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Title: Videogames that encourage healthy behavior did not alter fasting insulin or other diabetes risks in children: Randomized clinical trial

Author
item BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC)
item BARANOWSKI, JANICE - Children'S Nutrition Research Center (CNRC)
item CHEN, TZU - University Of Houston
item BUDAY, RICHARD - Archimage, Inc
item BELTRAN, ALICIA - Children'S Nutrition Research Center (CNRC)
item DADABHOY, HAFZA - Children'S Nutrition Research Center (CNRC)
item RYAN, COURTNEY - Children'S Nutrition Research Center (CNRC)
item LU, AMY - Northeastern University

Submitted to: The Games for Health Journal: Research, Development, and Clinical Applications
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/21/2019
Publication Date: 4/9/2019
Citation: Baranowski, T., Baranowski, J., Chen, T.A., Buday, R., Beltran, A., Dadabhoy, H., Ryan, C., Lu, A. 2019. Videogames that encourage healthy behavior did not alter fasting insulin or other diabetes risks in children: Randomized clinical trial. The Games for Health Journal: Research, Development, and Clinical Applications. https://doi.org/10.1089/g4h.2018.0097.
DOI: https://doi.org/10.1089/g4h.2018.0097

Interpretive Summary: Videogames offer promise of making health education fun. This study reports the outcomes from a randomized trial that tested the efficacy of two videogames designed to promote behavior changes in diet, physical activity and sedentary behavior for obesity and diabetes prevention. No changes were detected in any of the outcomes. The lack of effects could be due to the games really not working, a small sample (presented in another paper), the inadequacies of a game designed in the early 2000's not being engaging or fun in 2015, or research management failures that occurred. These results indicate that more attention needs to be devoted to duration of games for health development and project management.

Technical Abstract: 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). A two-group (treatment vs. wait list control) randomized clinical trial was used with baseline, immediate postintervention (~3 months postbaseline), and 2 months postassessments. 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. 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. No significant differences were detected in any of the tested outcome variables. 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.