The impact of narratives and active video games among Black and Hispanic children with overweight and obesity: A randomized controlled trial

Authors: LU, AMY - Northeastern University; BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC); BARREIRA, TIAGO - Syracuse University; FLEISCHMAN, AMY - Boston Children'S Hospital; GREEN, MELANIE - University At Buffalo; HUANG, SHIRLEY - Tufts Medical Center; LEE, I - Harvard Medical School; LEVITSKY, LYNNE - Harvard Medical School; NOUBARY, FARZAD - Northeastern University; Thompson, Deborah

Submitted to: International Journal of Behavioral Nutrition and Physical Activity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/24/2025
Publication Date: 5/26/2025
Citation: Lu, A.S., Baranowski, T., Barreira, T.V., Fleischman, A., Green, M.C., Huang, S.Y., Lee, I.M., Levitsky, L.L., Noubary, F., Thompson, D.J. 2025. The impact of narratives and active video games among Black and Hispanic children with overweight and obesity: A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 22(1). Article 60. https://doi.org/10.1186/s12966-025-01756-1.
DOI: https://doi.org/10.1186/s12966-025-01756-1

Interpretive Summary: This study examined adding an exercise-promoting narrative to active video games (AVGs) to improve physical activity (PA) and body composition in overweight and obese children. Active video games can improve children's PA and body composition, but their effectiveness is often limited by reduced interest and adherence. Adding narratives to AVGs offers a potential solution, yet this has not been investigated, especially using a randomized controlled trial. The addition of narrative to AVGs increased PA in the first three months. Both narrative plus AVGs and AVGs alone increased PA and mitigated fat mass increase in the second three months. Narratives and AVGs provided health benefits to children.

Technical Abstract: Overweight and obesity disproportionately affect Black and Hispanic children who also play more video games. Narratives, coupled with home-based active video games (AVGs), may enhance PA and mitigate these disparities. This study tested the effect of narrative-enhanced home-based AVGs among predominantly Black and Hispanic children with overweight and obesity. This 6-month three-group RCT recruited 135 children aged 7-14 from pediatric clinics in Boston, MA (January 2020 - May 2022) during the COVID-19 pandemic. Participants were randomized into: [Narrative+AVG], receiving an Xbox/Kinect with six AVGs interspersed with a narrative animation Ataraxia (72 episodes over six months), which accompanied the AVGs; [AVG Only], receiving the Xbox/Kinect and AVGs without narrative animation; and [Waitlist Control], receiving the intervention post-RCT. The primary outcome was objectively assessed daily moderate-to-vigorous PA (MVPA). Secondary outcomes included body composition (fat and lean mass, total region fat), BMI%, fasting insulin, glucose, lipid panel (Cholesterol, HDL, LDL, and Triglycerides), and C-reactive protein. Assessments occurred at baseline, 3, and 6 months. It was hypothesized that [Narrative+AVG] would outperform [AVG Only], which would outperform [Waitlist Control]. 79 children completed all three visits (Age=10.9+/-1.7; 63% Boys; 62% Black; 25% Latino; 11% Mixed; and 1% Asian). No statistically significant improvements in MVPA were observed within any condition at 3 or 6 months. A post-hoc exploratory analysis revealed that over the first three months, [Narrative+AVG] increased daily MVPA by 6.8 min compared to [Waitlist Control]. Over the same period, the [AVG Only] group exhibited 815 g less lean mass gain and 7.2 mg/dL lower HDL cholesterol levels relative to the [Waitlist Control]. While neither narrative-enhanced AVGs nor AVGs alone consistently increased daily MVPA across the 6-month RCT, participants in the narrative AVGs group demonstrated greater daily MVPA compared to the control group during the initial three months. During this same period, the AVG-only group exhibited reduced lean mass gain and lower HDL cholesterol levels compared to the waitlist control. The added advantage of narratives was inconclusive, likely due to implementation challenges encountered during the pandemic. These findings highlight the need for addressing these challenges in future research in a fully powered study.