroidering.  Eating used to be prompted by hunger and traditional mealtimes.  Now, it’s prompted by an ad and constant availability of highly processed high-calorie food.

Uncoupling the TV, computer and video from it’s by now natural companion – sugary drinks, snacks and ready to eat meals – is a tall task.

Any ideas on where to start?

Dr. Ayala

 

Can Google be trusted with your health?

It’s the middle of the night. Your baby’s sick. You’re sick with worry.

Ever thought of Googling his symptoms for some free medical advice or a second opinion?

Many people use the Internet for health-related information, and used correctly it’s a great resource. But how reliable or accurate is a search engine without medical guidance?

A group of British researchers found that health information on the Internet ranges from poor to excellent, depending on the topic and the resource. They Googled UK-based websites on five common pediatric issues in which the best practice is pretty clear, and found that only about 200 of 500 sites offered correct information. The results of their study were published in the Archives of Disease in Childhood.

The five search topics chosen for the study were "MMR autism" (current practice: there’s no association between the vaccine and autism), "HIV breastfeeding" (current practice: HIV-positive moms are advised not to breastfeed), "mastitis breastfeeding" (current practice: a mom with mastitis should breastfeed), "baby sleeping position" (current practice: a baby should be put to sleep on his back) and "green vomit"(current practice: if baby vomits green, go see a doctor).

Their analysis showed that governmental sites were accurate every time. Educational sites, companies, interest groups and individual’s sites performed rather well, and were accurate around 80 percent of the time. News sites did poorly (they had a 55 percent “correct” rate), and no sponsored site gave correct advice.

The authors conclude:

“Healthcare professionals should continue to strive to be the main source of information for patients but we should be aware that most will continue to use the internet to gather information. We suggest that in addition to verbal and written information, patients and parents should be signposted to NHS (National Health Service), governmental or other preapproved websites”

Google has no clinical judgment

This study posed to Google questions to which there are only two possible answers. Most health questions are much more complicated, and a search result brings in an enormous amount of information to sift through.

If your child has a fever—perhaps the most common reason to see a pediatrician—a search engine is practically of no help at all. A study looking at advice for kids with a fever found only three out of 22 sites visited gave information which matched current "best practice" guidelines. You may wind up worrying your head off over exotic and life-threatening causes of fever which have no relevance to your child. But how would you know? A study of Internet information on lumbar disc herniation ("slipped disc") found that less than 10 percent of relevant websites were of high-quality. Try searching “headache” and see what comes up.

Doctors don’t have secret information. Even complicated medical knowledge is widely available. The Internet is full of good information—and bad information and misinformation, too. Making sense of the information is what’s become harder and harder to do.

Doctors work many years to master clinical judgment—the application of information gathered from talking to and examining patients, combined with knowledge of the science of medicine, and that impossible-to-define art of medicine—that’s what makes a good doctor.

There’s no recipe for acquiring clinical judgment. The knowledge-base needs to be there (a service Google provides fairly well), but the thoughtful application of information comes from immersion in the care of patients, experience, interaction with peers and mentors, and a constant refinement and learning process. I don’t think a machine will ever be able to learn clinical judgment.

The Internet is one of my favorite inventions of all time, but it will never be able to answer complicated health questions, nor will it ever be able to offer comfort or compassion. Surfing health issues on the Internet is a great example of how a little knowledge can be a very dangerous thing.

Nevertheless it’s a great resource for gathering information—provided you use reliable and authoritative sources—and that knowledge can be a great starting point for a discussion with a health professional who can help make sense of it all, put things in perspective and individualize it to your specific health issue.

Do you use the Internet for health related issues? Who do you trust?

I promise to share some of my favorite online sources of reliable medical information in a future post.

Dr. Ayala