Outlook | A Quarterly Newsletter of the Society of Behavioral Medicine

From the Obesity and Eating Disorders SIG

Videogames for Diet and Physical Activity Change

Tom Baranowksi, PhD
Professor of Pediatrics
USDA-Children's Nutrition Research Center
Baylor College of Medicine
Houston, Texas, USA

Debbe Thompson, PHD, RD
Assistant Professor
USDA/ARS Scientist/Nutritionist-Child Obesity
USDA-Children's Nutrition Research Center
Baylor College of Medicine
Houston, Texas, USA

Janice Baranowski, MPH, RD
Assistant Professor of Pediatrics
USDA-Children's Nutrition Research Center
Baylor College of Medicine
Houston, Texas, USA

Computers, the Internet and related technologies are revolutionizing how people communicate and the enjoyments they get from life. Health behaviorists need to learn how to use these new technologies to promote diet and physical activity (PA) change.

Our recent literature review showed positive outcomes from 26 of 27 published evaluations of health related videogames¹. We have designed videogames and web sites (Squire's Quest!², Boy Scout Fit for Life Badge³, Boy Scout Five A Day Badge⁴, Fun, Food and Fitness^{5, 6}, Escape from Diab⁷, Nanoswarm: Invasion from Inner Space) to promote diet and physical activity change among children. Each of these games targeted specific behaviors (eating fruit and vegetables, drinking water, being physically active, and/or watching less TV) and employed state of the art theory based behavior change procedures (goal setting tailored to usual behavioral practices and food preferences, action and coping implementation intentions, behavior temptation inoculation, motivational messages tailored to child values, skill training, and practical knowledge enhancement).

Rather than using usual questionnaires, data are collected by game characters asking questions of the player as part of the storyline, thereby minimizing the response burden. Practical knowledge enhancement (e.g. what counts as a fruit?) is achieved by making a game of the knowledge test, imposing high standards of attainment, and repeating the test until the standard is attained. Alpha testing revealed that children required seven times to play the practical knowledge game before they achieved the standard, but reported they enjoyed it because it was challenging. Games, thereby, enable children to perceive learning and tests as attractive.

The story encompassing the game also provides opportunities for promoting behavior change. Attractive characters can 1) model the desired behaviors (social learning), 2) model overcoming barriers to performing the behaviors (enhancing self efficacy); 3) morph over the course of the story from not believing the value of the health behaviors to developing a new norm for healthy behavior; and 4) struggle with personal change developing empathy in the player¹. New perceptions of reality can emerge, e.g. from food vending machines being sources of tasty foods to sources of control and oppression1. (See trailers for "Escape from Diab" and "Nanoswarm" in the "screening room" at http://archimageonline.com/)

Another literature review revealed that active videogames (sometimes called exergames) can elicit physical activity at levels intense enough to induce a fitness effect, but in the average children didn't play them long enough to benefit in that way⁸. We are conducting research on how we can use "story" to enhance the long term playability of active videogames.

Videogames involving simulations of real world experiences have been used to train individuals to fly planes. We are exploring similar techniques to train parents in a fun way to conduct more effective fruit and vegetable parenting practices in which they can make mistakes in the game with no untoward consequences for their real child.

Interactive technology can be used to promote diet and physical activity behavior change almost as stealth learning. As we gain experience, we will learn how to do this better.

Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. Jan 2008;34(1):74-82.
Baranowski T, Baranowski J, Cullen KW, Marsh T, Islam N, Zakeri I, Honess-Morreale L, DeMoor C. Squire's quest! Dietary outcome evaluation of a multimedia game. American Journal of Preventive Medicine. Jan 2003;24(1):52-61.
Jago R, Baranowski T, Baranowski J, Thompson D, Cullen K, Watson K, Liu Y. Fit For Life Boy Scout Badge: Outcome evaluation of a troop & internet intervention. Preventive Medicine. 2006;42(3):181-187.
Thompson D, Baranowski T, Baranowski J, Cullen K, Jago R, Watson K, Liu Y. Fit For Life Boy Scout badge: Outcome results of a troop and Internet intervention. American Journal of Preventive Medicine. submitted.
Baranowski T, Baranowski J, Cullen KW, Thompson D, Nicklas T, Zakeri I, Rochon J. The Fun, Food, and Fitness Project (FFFP):The Baylor GEMS Pilot Study. Ethnic Dis. 2003;13(1):S1-30 - S31-39.
Thompson D, Baranowski T, Cullen K, Watson K, Liu Y, Canada A, Bhatt R, Zakeri I. Food, fun, and fitness internet program for girls: Pilot evaluation of an e-Health youth obesity prevention program examining predictors of obesity. Prev Med. Jul 30 2008.
Baranowski T, Buday R, Frazior M, Witsdon J, Baranowski J, Thompson D, Panzer S, Juliano M, Thompson V. "Escape from Diab": Diabetes Prevention Videogame. (being written).
Barnett A, Baranowski T, Buday R. Active videogames: Getting fit while having fun. Current Ped Reviews. submitted.


