The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity

Abstract

Background Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children. Objective The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P. Methods This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake). Results The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70%). Overall, 95% of the children liked the game very much or much. No group changes were observed at the behavioral level. Conclusions The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P. Trial Registration ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978

Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis

“…All included studies were clinical trials [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The total sample was 11,280 children and adolescents.…”

Improving Serious Games to Tackle Childhood Obesity

“…To date, four research groups took the initiative to develop multidisciplinary serious games including different game modules that can be used to promote healthy behaviors in children with obesity. Three of them were recently published ( Espinosa-Curiel et al, 2020 ; Mack et al, 2020 ; Ruggiero et al, 2020 ), while one is still in progress ( Mâsse et al, 2020 ). The overall content (i.e., available online) and outcome goals were to provide knowledge, enhance motivation, and encourage behavior change related to healthy eating, PA, and stress coping.…”

“…A subsequent study by Mack et al (2020) assessing the effects of their multidisciplinary game among children aged 8–12 years, indicated that players increased knowledge in the areas of nutrition and stress coping, and were able to apply the dietary energy density principle of nutrition education. The stress coping is an important factor in weight regulation, as stress can be associated with poor dietary habits and low physical activity, especially when an individual faces challenges that surpass his or her coping skills ( Mack et al, 2020 ). No changes at the behavioral level (e.g., media consumption and PA level) occurred because of the study focus (i.e., nutrition education) and design.…”

“…The last type aimed to provide knowledge, enhance motivation, and encourage behavior change related to healthy eating, PA, and stress coping (i.e., multidisciplinary serious games). Current studies showed that playing serious games might contribute to tackling childhood obesity ( Mack et al, 2020 ; Ruggiero et al, 2020 ). Despite the major importance of this finding, the use of serious games as a validated intervention in clinical practice requires further clarifications on some methodological aspects ( Lu et al, 2013 ; Dias et al, 2018 ).…”

The Role of Dishware Size in the Perception of Portion Size in Children and Adolescents with Obesity

“…The principles of weight management aim to reduce energy intake by improving diet and eating habits, i.e., modifications in the macronutrient distribution of energy intake, and to enhance energy expenditure by increasing physical activity and avoiding a sedentary lifestyle [ 4 ]. From a nutritional point of view, portion size and energy density [ 5 , 6 ] of foods as well as eating frequency [ 7 ] are key factors of weight management [ 8 ]. In view of the increase in portion sizes over recent decades, it is important to be familiar with appropriate food portion sizes [ 9 ].…”