Virtual Reality (VR) fights against Obesity Epidemic
The Obesity Epidemic
It cannot be denied that nutrition plays a vital role in our life and malnutrition, the condition in which body does not consume enough food or enough healthy food impedes our body and brain’s normal function and leads to several severe health issues and disease. Bad food choice and eating habits developed in childhood are hard to change and become key contributors to obesity and chronic diseases during adulthood (Perera, 2015). The research conducted by the Centers for Disease Control and Prevention (CDC) in 2017 revealed that in 2015 - 2016, nearly 4 in 10 adults and 2 in 10 youth in the U.S. were obese. The prevalence of obesity in adults have significantly increased since the beginning of the 21st century, growing from 30.5% in 1990 - 2000 to 39.6% (equivalent to 93.9 million of U.S. adults) in 2015 - 2016. Obesity is associated with a plethora of serious health risks such as heart disease stroke, type 2 diabetes and certain type of cancer that are some of leading cause of preventable, premature death (CDC, 2018). According to Finkelstein and colleagues, the estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars and an obese person on average has to pay $1,429 higher than a normal individual for medical expenses (Finkelstein et al., 2009).
Therefore, it is important to teach children about the nutrition, more specifically what nutrients are beneficial for their body and the roles that nutrients play in ensuring a sustainable physical and psychological development, so that the children can independently and confidently make healthy food choices on their own. Once children have good understanding of nutrition, the rate of obesity would be more likely to decrease and hopefully to be diminished (Bell et al., 2011). It is worth mentioning that schools play an important role in addressing the obesity epidemic by teaching nutrition and building up children’s good dietary habits and behaviors through the school meals program (IOM, 2012). However, the literature pointed out that schools were struggling with providing adequate effective nutrition education (Kann et al., 2006; NCES, 2000) and teachers were lacking of professional training in order to teach nutrition competently and confidently (NCES, 2000).
How can Virtual Reality help?
Given the obesity epidemic and various constraints of teaching nutrition in schools, there is a need for innovative approaches that can help enhance the effectiveness of nutrition education program and address the issue of obesity. Ershow and colleagues (2011) proposed that virtual reality (VR) may be able to offer a new approach for research and education in diabetes and obesity. In fact, with the capability of providing controllable, multisensory, interactive three-dimensional (3D) stimulus environments, VR technologies were proven a potentially valuable means of engaging patients in interventions that produce sustainable and desirable health-related behaviors for weight management through motivational reinforcement, personalized teaching approaches, and social networking (Ershow et al., 2011). Weight management education could be promoted and benefit from the integration into existing video games and other consumer based VR products (Ershow et al., 2011). Despite its potentials to tackle the national epidemic, the development of VR as a modality for obesity and diabetes studies has been very limited; thus there is a strong need for developmental research leading to new technologies and potentially commercializable products and utilizing motivational and teaching aspects of VR technology should be one of the priority topics (Ershow et al., 2011).
Food Fight
Food Fight and Sugar Goggles are two early developed examples of VR applications in the domain of obesity education in particular and nutrition education in general. Food Fight is a VR game produced by Health Impact Studio that aims to educate and promote healthy eating by engaging the players in the easy and fun game play where they have to differentiate healthy and unhealthy foods, avoid taking unhealthy food, and actively seeking healthy food alternatives (Health Impact Studio, 2019). According to the game producer, the game is designed for anyone seeking better control over excess or unhealthy food intake and wanting to make healthier food choices. However, it can be inferred from the game mechanics and aesthetics that the game is more geared towards younger players.