Winter 2009	Return to Outlook Main page >>
From the Obesity and Eating Disorders SIG Videogames for Diet and Physical Activity Change Tom Baranowksi, PhD Professor of Pediatrics USDA-Children's Nutrition Research Center Baylor College of Medicine Houston, Texas, USA Debbe Thompson, PHD, RD Assistant Professor USDA/ARS Scientist/Nutritionist-Child Obesity USDA-Children's Nutrition Research Center Baylor College of Medicine Houston, Texas, USA Janice Baranowski, MPH, RD Assistant Professor of Pediatrics USDA-Children's Nutrition Research Center Baylor College of Medicine Houston, Texas, USA Computers, the Internet and related technologies are revolutionizing how people communicate and the enjoyments they get from life. Health behaviorists need to learn how to use these new technologies to promote diet and physical activity (PA) change. Our recent literature review showed positive outcomes from 26 of 27 published evaluations of health related videogames¹. We have designed videogames and web sites (Squire's Quest!², Boy Scout Fit for Life Badge³, Boy Scout Five A Day Badge⁴, Fun, Food and Fitness^{5, 6}, Escape from Diab⁷, Nanoswarm: Invasion from Inner Space) to promote diet and physical activity change among children. Each of these games targeted specific behaviors (eating fruit and vegetables, drinking water, being physically active, and/or watching less TV) and employed state of the art theory based behavior change procedures (goal setting tailored to usual behavioral practices and food preferences, action and coping implementation intentions, behavior temptation inoculation, motivational messages tailored to child values, skill training, and practical knowledge enhancement). Rather than using usual questionnaires, data are collected by game characters asking questions of the player as part of the storyline, thereby minimizing the response burden. Practical knowledge enhancement (e.g. what counts as a fruit?) is achieved by making a game of the knowledge test, imposing high standards of attainment, and repeating the test until the standard is attained. Alpha testing revealed that children required seven times to play the practical knowledge game before they achieved the standard, but reported they enjoyed it because it was challenging. Games, thereby, enable children to perceive learning and tests as attractive. The story encompassing the game also provides opportunities for promoting behavior change. Attractive characters can 1) model the desired behaviors (social learning), 2) model overcoming barriers to performing the behaviors (enhancing self efficacy); 3) morph over the course of the story from not believing the value of the health behaviors to developing a new norm for healthy behavior; and 4) struggle with personal change developing empathy in the player¹. New perceptions of reality can emerge, e.g. from food vending machines being sources of tasty foods to sources of control and oppression1. (See trailers for "Escape from Diab" and "Nanoswarm" in the "screening room" at http://archimageonline.com/) Another literature review revealed that active videogames (sometimes called exergames) can elicit physical activity at levels intense enough to induce a fitness effect, but in the average children didn't play them long enough to benefit in that way⁸. We are conducting research on how we can use "story" to enhance the long term playability of active videogames. Videogames involving simulations of real world experiences have been used to train individuals to fly planes. We are exploring similar techniques to train parents in a fun way to conduct more effective fruit and vegetable parenting practices in which they can make mistakes in the game with no untoward consequences for their real child. Interactive technology can be used to promote diet and physical activity behavior change almost as stealth learning. As we gain experience, we will learn how to do this better. Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. Jan 2008;34(1):74-82. Baranowski T, Baranowski J, Cullen KW, Marsh T, Islam N, Zakeri I, Honess-Morreale L, DeMoor C. Squire's quest! Dietary outcome evaluation of a multimedia game. American Journal of Preventive Medicine. Jan 2003;24(1):52-61. Jago R, Baranowski T, Baranowski J, Thompson D, Cullen K, Watson K, Liu Y. Fit For Life Boy Scout Badge: Outcome evaluation of a troop & internet intervention. Preventive Medicine. 2006;42(3):181-187. Thompson D, Baranowski T, Baranowski J, Cullen K, Jago R, Watson K, Liu Y. Fit For Life Boy Scout badge: Outcome results of a troop and Internet intervention. American Journal of Preventive Medicine. submitted. Baranowski T, Baranowski J, Cullen KW, Thompson D, Nicklas T, Zakeri I, Rochon J. The Fun, Food, and Fitness Project (FFFP):The Baylor GEMS Pilot Study. Ethnic Dis. 2003;13(1):S1-30 - S31-39. Thompson D, Baranowski T, Cullen K, Watson K, Liu Y, Canada A, Bhatt R, Zakeri I. Food, fun, and fitness internet program for girls: Pilot evaluation of an e-Health youth obesity prevention program examining predictors of obesity. Prev Med. Jul 30 2008. Baranowski T, Buday R, Frazior M, Witsdon J, Baranowski J, Thompson D, Panzer S, Juliano M, Thompson V. "Escape from Diab": Diabetes Prevention Videogame. (being written). Barnett A, Baranowski T, Buday R. Active videogames: Getting fit while having fun. Current Ped Reviews. submitted.