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

Isabelle Mack, Nadine Reiband, Carolin Etges, Sabrina Eichhorn, Norbert Schaeffeler, Guido Zurstiege, Caterina Gawrilow, Katja Weimer, Riyad Peeraully, Martin Teufel, Gunnar Blumenstock, Katrin Elisabeth Giel, Florian Junne, Stephan Zipfel

Journal: Journal of medical Internet research 2020;22(4):e15725

PMID: 32329742

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Plain Language Summary

Authors developed a motion-controlled serious game for children, the Kids Obesity Prevention (KOP) program, addressing the areas of nutrition, physical activity, and stress coping. The aim of the KOP study was to evaluate the game in a cluster randomized controlled trial with two parallel groups in a primary school setting in children aged 9 to 12 years. The main aim of this study was to gain knowledge about important lifestyle factors with the focus on nutrition, especially the dietary energy density (DED) principle. Five fourth grade classes in a single school were randomly allocated to an intervention group or a control group. Results showed that: - children gained sustainable knowledge about the food pyramid concept, the DED concept (including the topic of liquids), and about stress and stress-coping strategies after game play. In fact, 4 weeks after the intervention, the knowledge level was similar to the level directly after intervention. - the children were able to apply their DED knowledge by transferring it to unknown foods. - physical activity decreased in roughly 30-40% of children, whereas it increased in 10% of the cohort. Authors conclude that the game was highly accepted by children, sustainably increased their knowledge of the topics addressed, and could be a useful tool for further studies and education.

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.

©Isabelle Mack, Nadine Reiband, Carolin Etges, Sabrina Eichhorn, Norbert Schaeffeler, Guido Zurstiege, Caterina Gawrilow, Katja Weimer, Riyad Peeraully, Martin Teufel, Gunnar Blumenstock, Katrin Elisabeth Giel, Florian Junne, Stephan Zipfel. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.04.2020.

Address: Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany.; Department of School Psychology, University of Tübingen, Tübingen, Germany.; Department of Media Studies Tübingen, University of Tübingen, Tübingen, Germany.; Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany.; Department of Paediatric Surgery, Nottingham Children's Hospital, Nottingham, United Kingdom.; LVR-Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany.; Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.

DOI: 10.2196/15725