Effects of a Gamified Educational Program in the Nutrition of Children with Obesity

[EN]Obesity is considered a global epidemic of the twenty-first century by the World Health Organization (WHO). Specifically, the Canary Islands has the highest level of this disease in Europe and 40% of children in Spain are overweight or obese. This increase is a direct result of changes in the lifestyles of the population and its nutrition. Because of this, we have designed an educational program based on motor games, active videogames and virtual learning environments to improve the long-term health of children. This article presents and analyzes the results of a study on the nutritional knowledge and adherence to the Mediterranean diet of 46 obese children aged 6 to 12 years in the Canary Islands who participated in an educational program. The study design was quasi-experimental, with two groups (experimental and control). A long-term longitudinal study (3 years) was carried out. A set of evaluation instruments was used for the different phases. The results show significant improvements between the experimental and control groups in terms of their knowledge of healthy nutrition and their adherence to the Mediterranean diet. As a main conclusion, we emphasize that a gamified educational intervention program supported by ICT helps to motivate and promote improvements in the nutrition of children

Meta-Analysis For Comparing Effect Between Game-Based Learning Versus Gamification Utilized In Nutrition Education

The prevalence of obesity tripled from 1975 to 2016 and was declared as a global epidemic by the World Health Organization (WHO) in 1997 (Haththotuwa et al., 2020; Controlling the global obesity epidemic, 2022). Nutrition education that involves knowledge and behavioral change is one major component addressing the problem ( Controlling the global obesity epidemic, 2022). Therefore, the effectiveness of each learning session is essential (Sharifirad et al., 2013). Thus, many nutrition educators have used gamified nutrition education to improve teaching effectiveness to increase healthy behavior or knowledge (Chow et al., 2020.; Munguba et al., 2008; Azevedo et al., 2019). Two approaches were often used for gamified learning: gamification and GBL (GBL; Browne et al., 2014; Johnson et al., 2016; Chow et al., 2020). Gamification applies a game mechanism to non-game content, while GBL or serious gaming involves a game that was built to achieve educational goals (De Freitas, 2006; Johnson et al., 2016). Despite many positive outcomes promoted by gamified education as a whole (Chow et al., 2020; Hamari et al., 2014), there is disagreement among researchers and professionals regarding how games affect education. This study aims to identify and analyze research literature on the effects of active game, gamification and GBL applied to nutrition knowledge and behavior. The researcher performed a network meta-analysis with three sub-constructs. First, searching journal articles that addressed nutrition education implied an intervention consolidated educational strategies into food choice knowledge, fruit and vegetable consumption, and physical activity to a non-medical background population. Then, the studies were compared on the average effect of treatment indirectly through the control group. Results indicated there were plenty of studies that investigated the effect of gamification or GBL to nutrition education. Out of three focused outcomes: food choice knowledge, fruit and vegetable consumption, and physical activity, only studies focusing on physical activity were able to produce measurable differences by comparing hours per week spent performing physical activity. Comparison of the treatment result showed that gamification had the greatest improvement in facilitating physical activity, but it was non-significant. This suggests that utilizing gamification across the globe would be the more successful intervention strategy, but would require improved heterogeneity of measurements for food knowledge and fruit and vegetable consumption in order to achieve consistent measurable results for comparison

A web-based gamification program to improve nutrition literacy in families of 3- to 5-year-old children: the Nutriscience Project

Objective: Assess the impact of a web-based gamification program on nutrition literacy of families andexplore differences in impact by socioeconomic status.Design: Quasi-experimental.Setting: Thirty-seven kindergartens from Portugal.Participants: Eight hundred seventy-seven families.Intervention: Web-based social network of participants' interactions, educational materials, apps andnutritional challenges, focused on fruit, vegetables, sugar, and salt.Main Outcome Measures: Parental nutrition literacy (self-reported survey − 4 dimensions: Nutrients,Food portions, Portuguese food wheel groups, Food labeling).Analysis: General linear model − Repeated measures was used to analyze the effect on the nutrition literacy score.Results: Families uploaded 1267 items (recipes, photographs of challenges) and educators uploaded 327items (photographs, videos) onto the interactive platform. For the intervention group (n = 106), the finalmean (SD) score of nutrition literacy was significantly higher than the baseline: 78.8% (15.6) vs 72.7%(16.2); P<.001, regardless of parental education and perceived income status. No significant differences inthe scores of the control group (n = 83) were observed (final 67.8% [16.1] vs initial 66.4% [15.6]; P= .364).Conclusions and Implications: Gamified digital interactive platform seems to be a useful, easily adaptededucational tool for the healthy eating learning process. Future implementations of the program will benefitfrom longer time intervention and assessment of the eating habits of families before and after intervention

