The features.

If you’re looking for a truly easy way to start eating healthier, look no further than Munch 5-a-Day. The interface is bright, the graphics are cute, and its functionality is very intuitive. Users can set personal daily “munch goals” which are automatically reset on a daily basis. Recording FV consumption is quick and easy. Simply tap the fruit and veggie icons on the homepage one time for each portion you eat. No scrolling around to find the exact food or measurement.

Tilting the phone gives users graphs of fruit and vegetables consumed over two time periods, weeks and months. Unlike most nutrition apps, the graphs are easy to read and interpret with red icons representing portions of fruit consumed and green representing vegetables.

Munch 5-a-Day also gives positive reinforcement with instant gratification through congratulatory messages and a slew of cute badges to earn. For those needing some social reinforcement, you can share your triumphs (and failures) with friends on Twitter and Facebook. The creators also see this app working well for parents that want to teach their children about plant-based diets in a fun, interactive way.

How to get it.

Munch 5-a-Day is available for iPhone and iPad in the App Store for only $0.99. I’ve downloaded the app on my iPhone, and I have to say, it’s very well done. Tracking fruit and vegetable consumption has never been so cute!

American Journal of Preventative Medicine, Elsevier: San Diego, CA, December 7, 2010 – Obesity in youngsters has risen dramatically in recent decades. Fruit and vegetable (FV) consumption and increased water intake can lower the risk of obesity, as can increased physical activity, but it is not always easy to convince children to eat better and exercise more. In a new study published in the January 2011 issue of the American Journal of Preventive Medicine, researchers found that video games designed to encourage these behaviors were effective.

About the games

“Escape from Diab” (Diab) and “Nanoswarm: Invasion from Inner Space” (Nanoswarm) are epic video games specifically designed to lower risks of type 2 diabetes and obesity by changing youth diet and physical activity behaviors. Designed by Archimage, Inc., and funded by a Small Business Initiative Research Grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, Diab and Nanoswarm are based on social cognitive, self-determination, and persuasion theories.

“Diab and Nanoswarm were designed as epic video game adventures, comparable to commercial quality video games. These games incorporated a broad diversity of behavior change procedures woven in and around engrossing stories. The games motivated players to substantially improve diet behaviors,” according to lead investigator Tom Baranowski, PhD, Professor of Pediatrics, U.S. Department of Agriculture/Agricultural Research Service supported Children’s Nutrition Research Center, Baylor College of Medicine. “Serious video games hold promise, but their effectiveness and mechanisms of change among youth need to be more thoroughly investigated.”

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The study and results

Children playing these video games increased FV consumption by about 2/3 serving per day, but did not increase water consumption or moderate to vigorous physical activity, or improve body composition. Despite the increase, FV and water consumption and physical activity remained below the minimum recommendations.

In this randomized clinical trial, 153 children ages 10 to 12 years, were divided into a treatment group (103 children) and a control group (50). Complete data were obtained on 133 subjects. The treatment group first played Diab and then Nanoswarm. The control group played diet and physical-activity knowledge-based games on popular websites. Each group was assessed at the start of the trial, immediately after Diab, immediately after Nanoswarm, and again two months later. Height, weight, waist size, and triceps skin-fold thickness were measured. Physical activity was monitored for at least 4 days by accelerometer-based data from each child at each assessment. Food consumption was measured using 24 hour dietary recalls conducted by registered dietitians.

[There is a video that cannot be displayed in this feed. Visit the blog entry to see the video.]

The article is “Video Game Play, Child Diet, and Physical Activity Behavior Change – A Randomized Clinical Trial” by Tom Baranowski, PhD, Janice Baranowski, MPH, RD, Debbe Thompson, PhD, Richard Buday, FAIA, Russ Jago, PhD, Melissa Juliano Griffith, MPH, Noemi Islam, MPH, Nga Nguyen, MS, and Kathleen B. Watson, PhD. It appears in the American Journal of Preventive Medicine, Volume 40, Issue 1 (January 2011) published by Elsevier. doi: 10.1016/j.amepre.2010.09.029

When I first started healthGAMERS we were in the process of creating a new online health game based on the food pyramid.  At that time, I was researching what was out there.  My conclusion: a call for better Food Pyramid games.  Someone at the USDA must have been reading because the latest news buzzing in the public health sector is the announcement of the USDA Food, Nutrition and Consumer Services (FNCS) Innovations for Healthy Kids Challenge.

According to their latest news release, the USDA is challenging the public to create new web-based learning applications, such as health games, to reach more tweens (kids ages 9-12).  The challenge is designed to highlight the Obama Administration’s commitment to combating childhood obesity and improving the national health of America’s youth.  They are providing open source federal datasets on Data.gov and MyPyramid.gov for those that wish to enter.  Access to this data is great in itself!

