European Journal of Cardiovascular Medicine

Childhood obesity has emerged as a major public health challenge globally, with significant short- and long-term consequences for physical and mental health. The World Health Organization (WHO) estimates that over 340 million children and adolescents aged 5–19 were overweight or obese in 2016, with the numbers continuing to rise steadily across both developed and developing countries [1]. Multiple factors contribute to this epidemic, including poor dietary habits, reduced physical activity, and increasingly, the pervasive influence of screen-based technologies.

In recent years, screen time has become an integral part of children’s daily routines through television, smartphones, tablets, and computers. Excessive screen exposure has been linked to sedentary behavior, reduced physical activity, and unhealthy dietary patterns [2], [3]. Moreover, screen time often coincides with mindless snacking or meal skipping, thereby disrupting normal eating behaviors and contributing to an energy imbalance [4].

Emotional eating, defined as the tendency to eat in response to emotional cues rather than physiological hunger, has been identified as a maladaptive coping mechanism in children experiencing stress, boredom, or anxiety [5]. Studies suggest that increased screen use may influence emotional regulation in children, potentially leading to greater reliance on food for comfort [6]. Furthermore, advertisements promoting high-calorie, low-nutrient foods are frequently encountered during screen exposure, which may exacerbate unhealthy food choices and emotional eating tendencies [7].

Although individual associations between screen time, emotional eating, and obesity have been studied, few investigations have concurrently assessed the interrelationship among these factors in school-aged children. Understanding these interactions is crucial for developing effective prevention strategies targeting modifiable behavioral risk factors.

The present study aims to evaluate the impact of screen time on emotional eating behaviors and its association with obesity risk in school-aged children.

Study Design and Participants

This cross-sectional observational study was conducted over a 6-month period in three urban primary schools. A total of 300 children aged between 8 and 12 years were randomly selected using stratified sampling to ensure equal representation of gender and age groups. Prior to data collection, written informed consent was obtained from the parents or guardians, and assent was taken from all participating children.

Inclusion and Exclusion Criteria

Children aged 8–12 years who attended school regularly and had access to personal or shared screen-based devices (e.g., television, smartphone, tablet, computer) were eligible. Children with diagnosed psychological or developmental disorders, chronic medical conditions affecting growth or appetite, or those on medications influencing weight or mood were excluded.

Assessment of Screen Time

Screen time was recorded through a parent-reported questionnaire that captured average daily time spent on various devices, including television, smartphones, tablets, and computers. Based on the responses, participants were categorized into three groups:

• Low screen time: <2 hours/day
• Moderate screen time: 2–4 hours/day
• High screen time: >4 hours/day

Emotional Eating Assessment

Emotional eating behavior was evaluated using the validated Children’s Eating Behaviour Questionnaire (CEBQ), focusing on the “Emotional Overeating” subscale. Scores ranged from 1 (never) to 5 (always), with higher scores indicating greater emotional eating tendencies.

Anthropometric Measurements

Weight was measured using a calibrated digital scale, and height was recorded using a wall-mounted stadiometer. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m²). BMI percentiles were determined based on WHO growth reference charts for age and sex. Participants were classified into:

• Normal weight: BMI <85th percentile
• Overweight: BMI 85th–94th percentile
• Obese: BMI ≥95th percentile

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS software version 25. Descriptive statistics (mean, standard deviation, and percentage) were calculated. One-way ANOVA was used to compare means across screen time groups, and Pearson correlation was applied to assess the association between screen time, emotional eating scores, and BMI. A p-value less than 0.05 was considered statistically significant.

A total of 300 children participated in the study, with a nearly equal distribution of males (51.3%) and females (48.7%). The participants were grouped based on their daily screen time: low (<2 hours/day), moderate (2–4 hours/day), and high (>4 hours/day). Table 1 summarizes the demographic and screen time characteristics of the study population.

Table 1: Distribution of Participants Based on Screen Time and BMI Classification

As shown in Table 1, the prevalence of overweight and obesity was significantly higher among children with greater screen time exposure. The high screen time group exhibited the highest combined prevalence (43%) of overweight and obesity compared to the low screen time group (11.7%) (p < 0.01).