Source: Food Fight
Previous research showed that serious digital games had positive effects on promoting healthy lifestyle and especially games having a sound theoretical foundation in behavioral change and effective game design was most effective (DeSmet et al., 2014). According to Health Impact Studio, the Food Fight’s game design that would engender positive lifestyle change is theoretically informed by two components of behavioral therapy: 1) Refusal Skills Practice - individuals learn how to respond “No” rapidly and assertively to an offer of a substance that they are trying to quit has been proven effective in addition treatment. 2) Counter Conditioning means an unwanted behavior is substituted by a positive action and the new behavior is rewarded. Integrating these approaches into game mechanics, while playing Food Fight, the players have to avoid taking unhealthy food and throw or shoot the food back to kill the monster and win the game. These behaviors of rejecting and destroying bad food which correspond to saying “No” in Refusal Skills Practice are rehearsed and rewarded to help players build and strengthen new positive habits which counter-condition and replace unhealthy food intake habits.
From the abovementioned analysis, in Food Fight, the VR technology simply helps to generate a more immersive and authentic environment (e.g. school pantry) for learning to take place and the unique affordances and characteristics of VR technology doesn’t contribute much to the core game mechanics/interactions and learning objective which is to distinguish nutritional and unhealthy food choices. It is fair to say that the immersive VR environment would certainly boost the students’ engagement and that generates a better learning outcome. However, the impact is not worthwhile and will probably be offset by the highly intensive resources and cost of VR application development and deployment while the similar game play and equivalent learning outcome could be achieved through other less immersive and technologically complex approaches.
Sugar Goggles
Another interesting application of VR in educating and promoting healthy eating is Sugar Goggles developed by Atkins. Based on similar idea of bad vs. good food choice, Sugar Goggles take a deeper look . VR takes players to go inside their body and flow into the bloodstream where they encounter pairs of food high and low in sugar (for instance, a banana and a whole-wheat bagel) and their job is to fly through the one that has the lowest impact on the level of blood sugar to get an in-game energy burst. If they choose poorly food that is higher in sugar, they will lose control and ultimately the entire game due to blood sugar spike. According to the producer, this simple “lack of control” scenario is a visceral feeling that one cannot get from watching a video or reading a pamphlet about sugar spikes and in that sense, the game provides players immediate feedback about what bad food options are actually doing to their bodies and how it relates to adverse health consequences.
Source: Atkins
HealthiAR commented that although Sugar Goggles is a simple game, graphically clunky, and especially doesn’t fully take advantage of what VR is capable of, it does have its heart in the right place and it’s the first VR attempt to help educate people about the impacts of certain food on short-term blood level that may lead to serious health risks and chronic diseases and hopefully help them change their dietary habits.
Since the game was launched in March 2017, the company has not released the game to the general public at large, yet they did bring the game to various high schools around the U.S. through an educational initiative with HealthCorps, a national non-profit organization that provides teenagers tools to improve physical and mental health so they can live happier and more productive lives (Atkins, 2017). Ramona High School was one of the schools participating in the program. According to HealthCorps (2019), the students’ experience was pretty positive and looking to the students’ journals after the experience, we could obviously see the learning goal had been achieved to some extents.
Prompt: Look up the definition of Diabetes and write it down. What causes it? How can it be prevented?
Cecilia: “Diabetes-noun: The level of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. It is caused by your glucose. It can be prevented by eating less sugar. The person I know who has diabetes is Carlos. They have to eat food without or little saturated fat and sugars. I want to stay healthy because it will keep my muscles strong.”
Prompt: Not all foods you like are bad for you? What foods do you eat that are okay? How come you like them?
Cecilia: “I realize all foods are not bad for me. There are some foods I like that are not all bad for me. These foods are meat, yogurt, salad, and bread. I like these foods because they keep me healthy and they are good. Some foods I eat are not good for me and they are: pizza, cake, and candy. I would like to change the way I eat because I want my body to stay healthy.” (HealthCorps, 2019)
As both games are the very first and rare attempt of designing VR educational games/applications aiming to teach students to make better food choices, it is understandable that their design did not meaningfully take advantages of the unique affordances of VR and the achieved learning outcomes seemed very limited given the high cost and resources of VR application development. Yet it is undeniable that the games did successfully stimulate students’ interest and raise their awareness of making healthy food choices to a certain degree. As the literature suggested that the research in this domain is still scant, there is still a long way to go until we can expect a more matured VR application for nutrition education.