Contest details.

• Who can apply? Entrepreneurs, software developers, and students who are U.S. citizens and not current USDA or White House employees.
• Who is the target audience? Kids 9-12 years old, aka “tweens”
• What kind of technology is required? Platform information will be posted soon, but entries are to be fully developed web-based games.  All data in the games must from be the USDA Nutrition Dataset and/or the Source Code.
• When is the deadline? Submissions will be accepted in spring 2010.  Further details are to follow.
• What are the prizes? Four prizes will be awarded including Gold ($3,000), Silver ($2,000), Bronze ($1,000) and Popular Choice $2,ooo).
• How are winners decided? All entries will be judged by a panel of public and private sector nutrition and gaming experts based on the following criteria: potential impact on target audience (40%), quality/accuracy/content of messages (20%), creativity/originality (20%) and potential for further development/use (20%).

For further contest information see the USDA Innovations for Healthy Kids Challenge page or sign up for email updates.

In my last post on mobile phone-based health games, I gave you an overview of Mindless Eating Challenge, a game by Cornell University Food and Brand Lab, funded in part by the Robert Wood Johnson Foundation as part of their health games research initiative.  As I had hoped, I was able to interview JP Pollak, doctoral candidate and lead researcher for the project.  JP gave healthGAMERS an inside look at this amazing project designed to teach middle school children about healthy eating through care of a virtual mobile pet or plant.

The interview.

HG: Why did you choose the book Mindless Eating to create a mobile game?  Who came up with the idea?

JP: The Cornell University Food and Brand Lab, directed by Dr. Brian Wansink has done some amazing academic work on this subject, and the popularized book Mindless Eating has received much well-deserved recognition.  Brian approached us (the Human-Computer Interaction Lab, directed by my advisor, Dr. Geri Gay) looking for a way to reach more people with the Mindless Eating message and the Challenge.  Basically, they have lots of great findings, and many people have had good results when participating, but they felt they could reach more people through technology and a more interactive medium.

After exploring many possibilities, we decided to target kids and make a game out of it.  Of course, the emphasis of our lab’s work is mobile technology, so the fact that it was going to be a mobile phone game was a given.  Then it was just a matter of taking a good look at existing research and games and seeing what worked. Virtual pets have been extremely popular (Tamagotchi, Nintendogs, etc.), and there is actually a fair amount of literature suggesting pet/ plant care can be used to encourage or reinforce behaviors.

HG: What aspects of the book were incorporated into the game?

JP: We use the eating tips from the book and from the Food and Brand Lab’s research as the healthy eating prompts for the game.  There are specific tips for snacks and for each meal and they vary based on the persons goals (losing weight, eating healthier, etc.).

HG: Is Mindless Eating Challenge specifically an iPhone app or is it a general mobile application?

JP: We have a J2ME version, a mobile-optimized web app, and there is an iPhone app currently in development.  Each has pros and cons.

HG: Was program design done in-house?

JP: All of the design was done in house.  The pets and graphics as well as some of the early coding was done by Sara Lin, a fantastic student working in our lab who has since graduated.

HG: What are the major goals of the project?

JP: The goals are two-fold.  First, we want to do good and improve health outcomes for kids.  The game is designed as a persuasive technology that we hope will improve eating behaviors in kids while they eat, and ultimately improve their awareness of what their eating and their self efficacy around eating.

Second, we’re an academic lab, so we’re interested in what we can learn from the game.  For example, what are the underlying mechanisms of gameplay that can be used to change behavior?  How does social influence play a role in behavior change?  These are questions that have been answered in other domains but haven’t been adequately addressed in terms of persuasive technology and health games.  Better understanding of these issues should inform the development of future health games that can be even more effective.  Addressing some of these questions is also the goal of the Robert Wood Johnson Foundation Pioneer Program grant we received to support our work on the game.

HG: What health results do you hope to see in players who use Mindless Eating Challenge?

JP: We hope players diets improve, that they become more aware of what they are eating and what they should (or shouldn’t) be eating, and that we can improve their confidence that they can make a positive change in their eating behavior.  We completed a study with 70 middle school students in upstate New York this spring and are currently working on getting the findings published.  We think they support some of our goals quite nicely.

HG: Will this game ever be made available for public consumption?  If yes, when should we expect the launch?

JP: This is a goal of ours.  We need to first answer a few more research questions and address some scalability issues, so unfortunately it’s hard to say when this will be available to the public.