Emotional eating scores increased proportionally with screen time duration. The mean emotional eating score in the high screen time group was 4.2 ± 0.6, compared to 3.4 ± 0.5 in the moderate group and 2.8 ± 0.4 in the low screen time group. These differences were statistically significant (p < 0.001) (Table 2).

Table 2: Comparison of Emotional Eating Scores Across Screen Time Groups

A positive correlation was found between screen time and both BMI (r = 0.41, p < 0.01) and emotional eating score (r = 0.47, p < 0.001), as shown in Table 3.

Table 3: Pearson Correlation Between Screen Time, Emotional Eating, and BMI

These findings demonstrate a significant association between higher screen time, elevated emotional eating behaviors, and increased obesity risk among school-aged children (Tables 1–3).

This study highlights a significant association between increased screen time, emotional eating behavior, and obesity risk among school-aged children. The findings revealed that children with higher screen exposure (>4 hours/day) demonstrated elevated emotional eating scores and a greater prevalence of overweight and obesity, consistent with prior literature.

Excessive screen time has long been associated with sedentary behavior, reduced physical activity, and increased caloric intake, all of which contribute to positive energy balance and weight gain in children [1], [2]. Our results support this, as nearly 43% of children in the high screen time group were either overweight or obese. A meta-analysis by Wu et al. also reported that screen time exceeding two hours per day significantly increases the risk of childhood obesity [3].

One notable observation in this study was the positive correlation between screen time and emotional eating tendencies. Emotional eating, often triggered by stress, boredom, or anxiety, can result in overconsumption of energy-dense foods [4]. This aligns with the findings of Nguyen-Rodriguez et al., who suggested that children engaging in emotional eating are more likely to consume sugary and high-fat snacks during screen use [5]. Prolonged screen exposure can act as a source of emotional arousal or escape, encouraging mindless eating habits [6], [7].

Moreover, digital content often exposes children to advertisements for unhealthy foods, influencing their preferences and increasing consumption of processed snacks and sugary beverages [8], [9]. Harris et al. found that children exposed to food advertisements consumed 45% more food shortly afterward, irrespective of hunger status [10]. Our study reinforces this connection, with emotional eating scores significantly higher in children with greater screen exposure.

The link between emotional eating and BMI also deserves attention. Children who reported higher emotional eating tendencies showed increased BMI percentiles, similar to findings from van Strien et al. who identified emotional eating as a predictor of weight gain in both children and adolescents [11]. Furthermore, repeated exposure to screens, especially before bedtime, may alter sleep patterns, leading to hormonal dysregulation (leptin and ghrelin imbalance), which influences hunger and satiety [12], [13].

Interventions targeting reduced screen time and promoting emotional regulation may prove beneficial in controlling unhealthy eating behaviors. School-based programs incorporating physical activity, nutrition education, and screen time awareness have demonstrated positive outcomes in modifying behavior and preventing obesity [14], [15].

While this study provides valuable insights, it is not without limitations. The use of self-reported screen time and emotional eating questionnaires may introduce recall and reporting bias. Additionally, the cross-sectional nature limits causal inference. Longitudinal studies are warranted to better understand the temporal relationship between these variables.

In conclusion, our findings emphasize the multifactorial influence of screen time on children's dietary behaviors and body weight. Addressing screen exposure alongside emotional eating patterns could be a strategic component in childhood obesity prevention efforts.