Exploring the Benefits of Using Gamification and Videogames for Physical Exercise: a Review of State of Art

There is a lack of motivation in children and adolescents to do physical exercise and at the same time a worldwide obesity epidemic. Gamification and active videogames can be used to increase the motivation of young people, promoting healthy habits. In this work we explore different studies on active videogames, eSports and gamification applied to physical exercise and health promotion. Main findings include positive effects in a reduction in body weight and in the promotion to continue performing of physical exercise. It also contributes to increase the motivation in children and adolescents to practice exercise. The personalization of user experience and emerging technologies (big data, wearables, smart technologies, etc.) are presented as promising opportunities to keep the engagement in game-based program and gamification of physical exercise

Gamified Wearables in Obesity Therapy for Youth

Introduction: Obesity in children has become a global phenomenon. Most of the existing programs have only limited effects and often require an expensive and laborious multi-professional therapy. The aim of this study was to examine which guidelines for gamified wearables can be developed into an effective tool for weight loss and long-term behavior changes within children. Methods: The paper comprises a literature analysis and qualitative research design. Open-ended questionnaires were distributed to 3 clinicians and 18 children and analyzed using MaxQDA. Three independent variables age, gender and BMI were considered. Results: The research has identified four fundamental guidelines for gamified wearables for which a prototype was developed. These guidelines are in short: practical obesity management tool, appealing game-approach, challenging rewards and positive education. Personal emotional support was theoretically a fifth guideline but is not supported. Results could not reliably answer whether long-term behavior change can be triggered through gamified wearables

Health Promotion for Childhood Obesity: An Approach Based on Self-Tracking of Data

[EN]At present, obesity and overweight are a global health epidemic. Traditional interventions for promoting healthy habits do not appear to be e ective. However, emerging technological solutions based on wearables and mobile devices can be useful in promoting healthy habits. These applications generate a considerable amount of tracked activity data. Consequently, our approach is based on the quantified-self model for recommending healthy activities. Gamification can also be used as a mechanism to enhance personalization, increasing user motivation. This paper describes the quantified-self model and its data sources, the activity recommender system, and the PROVITAO App user experience model. Furthermore, it presents the results of a gamified program applied for three years in children with obesity and the process of evaluating the quantified-self model with experts. Positive outcomes were obtained in children’s medical parameters and health habits

The development and feasibility of gamified digital intervention aiming to promote physical activity in early childhood

