"Creature-101": A Serious Game to Promote Energy Balance-Related Behaviors Among Middle School Adolescents.

Background: Considering adolescents' heavy use of media, serious videogames may provide an engaging and innovative way to achieve positive impact on adolescents' diet and physical activity. The objective of this study was to evaluate the efficacy of playing a serious game, "Creature-101" (developed by Teachers College, Columbia University [New York, NY] and Stottler Henke Inc. [San Mateo, CA]), at promoting energy balance-related behaviors (EBRBs) such as increasing fruits and vegetables intake, water intake, and physical activity and decreasing processed snacks intake, sweetened beverages intake, and recreational screen time.

Subjects And Methods: This pre-post intervention-control study (=590) was conducted in New York City low-income public middle schools. The students (11-13 years of age, 51.6 percent male) played "Creature-101" online in science/health education classes (seven sessions, 30 minutes each session for 1 month). "Creature-101" used behavioral theories as the framework for "creature care" in a world "Tween." Students were provided with scientific evidence that promoted energy balance through minigames, educational videos, and slideshows and were motivated with interactive dialogues with game characters. Students also assessed their own behaviors, created their own "real life" food and activity goals, and reported their progress. A self-reported, validated, online instrument that measured frequency and amount of targeted behaviors was administered at baseline and post-intervention.

Results: Analysis of covariance compared post-test means between groups with pretest scores as covariates. Intervention students reported significant decreases in frequency and amount of consumption of sweetened beverages and processed snacks compared with the controls. No changes were observed for the other behaviors.

Conclusions: "Creature-101" was effective at reducing consumption of sweetened beverages and processed snacks, which are related to obesity risks, indicating that the game shows promise at promoting EBRBs.