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Playing to Win: Video Games and the Fight against

Obesity

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ome video game systems like theSony Playstation 2 or MicrosoftXBox have rarely been associ-

ted with good health. With perceivedies to violence and social maladjust-ent in youths who play video games,

here is also a perceived associationetween video games and childhoodbesity, their popularity coincidingith the jump in obese and over-eight children 2 decades ago.“[The] association of electronic

ame use with obesity was . . . signifi-ant, with a nearly two-fold increasedisk for obesity by hour per day spentlaying electronic games,” saytattler and colleagues in a 2004 is-ue of the journal Obesity Research.Therefore, use of electronic gameshould be considered as another sed-ntary activity to be targeted for obe-ity prevention in children” (1).Another study, published by the

ournal of Adolescence in 2004, foundhat “while television use was not re-ated to children’s weight status,ideo game use was. Results also in-icated that children with highereight status spent more time in sed-ntary activities than those withower weight status” (2).

Lastly, a study in the Internationalournal of Obesity found that child-ood body mass index was directlyroportional to the mean hours ofelevision viewing. “Time spentatching television is a significantredictor of [body mass index] andverweight in childhood,” researchersaid. Video games by their very na-ure require television viewing (3).

However, these studies do not men-ion games that are specifically madeo educate children on diet, and some

This article was written byDamon Brown, a freelancewriter in Los Angeles, CA, whospecializes in the video gameindustry.

sdoi: 10.1016/j.jada.2005.12.015

88 Journal of the AMERICAN DIETETIC ASSOCIATIO

octors and fitness experts now arguehat video games can be a legitimateool to create health-conscious chil-ren. “We encourage kids to readooks, so why not allow them to useovies and other mediums to learn?”

ays Tony Findlay, creator of the in-eractive game Escape From Obeezity. “Instead of fighting it . . . let

hem use different things as re-ources.”

IGITAL DIETETICSFantastic Voyage–style adventure,

scape From Obeez City (Big Redrog, North Sydney, Australia) hashe child maneuvering a miniaturizedeam inside a critically ill obese pa-ient, Jack Decayd (4). A personalrainer for more than 2 decades, Find-ay says he made the colorful gamefter getting feedback during hisealth seminars. “I understood that ifou weren’t Harry Potter, it would beard to get a book into kids’ hands.”To make it more appealing, every

haracter is an anthropomorphic rep-esentation of a medical term. For in-tance, Col Esterol (cholesterol) is atreet thug that spray paints graffitin the walls of arteries. The playerust stop him before he clogs up the

assageways and hurts the patient.Last fall Findlay’s Australian com-

any, Big Red Frog, launched theody Mechanics Toolkit. It includes aVD movie, the interactive game, anctivity program, and a parents’uide. Big Red Frog supported the re-ease with a 13-city school tour of the

ost obese American cities, Findlayays, to positive results. “Researchas found that when it comes to

earning, between ages 5 and 8 youave a complete level of competence

n the ability for them to believe whatou say,” Findlay says. “From 9 to 13,hey start to question and begin fol-owing their peers. After 13, they

tart to go off on their own. [We have c

N © 2006

o get them] while we have some in-uence.”Findlay’s findings have been pri-arily anecdotal, though Big Redrog has an advisory board that in-ludes obesity expert James “Butch”osser, MD, FACS, chief of Minimally

nvasive Surgery and director of thedvanced Medical Technology Insti-

ute at Beth Israel Medical Center inew York, NY.More pointed evidence of the poten-

ial restructuring of games to fighthildhood obesity was published inhe American Journal of Preventiveedicine in 2003 (5). The research

enters around Squire’s Quest!, aame made to encourage healthfulating.In Squire’s Quest!, the child plays a

quire earning his way to knighthood.o become a knight, the child must doifferent tasks to help the kingdom,uch as create fruit, juice, and vege-able recipes in a virtual kitchen toake sure the king and court are

trong enough to battle invaders. Re-earchers studied 1,578 fourth-gradehildren who played 10 sessions of theame over a 5-week period, each ses-ion lasting about 25 minutes. Duringach session the child was asked toreate a virtual recipe, eat anotherruit, juice, or vegetable serving at aeal or as a snack, or to ask for his or

er favorite fruit, juice, or vegetableo be more available at home (5).

The study found that children par-icipating in Squire’s Quest! in-reased their fruit, juice, and vegeta-le consumption by 1.0 servingompared to children who did not par-icipate. “Squire’s Quest! demon-trates that PEMT [psychoeduca-ional multimedia training] gamesan induce dietary behavior changemong elementary school children.urther research is warranted . . .”,esearchers concluded. “Health edu-ators can benefit from more contactith developers who create games for

hildren and by integrating theoreti-

by the American Dietetic Association

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FOR YOUR INFORMATION

al behavioral frameworks into edu-ational games.”

They also discovered a problemith psychoeducational multimedia

raining games, titles that are createdpecifically to promote behavioralhange. “Creating such educationalames is very expensive, requiringarge teams of educational, dietary,nd behavioral professionals, withubcontracting for professional art-sts and programmers.”

In short, researchers found thatsychoeducational multimedia train-ng games should be further explored,ut were cost prohibitive by their veryature.

