Sweat, Score, and Staying Healthy: Is Exergaming a Technological Fix for Childhood Obesity?

Exergaming illustration (Source)

“Children are the world’s most valuable resource and its best hope for the future.” — John F. Kennedy

If this is the case, how hopeful can we be if children’s health are compromised from a young age? Childhood obesity is a major public health issue, and despite government goals and interventions it continues to rise to the extent that the UK is one of the most unfit nations in Europe, where nearly 1 in 4 children are obese (aged 10–11). Consequently, these children being predisposed to obesity in adulthood, leading to greater risks of mental and physical health, disability and premature deaths.

Childhood Obesity in England 2021/22 (Source)

We often think technology is to blame — eyes glued to the screen, whether it’s TV, social media or playing video games. If we live in a society where our phones and TV screens are part of our daily lives, how can we use them to our advantage and provide solutions to a **wicked problem **that is often a symptom of social factors? But in turn, what are their barriers and unintended consequences?

A Digital Playground of Exergaming

So, what exactly is exergaming? It involves playing digital games using bodily movements to actively play, resulting in a form of physical activity.

The first exergame dates back to 1986 using a bike pedal, although, since that was before my time, I instead spent time playing exergames on the Nintendo Wii which launched in 2006, allowing users to play a range of **Wii Sports from bowling to tennis, alongside my personal favourite, [Just Dance](https://en.wikipedia.org/wiki/Just_Dance_(video_game_series)). **Perhaps, I’m biased coming from a dance background, but even my Mum who barely dances enjoyed it! With a controller in hand, tracking your movements to an upbeat song, mirroring the character on screen, and awarding points for accuracy of timing and movement. Gamification of dance makes it feel rewarding and there’s competitive fun when playing against friends.

Furthermore, a 6 month study in the U.S., resulted that using home-based exergaming such as Just Dance for 1 hour 3 times a week improved children’s BMI z-score, and stated that with social support it can be promoted as a viable exercise option.

Have a try for yourself (without a controller)!

[embed]Just Dance example (Source)

Are Exergames a Technological Fix?

A **technological fix is a term coined by Weinberg in 1966, where technology provides practical solutions without needing to change human behaviour; compared to social engineers that use deliberate and planned efforts to modify behaviour and societal structures. 12 years later, Sarewitz and Nelson create ***Three rules for a technological fixes*— to what extent do they apply to exergaming for childhood obesity?

1. “The technology must largely embody the cause-effect relationship connecting problem to solution”

Exergaming embodies a direct cause-effect relationship, addressing sedentary behaviour and lack of exercise. As discussed in the Just Dance case, technology uses gamification of movement for in-game movement and progression, motivating children to engage in physical activity.

2. “The effects of the technological fix must be assessable using relatively unambiguous or uncontroversial criteria”

The WHO use a BMI growth reference index for what is a “healthy” z-score for boys and girls between ages 5–19 years-old, allowing improvements in health outcomes of exergaming to be assessed relatively unambiguously. Other parameters including duration and intensity of physical activity, and changes in fitness levels have scientific measurements making them relatively objective and uncontroversial. However, there’s debate over the long-term effectiveness of exergaming, alongside unintended consequences.

Also, it is important to note that BMI is not a perfect measurement, and new policies encourage doctors to avoid relying solely on BMI when diagnosing obesity. Comprehensive assessments including blood pressure, cholesterol, and glucose measurements creates a better picture of an individual’s overall health.

3. “Research and development is most likely to contribute decisively to solving a social problem when it focuses on improving a standardised technical core that already exists”

The standardised technical core exergaming builds upon is video game technology, adapting this core to promote physical activity and exercise. R&D is seen in improving its user-centred design on interactive and motivational aspects and innovation to result in a more engaging and effective product.

Overall, whilst exergaming aligns reasonably to the 3 rules for a technological fix, it is important to discuss are there any groups being excluded and what are the potential unintended consequences that come from this approach?

The Barriers That Might Make Technologists Break a Sweat

So far it seems that exergaming is a revolution providing a solution for childhood obesity, but it is important to consider that it’s not a holistic solution. As depicted in the figure below, childhood obesity consists of a variety of factors from individual to social, environmental, and political.

Socioecological Model of Childhood Obesity (Source: created by me on Canva)

A successful intervention should be easily accessible to all, however, **childhood obesity is 2x more prevalent in low socio-economic households than middle or high, thus raising issues over a [digital divide](https://www.investopedia.com/the-digital-divide-5116352#:~:text=Understanding%20the%20Digital%20Divide,-The%20digital%20divide&text=It%20refers%20to%20the%20socioeconomic,necessary%20to%20use%20it%20effectively.)**. Those unable to access technologies using exergames may consequently face further health inequalities. Therefore, considering to integrate exergaming in a broader approach that involves family, community, and school support would be beneficial for the effectiveness and accessibility.

Deprivation and Obesity Prevalence among Year 6 Children in England (Source)

Lastly, it is important to consider the technology’s unintended consequences, mentioned in Jasanoff’s book *The Ethics of Invention*. One significant concern is the potential overuse, the high screen time could result in adverse effects on children’s wellbeing. Additionally, the risk of neglecting other forms of physical activity, which can be detrimental to their overall development.

Furthermore, there is a risk of injury both physically through overexertion or improper use of equipment, but also risk of injuring a child’s self-esteem. For example, if exergaming products are improperly marketed, emphasising body image over the enjoyment of staying healthy. This highlights the importance of responsible marketing and communication practices by technology companies, ensuring that their products are promoted as a fun and healthy way to engage in physical activity. Establishing clear guidelines can mitigate unintended consequences, providing caregivers and educators with valuable information on ensuring a balanced and positive exergaming experience.

Final Thoughts

Overall, exergaming provides a promising and fun future as a technological intervention for childhood obesity. However, it is essential to recognise the barriers that come with technological fixes, and what can be done by policymakers, charities, communities to make this accessible with long-term effectiveness; alongside parental guidance and support to minimise potential unintended consequences.