Might Video Games Help Remedy Childhood Obesity

[Author Affiliation]Tom Baranowski. USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX.Address correspondence to: Tom Baranowski, PhD, Professor of Pediatrics (Behavioral Nutrition and Physical Activity) Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Houston, TX 77030, E-mail: tbaranow@bcm.eduAs readers of this journal know all too well, obesity is the most prevalent health problem among children in the United States1 and globally,2 leading to diverse health problems3 and staggering costs.4 Most child obesity prevention interventions are not working well, or not at all.5 Part of the problem is that the causes of child obesity are not clearly known6 ; nor are the influences on weight control.7 Further, our common measures of diet and physical activity (PA) are fraught with error,8 thereby minimizing our ability to detect true relationships between lifestyle behavior and adiposity or the outcomes of our interventions.9 What a mess!Within this conundrum, new ideas and approaches are needed. Video games, the most commonly enjoyed medium by this generation of children, generates more money than Hollywood productions. Whereas some believe that games are anathema to childhood obesity prevention or treatment because most games involve sedentariness, the literature on media exposure and childhood obesity indicates that time watching television (TV), and not time playing video games, is the major offending screen medium10 and the pathway of TV exposure to obesity is primarily through diet, not physical inactivity.11Games for health (G4H) is a new arena of research and practice that uses entertainment game technology to attain health goals. Diverse G4H have been designed and tested for childhood obesity prevention and treatment.12 A scoping and systematic review of these articles identified 28 studies involving video games, mostly for childhood obesity prevention. Forty percent of these studies influenced obesity or obesogenic behavior in the desired directions.12 A roundtable discussion of investigators of G4H and obesity indicated substantial potential for video games to reduce child obesity, but emphasized the need for games to be fun, not just health promoting.13 Some of the obesity-related studies used games specially designed to target diet and/or PA change outside the games.14-17 "Squire's Quest!," targeted at dietary change alone, resulted in an increase of one serving of fruit and vegetables among fourth-grade students after only 5 weeks of game play.15 "Creature 101," a comprehensive behavior management software system, including video games, enabled middle school students to decrease sweetened beverage and processed snack intake.16 "Fitter Critters" enhanced attitudes and self-efficacy toward healthy eating among elementary school students.17 "Escape from Diab" and "Nanoswarm: Invasion from Inner Space" targeted diet and PA among 10- to 12-year-olds and achieved diet, but not PA, change.14Most research on games targeted at PA used commercially available active video games, also called exergames. Exergames were designed by corporations as a new profit-making strategy to incorporate PA into game play (e.g., fancy footwork was needed for the game to progress). Reflecting public health interest in the potential of exergames to encourage PA, many reviews of this literature have appeared.18-20 Some reviews have been sympathetic,21,22 whereas others have been critical.23,24 A reasonably balanced assessment revealed that, in research laboratories, exergames could provide an intense workout that included moderate-to-vigorous PA, but under less-supervised circumstances, children tended not to get much activity18 and their interest in the activity waned over 1 week or less. …