1. Votsi IC, Koutelidakis AE. How Screen Time Affects Greek Schoolchildren's Eating Habits and Functional Food Consumption? A Cross-Sectional Study. Nutrients. 2025;17(8):1311. doi:10.3390/nu17081311. PMID: 40284175.
2. Pérez-Farinós N, Villar-Villalba C, López Sobaler AM, Dal Re Saavedra MÁ, Aparicio A, Santos Sanz S, et al. The relationship between hours of sleep, screen time and frequency of food and drink consumption in Spain in the 2011 and 2013 ALADINO: a cross-sectional study. BMC Public Health. 2017;17(1):33. doi:10.1186/s12889-016-3962-4. PMID: 28056890.
3. López-Gil JF, Quiroz-Cárdenas F, Montenegro-Espinosa JA, Cisneros-Vásquez E, Miño C, Castillo-Miñaca ME, et al. Eating distractions as predictors of ultra-processed food consumption and Mediterranean diet adherence in adolescents. Sci Rep. 2025;15(1):7579. doi:10.1038/s41598-025-91754-x. PMID: 40038379.
4. Rey-López JP, Vicente-Rodríguez G, Répásy J, Mesana MI, Ruiz JR, Ortega FB, et al. Food and drink intake during television viewing in adolescents: the HELENA study. Public Health Nutr. 2011;14(9):1563–9. doi:10.1017/S1368980011000383. PMID: 21338558.
5. Borghese MM, Tremblay MS, Leduc G, Boyer C, Bélanger P, LeBlanc AG, et al. Independent and combined associations of total sedentary time and television viewing time with food intake patterns of 9- to 11-year-old Canadian children. Appl Physiol Nutr Metab. 2014;39(8):937–43. doi:10.1139/apnm-2013-0551. PMID: 24892903.
6. Oliveira GAL, Gonçalves VSS, Nakano EY, Toral N. The effect of parents' lifestyle on schoolchildren's consumption of ultra-processed food. Public Health. 2024;237:443–8. doi:10.1016/j.puhe.2024.11.005. PMID: 39536665.
7. Avery A, Anderson C, McCullough F. Associations between children's diet quality and watching television during meal or snack consumption: A systematic review. Matern Child Nutr. 2017;13(4):e12428. doi:10.1111/mcn.12428. PMID: 28211230.
8. Buja A, Miatton A, Zanovello A, Brocadello F, Baldovin T, Muhiddin MN, et al. Media usage and adherence to the Mediterranean diet in children. Nutrients. 2024;16(20):3481. doi:10.3390/nu16203481. PMID: 39458476.
9. Utter J, Scragg R, Schaaf D. Associations between television viewing and consumption of commonly advertised foods among New Zealand children and young adolescents. Public Health Nutr. 2006;9(5):606–12. doi:10.1079/phn2005899. PMID: 16923292.
10. Taveras EM, Sandora TJ, Shih MC, Ross-Degnan D, Goldmann DA, Gillman MW. The association of television and video viewing with fast food intake by preschool-age children. Obesity (Silver Spring). 2006;14(11):2034–41. doi:10.1038/oby.2006.238. PMID: 17135621.
11. Jensen ML, Dillman Carpentier FR, Corvalán C, Popkin BM, Evenson KR, Adair L, et al. Television viewing and using screens while eating: Associations with dietary intake in children and adolescents. Appetite. 2022;168:105670. doi:10.1016/j.appet.2021.105670. PMID: 34478756.
12. Ghobadi S, Totosy de Zepetnek JO, Hemmatdar Z, Bellissimo N, Barati R, Ahmadnia H, et al. Association between overweight/obesity and eating habits while watching television among primary-school children in the city of Shiraz, Iran. Public Health Nutr. 2018;21(3):571–9. doi:10.1017/S1368980017003251. PMID: 29173231.
13. Bjelland M, Soenens B, Bere E, Kovács É, Lien N, Maes L, et al. Associations between parental rules, style of communication and children's screen time. BMC Public Health. 2015;15:1002. doi:10.1186/s12889-015-2337-6. PMID: 26428894.
14. Lampropoulou M, Chaini M, Rigopoulos N, Evangeliou A, Papadopoulou-Legbelou K, Koutelidakis AE. Association between serum lipid levels in Greek children with dyslipidemia and Mediterranean diet adherence, dietary habits, lifestyle and family socioeconomic factors. Nutrients. 2020;12(6):1600. doi:10.3390/nu12061600. PMID: 32485939.
15. O'Connor SG, Koprowski C, Dzubur E, Leventhal AM, Huh J, Dunton GF. Differences in mothers' and children's dietary intake during physical and sedentary activities: An ecological momentary assessment study. J Acad Nutr Diet. 2017;117(8):1265–71. doi:10.1016/j.jand.2017.02.012. PMID: 28392348.