Videogames That Encourage Healthy Behavior Did Not Alter Fasting Insulin or Other Diabetes Risks in Children: Randomized Clinical Trial.

Background: Previous research indicates games for health have substantial promise in promoting change in children's diet and physical activity (PA) behavior for obesity and diabetes prevention, but the research has generally not been rigorous. The study reported here was an efficacy trial of two role-playing videogames played in sequence, "Escape from Diab" (hereinafter called Diab) and "Nanoswarm: Invasion from Inner Space" (hereinafter called Nano), on diabetes and obesity risk factors: fasting insulin and body mass index (BMI), and risk-related behaviors: diet, PA, and sedentary behavior (SB). Design: A two-group (treatment vs. wait list control) randomized clinical trial was used with baseline, immediate postintervention (∼3 months postbaseline), and 2 months postassessments. Intervention: Diab and Nano were desktop or laptop role-playing videogames with nine sessions (each episode/session lasting ∼60 minutes). Two storylines attempted to immerse players and used ethnically diverse characters to model desired behaviors. Tailored goal setting, problem solving, and motivational statements were used. Methods: A sample of 200 overweight or obese children (ages 10-12 years from 85th to 99th BMI percentile [%ile]) was recruited, primarily using a volunteer list. Fasting insulin was the primary dependent variable. BMI, fruit, vegetable and sweetened beverage intakes, PA, and SBs were secondary outcomes. Generalized linear mixed models were used to test for the treatment effects. Results: No significant differences were detected in any of the tested outcome variables. Conclusions: The lack of differences may indicate that games cannot change dietary behaviors and thereby not change-related clinical outcomes. Alternatively, there seem to have been changes in (1) the types of videogames children expect and like to play since a pilot study was conducted, (2) productization challenges, and/or (3) problems in staff management of the trial. All may have contributed to the lack of effect.

Influences on children's dietary behavior, and innovative attempts to change it.

Fruit and vegetable (FV) intake may protect against several chronic diseases, and the preferences and habits in relation to FV intake appear to form in early childhood. Child FV intake reflects many influences from multiple levels (e.g. internal to the child, family, school, and neighborhood). We have documented influences at each of these levels, but more definitive research in longitudinal samples remains to be conducted. Even though validated comprehensive models of influences on child FV intake in longitudinal studies are not available to guide intervention design for children of different ages, there has been an urgency to initiate chronic disease prevention interventions to mitigate the substantial health consequences. Effective interventions use known behavior change procedures to change the influences on FV intake enough to change the behavior, but few such interventions have demonstrated effectiveness at meaningful levels. Innovative methods need to be explored. Videogames for Health offer a medium that is attractive to children and shows promising results, especially for dietary behavior change. Exciting additional research is needed to clarify possible bidirectional influences between the environmental and individual influences on child intake with possible age-related differences in influence and in the optimal design of video games for dietary change.

Non-curricular approaches for increasing physical activity in youth: a review.

BACKGROUND: To prevent obesity, the physical activity of youth should be increased. Since time for school physical education has declined and curricular interventions have had limited effects, alternative non-curriculum approaches need to be tested. METHODS: A systematic review was conducted to identify research that evaluated the effectiveness of non-curricular interventions on the physical activity of children and adolescents. RESULTS: Results showed that children were active during school break periods and inexpensive interventions further increased activity during these times. Active travel to school offered potential, but its effectiveness was impaired by traffic congestion and parental fears for child safety. Extracurricular, school-based interventions had problems with low attendance, which might be removed if delivered through existing community organizations. Summer day camps offered potential for increasing activity of youth, but research is required to determine how best to convert camp activity into increased post-camp habitual activity. CONCLUSIONS: Physical activity can be increased during school break periods, through existing youth organizations, summer day camps, and possibly through active transportation. Future research should focus on further enhancing the effectiveness of these innovative interventions.