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

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 (<i>P</i><.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. CLINICALTRIAL ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978

Energiedichte von Lebensmitteln als Ernährungsstrategie bei der Gewichtsregulation

“…Für die praktische Umsetzung des Energiedichte-Prinzips gibt es gute Literatur, die auch für den Laien verständlich ist 16 70 71 . Meine Arbeitsgruppe selbst arbeitet an der Umsetzung der Thematik in attraktiven Lernspielen für Kinder und Erwachsene, die jedoch derzeit nur im Rahmen von Forschungsprojekten eingesetzt werden 13 14 . In unserer aktuell laufenden großen STARKIDS-Studie – Stufenmodell Adipositas-Therapie im Kindes- und Jugendalter 72 , einer cluster-randomisierten kontrollierten Studie mit 1000 Studienteilnehmer*innen, wird das Energiedichteprinzip als Ernährungsstrategie erstmals auf seine Wirksamkeit bei Adipositas im Kinder- und Jugendbereich untersucht.…”

“…Gleichzeitig sind die Strategien zur Reduktion der Energiedichte flexibel und vielfältig und können auf verschiedene Ernährungsmuster, Nahrungsmittelvorlieben und kulturelle Besonderheiten angepasst werden 10 11 12 . Zwei randomisierte, kontrollierte Studien konnten zeigen, dass bereits Grundschulkinder das Energiedichte-Prinzip verstehen und anwenden können, selbst noch im 6 Monate follow-up 13 14 . Die Deutsche Gesellschaft für Ernährung hat das Energiedichte-Prinzip als Ernährungsstrategie im Rahmen der Gewichtsregulation anerkannt 15 .…”