Title: MotiVar: Motivating weight loss through a personalised avatar
Funder: Department of Health and Social Care

Abstract: Background Obesity is a global concern and a UK health priority. Obesity is associated with a range of increased health risks resulting in an increased demand for, and complexity of, healthcare interventions. Obesity interventions in adults rely predominantly on managing dietary intake and/or increasing physical activity but lack of sustained motivation and poor adherence to behavioral regimens are commonly reported barriers to successful weight loss. Virtual reality enables people to experience an alternate visual reality through a computerized representation of self (avatar). While avatar technology is well established within the media industry, translation of this technology to healthcare is minimal. Experimental research has confirmed that individuals identify with self resembling avatars and real world behaviors and attitudes can be influenced by changing avatar appearances. We propose that virtual reality technology and the creation of personal avatars may have significant potential for motivating sustained weight loss behaviors. Aims This feasibility study aims to determine whether a full randomized trial evaluating the avatar intervention is warranted. The study aims are therefore to: Develop a purposefully designed avatar generation and display programme to be used as an adjunct to an existing weight loss programme; Investigate the acceptability of the avatar intervention, study materials and data collection tools to patients and healthcare professionals; Provide estimates of key aspects of trial design necessary for implementing a fully powered randomized trial. Plan of investigation This is two phase, sequential, mixed methods study. Phase 1: the iterative development of an avatar generation/display programme involving service user and healthcare professional feedback within each design stage. Stage 1: Development of a flexible, fully parameterized 3D computer model of the human body, responsive to different body shape dimension data. Stage 2: Development of a computer interface for input of body dimension parameters through digital photographic data. Image processing techniques will be applied to automatically extract key body measurements and facial features from a full body (clothed) photograph and generate a personalized avatar. Stage 3: Optimization of the avatar programme display, accessibility and operation. Phase 2: a single site clinical feasibility study to determine the case for, and parameters of, a future randomized trial. A sample of 60 obese adult patients will be recruited from Mid Yorkshire Hospitals NHS Trust weight improvement service and randomized into a standard treatment or intervention (standard treatment plus avatar programme) arm. All participants will attend the weight loss service appointments as planned and will be weighed and complete quality of life and self efficacy surveys at their initial appointment and at months 1, 3 and 6. Intervention arm participants will also be photographed and measured to facilitate generation of their personalized avatar which will be used by the healthcare professional during the planned appointment to display current, past and potential future weight as changes in avatar appearance and associated general health risks at BMI boundaries. Intervention arm participants will also be encouraged to access their personal avatars, hosted on a secure password protected website, and explore avatar appearance/weight changes independently. Service user and healthcare professional feedback on study materials, data measures and experiences of using the avatar programme will be sought through separate focus groups. This data, in addition to recruitment, retention and attrition data, weight loss outcomes and survey measures, will inform the design of, and provide key estimates necessary for, a future trial. Potential Benefits As the first study to explore the application of avatars as a motivational technology to support weight loss, this proposed feasibility study, and subsequent clinical trial, represent a step change in our understanding of the potential of avatar technologies to motivate behavior change in healthcare.

Lay abstract: Population obesity is a UK health priority. Obesity increases the risk of ill health (e.g. diabetes, heart disease, cancer, depression) and the demand for, and cost of, healthcare services. Adult obesity interventions rely mainly on individuals reducing food (calorie) intake and increasing physical activity but lack of sustained motivation and poor adherence to diet plans remain key barriers to weight loss success. Virtual reality technology is expanding rapidly. This has great potential for supporting weight loss through the use of a personalised avatar (computerised image of oneself). Experimental studies have shown that an individual s behaviour can be positively influenced by changing the appearance, experience and behaviour of an avatar. Experiments have also shown that when different potential futures are presented to an individual through an avatar, their behaviour changes to enable achievement of their preferred future option. We aim to develop an avatar programme to support weight loss. A computer programme for generating self-resembling avatars will be developed through a series of design phases with feedback from service users and healthcare professionals. The final prototype will allow individuals to see their avatar gaining/losing weight and the influence this has on their health risks. The avatar programme will be tested within a NHS weight loss clinic as a two arm (intervention and routine care) clinical feasibility study. With the help of healthcare professionals, data will be collected on weight loss, patient feelings about weight loss and their experience of using the avatar programme. The study findings will determine whether a full clinical trial is warranted to test the impact of avatar technology on population weight loss. The study findings will be presented to service users, healthcare professionals, policy makers and commissioners through dissemination events, conferences and publications. We will also engage the wider community through online virtual reality technology portals.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: ORAL AND GASTROINTESTINAL;STROKE;CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE