Research articleVideo Game Play, Child Diet, and Physical Activity Behavior Change: A Randomized Clinical Trial
Section snippets
Background
Youth obesity rose dramatically during recent decades.1 Although the increases since 1999 have been small, there have been no declines from the high levels,2 with resulting increased prevalence of type 2 diabetes.3 Obesity results from energy imbalance, with energy intake exceeding expenditure.4 Increased fruit and vegetable and water intakes have been associated with decreased risk of obesity.5, 6 Many youth consume less than the recommended minimum of five fruit and vegetable servings7 and
Design
This small efficacy trial used a two-arm randomized control design with assessments of outcome at baseline; between games (Post 1); immediate postgame (Post 2); and 2 months postgame (Post 3). Children were randomly assigned to intervention (n=103) or control (n=50) groups. Twice as many treatment as control group participants enabled substantial assessment of game play while maintaining the robustness of the F statistic to heterogeneity of differences in variation between groups.16
Sample
Inclusionary
Results
The CONSORT statement flow chart (Figure 1) indicates that 260 children were initially contacted, with 133 providing complete data. There were no significant differences in any demographic variables between treatment and control groups, or between those retained or eliminated from the sample. The sample had more 10-year-olds, men/boys, whites, and parents with a college degree or higher (Table 1). There were no differences in demographics or anthropometrics between participants with or without
Discussion
Diab and Nano combined had a meaningful effect on dietary fruit and vegetable intake, which is comparable to others reported in the literature.30, 31 The average BMI percentile across both groups at baseline was 78th percentile. Because most interventions showing effects did so primarily among samples with a minimum participation requirement above the 85th percentile,32 repeating this intervention with a higher-risk group may result in more positive outcomes.
Although these findings advance
Conclusion
Diab and Nano were designed as epic video game adventures, comparable to commercial-quality video games. These games incorporated a broad diversity of behavior change procedures woven in and around engrossing stories. The games motivated players to substantially improve diet behaviors. Fruit and vegetable intake and water consumption and physical activity were still below the minimum recommendations, indicating that more work is needed. Serious video games hold promise, but their effectiveness
References (33)
- et al.
Beverage consumption and adult weight management: a review
Eat Behav
(2009) - et al.
Squire's quest! Dietary outcome evaluation of a multimedia game
Am J Prev Med
(2003) - et al.
eHealth recruitment challenges
Eval Program Plann
(2006) - et al.
Food, fun, and fitness Internet program for girls: pilot evaluation of an e-Health youth obesity prevention program examining predictors of obesity
Prev Med
(2008) - et al.
Disappointment and drop-out rate after being allocated to control group in a smoking cessation trial
Contemp Clin Trials
(2010) - et al.
5 a day achievement badge for African-American Boy Scouts: pilot outcome results
Prev Med
(2002) - et al.
Prevalence of overweight in the U.S., 1999–2004
JAMA
(2006) - Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and...
- et al.
Variations in BMI and prevalence of health risks in diverse racial and ethnic populations
Obesity (Silver Spring)
(2010) - et al.
Assessment of child and adolescent overweight and obesity
Pediatrics
(2007)
Changing the energy density of the diet as a strategy for weight management
J Am Diet Assoc
Patterns in children's fruit and vegetable consumption by meal and day of the week
J Am Coll Nutr
Physical activity in the U.S. measured by accelerometer
Med Sci Sports Exerc
Playing for real: video games and stories for health-related behavior change
Am J Prev Med
Communication and persuasion: central and peripheral routes to attitude change
Social foundations of thought and action: a social cognitive theory
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