Evidence has suggested that health promotion may be achieved using repre-sentations of the self in virtual environments (avatars) to alter self-perception,and model behaviours. This systematic review aimed to assess evidence ofthe role that the appearance of avatars plays in influencing health-relatedattitudes and behaviours.Journal databases, author books and websites, grey literature sources weresearched. Rehabilitation and mental health outcomes were excluded.A total of 13 articles (14 studies) addressing primary (e.g. exercise, diet, andsmoking), and secondary (e.g. body satisfaction) health related attitudes andbehaviours were included.Seven studies reported significant main effects of avatar manipulation, whichincluded avatar body type (varied by adiposity or muscularity), and Self Dis-crepancy Theory-based (SDT; e.g. actual, ideal, ought selves) customisation.The review indicates a dearth of research on avatar appearance and health-related outcomes. The assignment of avatars with varying body types ap-peared to be the most consistent manipulation for in-game physical activity.The assignment of ‘obese’ avatars appeared to reduce behavioural outcomes,however the absence of control conditions means the actual direction is un-clear. Results from this review indicate a need for a grounded, theory-drivenapproach to future avatar appearance-based studies

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