Closing remarks.

I hope JP is correct about the possibility of Mindless Eating Challenge being made available to the public.  I think the market, especially the iPhone App market, is ready for a mobile health game.  We look forward to the results of the study!  For more information on Mindless Eating Challenge, visit the following resources:

• Kotaku article “Grants Awarded For Inspiring Health Games Research”
• Cornell University Food and Brand Lab
• Human-Computer Interaction Lab at Cornell University
• Mobile Eating Game Challenge summary page

Nanoswarm

Invasion From Inner…

By Mary Ann Pendino …

Book Preview

Why publish?

Archimage, developers of Nanoswarm: Invasion From Inner Space, decided to release the book for publication so the story can be enjoyed while the public awaits the clinical trial results from researchers at the Children’s Nutrition Research Center at Baylor College of Medicine.  Data is scheduled to be released by the end of 2009.

The book was originally written to help the developers fully understand the backstory and characters appearing in the game.  It turned out to be such a good story that co-author Richard Buday felt it shouldn’t gather electronic dust on some hard drive.  It needed to be in print.

The story.

The book sells for $12.95 and will soon include an educational workbook. Here’s what to expect from the novel:

Life in the year 2030 was almost perfect.  War, crime and hunger were history.  Microscopic robots had eradicated pollution.  Scientists were on the verge of curing disease.  Then, one day, people all over the world started getting sick. And no one knew why.  That’s when you, a 12-year-old Trainee Second Class, joined the world’s leading research team. Wings, this is your story.  How will you choose?

According to a recent news release in Amsterdam, a research study presented at the European Congress on Obesity determined that food intake alone explains the increase in American body weight over the last thirty years.  Professor Boyd Swinburn, Director of the World Health Organization Collaborating Centre for Obesity Prevention and Related Research and Chair in Population Health at Deakin University in Australia was quoted saying,

“There have been a lot of assumptions that both reduced physical activity and increased energy intake have been major drivers of the obesity epidemic. Until now, nobody has proposed how to quantify their relative contributions to the rise in obesity since the 1970s. This study demonstrates that the weight gain in the American population seems to be virtually all explained by eating more calories. It appears that changes in physical activity played a minimal role.”

There are many nutrition experts that disagree, citing potential flaws in the study including the interpretation of food supply data used and ignoring the fact that Americans are more likely to keep off weight if they change their diet and physical activity habits.

Will this have an impact on the exergaming industry?

We’ve heard from many individuals how exergames have changed their lives.  But does this study make these people just lucky Wii fans?  What does this mean for non-active games that are designed to change eating behaviors or focus on nutrition?  Tell us your thoughts in the comments section.

We are honored to present our first guest contributor today, Dr. John La Puma, MD.  He is going to share some of his insight on the world of cooking games for weight loss.  A big thanks to Dr. La Puma for this article.  -Melanie L.

The top four.

When Dr. Mike Roizen and I taught nutrition and cooking to medical students at SUNY-Syracuse six years ago, we thought we needed to be there.

But people learn in all sorts of ways. Now Nintendo is out with four popular choices.

1. My Weight Loss Coach software. A simple stick-figure tool for someone starting out, this is more of an adult health app than a game. It coaches small, bite-size daily steps and reminders: skip the corn chips today. Put the salt shaker in the cabinet. There is a calorie counter and an iphone app.
2. Cooking Mama. Educational and slightly second-life-ish, Cooking Mama allows you to use the stylus as your ubi-tool (stir, chop, slice, dice, knead) for 70+ largely Japanese-style recipes. Cooking Mama has a bit of Gordon Ramsay, but only a little nicer. When you make a mistake cooking you’re not lambasted, though her eyes can flame. Recipe difficulty varies greatly; with little emphasis on calories.
3. Cooking Mama 2 can feed friends, and you can customize the kitchen, cookware and Mama’s clothes (nothing too racy, at all). Both Mama games have their adult fans, but cutesy graphics and the simple characters cater especially to preteens.
4. Personal Trainer: Cooking. Quirky and eclectically international, this is an interactive cookbook. You get detailed guidance for shopping and cooking 245+ recipes from lasagna to bulgogi on two small screens with WiFi. You can select dishes (using voice recognition and touch screens) according to calories per dish.

Hands-on is still the best way I know to teach healthy cooking. But if private weight loss coaching can work well by email, phone and fax, then this first phalanx of weight loss and cooking games is worth a look.

About Dr. La Puma.

John La Puma, MD is obsessed by games that can do good and still be as fun as World of Warcraft.  A practicing physician, professionally trained chef, and a New York Times best-selling author, he hosts “What’s Cooking with ChefMD? Sunday mornings on Lifetime TV’s “Health Corner”.  Visit him at www.drjohnlapuma.com.

