Playing Public Health

Online and On Message

Will Wii Rock You?

Our increasingly obese and isolated children are spending more time than ever playing online games. Can real-world health messages get through to this wired demographic? Kwok W Wan looks at how using a mouse might make health messages click with kids.

One of the challenges of health promotion is access. 'We need to go where the kids are,' says Dr Trina Histon, Director of Kaiser Permanente (KP) Weight Management Initiative. 'They are spending longer online, either doing homework or chatting to friends.' KP, one of America's biggest health organizations, has recently launched a free internet game specifically for tackling childhood obesity. 'Schools have health professionals come in once a year to talk to students. And when visiting a doctor, often the journey to see them is longer that the time you have talking to them,' she says.

'The Incredible Adventures of the Amazing Food Detective' is aimed at nine to 10-year-olds. 'The puzzles in the game came from doctors' feedback about what kids don't know enough about,' explains Dr Histon. The game lets the player be a detective with a series of eight health related mysteries to solve. 'Initial focus group testing suggests the game resonates with kids. We hope it will raise awareness and will be one way to start conversations about health.'

Computer games have often been blamed for the rising levels of childhood obesity and Dr Histon is very aware of the irony of using these very games to combat weight problems. To address this, the game has a unique feature that 'locks out after 20 minutes, and doesn't allow the user to play again for the following hour so therefore tempering the desire to carry on playing,' she says.

Last month, Inspire launched Reach Out Central (ROC), the world's first online game to help improve young people's mental health. The single-player role playing game encourages users to interact with characters in a virtual town, reacting and making decisions to different situations. The non-profit youth support organization developed the game in collaboration with psychologists and computer game creators. 'The early impact is quite staggering,' says Jonathan, and this has been true of the hardest demographic to reach: young men. 'In the weeks previous to the launch, we were getting 150 new members and 20% were male. Since the launch of ROC we've had over 2000 new members and 54% were male. In one week, we've had more new members than the previous nine months.'

Jonathan believes a couple of crucial factors have contributed to the early success of ROC. First is developing a youth brand that the user can empathise with and feel ownership for. 'The public sector has a lot to learn from the private sector. For example, Adidas is a brand that happens to sell sports wear. We're a brand that happens to be about mental health.'

The second factor is technology. In Australia, a recent survey showed that after family and friends, 15-24 year olds look for health information on the web, preferring it to telephone helplines, teachers and doctors. 'Over time, an online community builds that young people can understand and identify with,' says Jonathan. 'We work on getting the language right and we collaborate with young people and get them to re-write things in a style they'll relate to.' Early results also show nearly 40% of users went on from the website to seek help from community health professionals. 'It's not a replacement but a bridge to better health,' he says. 'We believe we have the right formula to influence behavioural changes in a positive way.'

Computer games and the internet, usually accused of promoting violence and being a web of mis-information, might turn out to be the most powerful weapon for health promotion to young people. As Dr Histon remarks, 'Instead of banishing it, we have to work within the framework.'

Related links:
Kaiser Permanente
The Incredible Adventures of the Amazing Food Detective - Obesity Game
Inspire Foundation
Reach Out Central - Mental Health Game

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Christmas 2007 held disappointment for thousands as shops failed to meet demand for the latest 'revolutionary' computer games console. Does demand for the 'active console' known as the Nintendo Wii run deep enough to signal a lifestyle change for sedentary demographics? Kwok W Wan asks whether the national Wii shortage is really a blow for health.

In a recent paper, Professor Cable found that playing the Nintendo Wii (a console that requires the players to use motion sensors) greatly increased a player's physical activity, when compared to playing traditional seated consoles. The study looked at the heart rate and movement of 13-15 year old girls and boys when playing different types of computer consoles. During the 15 minute trial, the energy expenditure when playing traditional seated consoles increased above resting values by an average of 60%. In comparison, playing the Nintendo Wii increased energy expenditure by an average of 156%.

'The children really enjoyed engaging with the games and anything to help promote physical activity is a good thing,' Professor Cable adds. Based on an average of 12.2 hours of gaming a week, the study also suggests that using the Wii could burn an extra 1830 calories a week and this could mean shedding 27lbs over the course of a year.

Reports from different countries say this attraction to video games is not restricted to children. 70 year old residents at the Amity nursing home in Greenacre, Australia are enjoying Wii tennis, a game that simulates the motion of real racket swings and serves. In Sedgebrook retirement community near Chicago - where the average age is 77 - staff have arranged a popular Wii bowling tournament every Sunday in the lounge. In England, Sunrise Senior Living Centre are planning to have the Wii system in each of their 15 residential homes, allowing inter-care homes tournaments to take place with teams travelling to other care homes via minibus.

Though this all sounds like good news, it is dangerous to think of the Wii as an alternative to exercise. 'They have advantages,' says Professor Cable but also adds, 'Parents should encourage other physical activities and outdoor pursuits in order for their children to lead well-balanced lives.'

A recent paper in the British Medical Journal also concludes that, 'Playing new generation active computer games uses significantly more energy than playing sedentary computer games but not as much energy as playing the sport itself.'

Despite this shortcoming, the Wii has proved a global phenomenon. And with the release of a 'Wii Fit' pressure mat early this year increasing the range of movement the Wii allows - letting gamers participate in virtual aerobics and virtual yoga - it is clear that Nintendo are investing heavily in developing this new direction for the gaming market.

Given Nintendo's belief that the popularity of active consoles is set to continue, there must surely be health outcomes to be had for both young and old, if we're game.

Related links:
Liverpool John Moores University
British Medical Journal
Nintendo Wii
British Heart Foundation

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