ANCING TO GOOD HEALTHddly enough, a majority of the re-

earch just beginning in the area ofbesity and video games is comingrom a Japanese arcade game that, byhe creator’s own admission, was notntended for fat fighting. In 1999onami (Tokyo, Japan) releasedance Dance Revolution, a gamehere players quickly step on one of

our appropriate square floor matsased on the designated symbolsashing onscreen. It was a major hit,

nspiring the company to produce sev-ral sequels and even to invest in atness club franchise shortly after itselease (6).

American audiences tend to beore conservative, but Konami took a

isk and brought the quirky game tohe United States the following year.ow in its third home edition inmerica and sixth in Japan, the dy-amic party series has sold 2.5 mil-

ion home units in the United Stateslone (7). The latest home edition,ance Dance Revolution Ultramix 3

or the Microsoft XBox, tells playersow many calories they burn perance session. It also comes with a0-day trial membership to the 24-our Fitness gym franchises (8).Noticing the popularity of the

ame, West Virginia Public Employ-es Insurance Agency began an at-ome study to see if Dance Danceevolution could promote more exer-

ise for covered dependents. Almost3% of adults and more than 25% ofhildren in West Virginia are over-eight and obese, respectively, ac-

ording to the Coronary Artery Risketection in Appalachian Communi-

ies project that from 1999-2002 i

ested nearly 6,000 children in 27 ru-al West Virginia counties (9). Publicmployees Insurance Agency, whichepresents 215,000 public employees,eachers, and dependents, conductedhe 6-month study on 85 insured chil-ren. The kids met with researchersegularly, played for set limits, woreedometers, and kept a journal.onami and the agency believe thatublic Employees Insurance Agency

s the first insurance group to use aideo game to cut potential futureealth costs. The results should bennounced sometime in 2006.In 2005, Penn State University

rofessor of Kinesiology George Gra-am, PhD, and graduate student Ste-hen Yang studied heart rates of chil-ren playing 45-minute sessions ofance Dance Revolution. They found

he children’s’ average heart rate toe 144 beats per minute, roughly dou-le the 60 to 70 beats per minute of anverage resting heart. The research-rs concluded that dancing for 45inutes increased the children’s me-

abolism and calorie burning (10).Graham says that interactive

ames are really the best way to keepdolescent attention spans occupied.You hear solutions like ‘walk withour parents’ or ‘ride your bike.’ Well,eens aren’t going to do that. Whenhey ride their bike, it’s to go some-here and do something else. Weave to realize that for many of theseids, video games are the only wayhey’re going to do anything active”9).

MPLICATIONS FOR DIETETICSROFESSIONALSeing experts in nutrition and how

hat is influenced by behavioral mod-fication, dietetics professionals mayant to inform their clients of theart that video games can play in aedentary lifestyle in youths. At theame time, since video games areuch a draw to children, dietetics pro-essionals may consider adding inter-ctive, educational games to theirver-growing repertoire of dieteticsnowledge, skills, and patient/clientducation. As studies continue to ar-ive, we will have more insight intohe use of video games for healthful

nfluence, not just for entertainment.

February 2006 ● Journa

eferences1. Stattler N, Signer TM, Suter PM.

Electronic games and environ-mental factors associated withchildhood obesity in Switzerland.Obes Res. 2004;12:896-903.

2. Vandewater EA, Shim MS,Caplovitz AG. Linking obesityand activity level with children’stelevision and video game use. JAdolesc. 2004;27:71-85.

3. Hancox RJ, Poulton R. Watchingtelevision is associated withchildhood obesity: But is it clini-cally important? Int J Obes. 2006;30:171-175.

4. Big Red Frog. Escape from ObeezCity. Available at: http://www.obeezcity.com. Accessed Decem-ber 1, 2005.

5. Baranowski T, Baranowski J,Cullen KW, Marsh T, Islam N,Zakeri I, Honess-Morreale L, de-Moor C. Squire’s Quest! Dietaryoutcome evaluation of a multime-dia game. Am J Prev Med. 2003;24:52-61.

6. Chen S, Michael D. Games forPhysical and Mental Health. In:Serious Games: Games That Edu-cate, Train, and Inform. Boston,MA: Thomson Course Technology;2005. Available at: http://www.gamasutra.com/features/20051031/chen_01.shtml. Accessed Decem-ber 1, 2005.

7. Bounds G. Interactive DVD aimsat younger health market. Avail-able at: http://www.bigredfrog.com.au/pages/frog_stuff/press_article_002.php. Accessed December 1,2005.

8. Dance Dance Revolution Ultramix3. Konami, Tokyo, Japan. Avail-able at: http://www.musicineverydirection.com. Accessed December1, 2005.

9. Barker A. Study uses video gamesto fight obesity. USA Today. Avail-able at: http://www.usatoday.com/news/nation/2005-04-02-obesity-video-game_x.htm. Accessed De-cember 1, 2005.

0. Carolipio R. Video games, medi-cine team up. San BernardinoCounty Sun. Available at: http://www.sbsun.com/redmondcarolipio/ci_3029228. Accessed December 4,2005.

l of the AMERICAN DIETETIC ASSOCIATION 189