We’re in the process of creating a health game about the food pyramid at the Playnomous office.  And it hasn’t been easy.  In my opinion, from a graphical standpoint, the latest edition of the USDA food pyramid (or MyPyramid) is nonsensical.  It uses a pyramid shape, but the new schematics work more like a pie chart since MyPyramid is all about percentages for individuals.  Frankly, I think they should have changed the shape and scratched the word “pyramid” altogether.

Food pyramid game or food pyramid lame?

However, sometimes you have to work with what you have, so we hope to soon release Food Pyramid Pile Up, pyramid and all.  At our last meeting the question was posed “How do other food pyramid games handle the new MyPyramid format?”  An excellent question and one I couldn’t answer right away.  I was well aware of MyPyramid Blast Off, an online game by the USDA which uses the analogy of fueling up a rocket ship to fueling up your body.  But what other games are out there?  After a few hours of searching, I didn’t come up with many.

• MyPyramid Game – a drag and drop category matching game by the Dairy Council of California
• MyPyramid Food Gallery and Quizzes – a basic tutorial and test of knowledge by Oklahoma State University
• Healthy Hurdles Nutrition Game – a meal balance board game by Learning Resources
• MyPyramid Pursuit Game - a pyramid completion board game by Learning ZoneXpress

All in all, I think MyPyramid, if that is indeed the format we’re going to stick with, needs some help.  There aren’t many health games out there that:

1. Do a good job of making MyPyramid easy to understand.
2. Aren’t just drag and drop category games.
3. Are actually fun to play.

Prove me wrong.

If you know of a stellar Food Pyramid or MyPyramid game that I missed, please add it to our list.  Prove me wrong! Good Food Pyramid games are wanted here on healthGAMERS!

Continuing on with our series, today’s great game must is music to my ears.  You guessed it, Great Game Tenet #7: a great health game has great sound.  This isn’t just your run-of-the-mill sound effects.  Sound includes the sfxs, music, and voices.  All are crucial.

Sounds adds credibility and tone.

The obvious purpose of sound in a game is to activate your auditory senses, not just your visual.  This further immerses the player; it sucks them in.  In my opinion, sound can make or break a health game.  We’ve already talked about how important immediate feedback can be in a health game.  But what about the other sounds like music?  One might argue that music is unnecessary, but if it is used, music can set the tone for the entire game.  Is the game meant to be light-hearted or serious?  Dramatic or just educational?  Sound can also make or break your characters.  Does your character from China sound credible or stereotypical?  Does the character’s voice allow the player to identify with him/her or does it offend the player?  One must also consider general voice over.  This can be a necessity for an audience with a low reading level such as children.  Without voice over, your health message may not get across at all.

Health games that do it well.

Escape from Diab, a PC adventure game that was created to target obesity and decrease type 2 diabetes in children, is a perfect example of a pristine game full of sound.  With a custom soundtrack and professional voice talent, this NIH-funded creation goes above and beyond in the sound category.  The medical training game Pulse!! by BreakAway Ltd and Texas A&M Corpus does an amazing job of using sound to simulate the realities of a clinical emergency after a catastrophic event, such as combat or bioterrorism.  The goal of the game is to be lifelike.  Without sound, this would be a sub-par simulation.

Recommended readings.

• What Makes a Great Health Game Great – Part 6

The style, the color, the flare!  An important element to any game is the art assets.  This gives the game its feel, its personality.  Great Game Tenet #5: great health games have great art.

Art versus content.

Some, like Whyville’s founder Dr. James Bower, believe that good art isn’t necessary for a successful health game.  At last year’s Games for Health Conference in Baltimore, Dr. Bower argued that you have good content, people will come.  I agree with this to a certain extent, however, especially where kids are concerned, there is a certain level of expectation in gaming.  High-quality design, characters, textures, colors, saturation, and lighting are all things kids come to expect in a “good” game.  Some purely educational games can get away with limited art, but even these are starting to catch up with the commercial competition.

Health games that do it well.

Free Dive is a perfect example of a health game that uses art to its fullest potential.  With breathtaking waterscapes and life-like 3D sea creatures, this game is so amazing to watch that it is used to distract children who undergo painful medical procedures.  In a more cartoonish style, Fatworld also has its art down pat.  This game, which tackles issues like obesity, nutrition and food politics, has an elaborate set of art assets, right down to customizable characters.  Fatworld has its own sense of artisitc style, making it easy to distinguish from all other obesity/nutrition games out there.