This study aimed to develop a gamified digital intervention aiming to promote physical activity in early childhood. A further aim was to evaluate the feasibility of the intervention among the target group in child health clinics. The study consists of two phases. The development phase – a cross-sectional correlational study explored developmental factors associated with active play behaviour of 2.5-year-old toddlers (n = 717). Data were collected in child health clinics and consisted of the assessment of child’s neurological development and preference to participate in active play. Data were analyzed statistically. The results showed that delayed gross motor skills, self-help skills and auditory perception were negatively associated with a child’s preference to participate in physically active play. A quantitative systematic review explored previous gamified digital interventions that enhanced the physical activity self-efficacy of children. Data were collected from five electronic databases and analyzed narratively and statistically. The results showed that the gamified digital interventions are effective in enhancing the physical activity self-efficacy of children. The results from a correlational study and systematic review, together with National Physical Activity Recommendations, contributed to the development of the intervention. The feasibility and piloting phase – a mixed-method post-test feasibility study – evaluated the usability and acceptability of the intervention from the perspective of public health nurses (n = 5) and families with a child either 1.5 or 4 years old (n = 15). Data were collected using questionnaires and interviews, and analyzed statistically and with deductive qualitative content analyses. The results showed that the intervention was usable and acceptable. Suggestions for further development of the intervention consisted of simplifying the intervention, adding more gamified elements to be more attractive to children and adding more precise feedback for the parents. Based on these results, the intervention was modified and a cluster-randomized controlled study was planned to evaluate the effectiveness of the intervention.Varhaislapsuuden fyysistä aktiivisuutta edistävän pelillisen digitaalisen intervention kehittäminen ja soveltuvuus Tämän tutkimuksen tarkoituksena oli kehittää pelillisyyttä hyödyntävä digitaalinen interventio lasten fyysisen aktiivisuuden edistämiseen lastenneuvoloissa, sekä arvioida intervention soveltuvuutta lasten, perheiden ja terveydenhoitajien näkökulmasta. Tutkimus koostuu kahdesta vaiheesta. Kehittämisen vaiheessa, korrelatiivinen poikkileikkaustutkimus tutki 2,5-vuotiaiden lasten (n=717) kehityksen ja liikunnallisen leikin välisiä yhteyksiä. Aineisto kerättiin lastenneuvoloissa ja se koostui lasten neurologisen kehityksen arvioinneista ja liikunnalliseen leikkiin osallistumisen arvioinneista. Aineisto analysoitiin tilastollisin menetelmin. Tulosten mukaan motorinen kehitys, omatoimisuus ja kuullun ymmärtäminen olivat yhteydessä lapsen liikunnalliseen leikkiin osallistumiseen. Kvantitatiivisen systemaattisen katsauksen tarkoituksena oli tarkastella aiempia pelillisiä interventioita lasten fyysisen aktiivisuuden minäpystyvyyden edistämisen näkökulmasta. Aineisto kerätiin viidestä sähköisestä tietokannasta ja analysoitiin narratiivisesti ja tilastollisin menetelmin. Tulosten mukaan peli-interventiot ovat tehokkaita lasten fyysisen aktiivisuuden minäpystyvyyden edistämisessä. Korrelatiivisen tutkimuksen ja katsauksen tulokset sekä kansalliset lasten liikunnan suositukset toimivat intervention kehittämisen pohjana.  Soveltuvuuden ja pilotoinnin vaiheessa, monimenetelmäinen soveltuvuustutkimus arvioi intervention käytettävyyttä ja hyväksyttävyyttä terveydenhoitajien (n=5) sekä 1,5- ja 4-vuotiaiden lasten ja heidän perheidensä (n=15) näkökulmasta. Aineisto kerättiin kyselyin ja haastatteluin sekä analysoitiin tilastollisin menetelmin ja laadullisella deduktiivisella sisällön analyysilla. Tulosten mukaan interventio oli käytettävä ja hyväksyttävä. Tutkittavat toivat esiin intervention parantamisehdotuksia, jotka liittyivät intervention sujuvuuden ja pelillisten elementtien lisäämiseen sekä vanhemmille osoitetun yksityiskohtaisemman palautesysteemin luomiseen. Soveltuvuustutkimuksen tulosten perusteella interventiota muokattiin ja intervention vaikuttavuuden tutkimus suunniteltiin satunnaistettuna kontrolloituna tutkimuksena

Promoting healthy lifestyle habits through learning based on active video games

The overweight and obesity have been declared as a worldwide health problem. Active videogames and technologies can be used as attractive tools to support educational interventions with children. Thus, in this paper, we present an educational program to promote healthy habits in children with obesity using active videogames and motor play as main strategies. This program was developed with 46 children and their parents in collaboration with the hospital and schools. The results show positive effects in the knowledge about healthy habits and behaviors of children

Treatment of children obesity and diabetes through gamification

Childhood obesity is nowadays a global epidemic. This illness sometimes comes with another associated problem, like Diabetes type II. In this paper we present a case of study about the results of the application of a gamified educational program. A 3-year longitudinal and prospective study was conducted a patient with obesity and diabetes. Different assessments regarding the health state of the patient have been developed (family background, physical/medical, emotional state and physical activity). Using Positive outcomes have been obtained in their medical registers and also, in their health habits. Thus, the application of gamification strategies in the educational program has positive impact in the health

Growing Strong and Healthy with Mister Bone: An Educational Program to Have Strong Bones Later in Life.

Optimal peak bone mass and bone health later in life are favored by a sufficient calcium intake in infancy, childhood and adolescence. The purpose of this study was to test a new educational program created to monitor and to improve calcium and vitamin D intake in children. Nutritional habits in children were evaluated through a food frequency questionnaire (FFQ) to assess the intake of calcium, vitamin D, dairy products, and total caloric energy at baseline and after seven months of exposure to a unique educational program applied between November 2013 and May 2014 in 176 schoolchildren (48% male, 52% female) attending the fourth and fifth grades of two selected primary schools in Florence, Italy. A significant increase of calcium (from 870 ± 190 to 1100 ± 200 mg/day, p &lt; 0.05), and vitamin D (from 3.6 ± 1.53 to 4.1 ± 2 µg/day) intake in children was documented after the educational program. The amount of specific foods important for bone health consumed, such as milk and vegetables, increased significantly, both in male and female children (p &lt; 0.05). The proposed educational program appears to be effective in modifying calcium intake in children, with a significant increase in the consumption of dairy products and vegetables, but without a significant change in the total caloric intake