Research plan to understand which kids and contexts work to bring active video games to more children for pediatric obesity

Research plan to understand which kids and contexts work to bring active video games to more children for pediatric obesity

United States
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

We will use rigorous research methods testining the safety and efficacy of Exergames on health outcomes in youth using larger, real world settings

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Plot your innovation within the mosaic of solutions
Which of these barriers is the primary focus of your work?

Insufficient Evidence that Games Improve Health

Which of the principles is the primary focus of your work?

Physical Health

If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:

Although we now have a few exploratory and laboratory evidence from Lanningham-Foster and others regarding Exergames, we are not seeing them "prescribed" by doctors or used in communities for prevention or treatment of obesity on a wider scale. Although we have feasibility data or "proof of concept" that we can get kids to play these games at home, after school groups and in school, what we need is a way for doctors, schools and teachers as well as weight management specialty centers to endorse and support Exergaming. We need specialists, generalists and public health champions to look at these studies in their own journals and begin to see the value for their patients. Only then will Exergaming be credible and really fun adjunctive treatment.

What is your signature innovation in one sentence?

We will use rigorous research methods testining the safety and efficacy of Exergames on health outcomes in youth using larger, real world settings

Describe your innovation. What makes your idea unique and different than others doing work in the field?

This plan is to really roll up our sleeves and work out the details of why Exergames are cognitively captivating, inherently motivating and energetically demanding. What gets kids hooked on them (or not)? For instance, in three previous studies, our team has successfully piloted DDR type games in homes, after schools and in schools (outside of PE). We have randomized youth to intervention vs control conditions and we have learned a great deal in focus groups. What is needed next is a full scale study of youth who are at risk or who are obese who are given a variety of Exergames and tracked closely for outcomes (like lipid profile, weight status, BMI, fitness, and psychiatric measures like efficacy and enjoyment). Family must be a part of any long-lasting change in a child's life, so we must study factors that lead to improved and reinforcing parent and child interaction. In summary, the innovation is to do careful investigation of these new technologies on health outcomes.

What barriers exist that are creating the problem your innovation is hoping to address/change?

There are many societal barriers to normal body weight. Physical Education and recess have been minimized or removed from schools. Many families do not have the money or time to take children to extracurricular activities. Placing DDR and similar games in the hands of youth will overcome some of these hurdles.

In addition, adults fear video games they think are violent. Educating adults about healthier choices of games and the benefits of Exergaming is a critical mission for acceptablity.

Delivery Model: How do you implement your innovation and apply it to the challenge/problem you are addressing.

Through academic publications and community partnerships, we will apply Exergaming to the Maine laptop program and via youth centers, homes, schools and to other stakeholers. We propose a series of studies to examine the factors that lead youth and families to play (or get bored) with Exergames, what factors are barriers and need correction. Do novel games every 6 weeks help in long term adherence to physical activity? Imagine a NetFlix-type system of using a games. Helping kids discover what they like to do and how they can assist in "budgeting" active and sedentary time, just as food intake needs to be re-taught (sensible portions). Using a combination of the "Robinson Box" to set limits on TV and sedentary screen time, these games like Wii and In the Groove/Generation Fit can be used to enhance self efficacy. We will track distribution of time spent in active and inactive pursuits and try to help families understand what shifts are needed to tackle weight problems.

How do you plan to scale your innovation?

This is in progress as we deliver this to a wider audience. We have completed 3 pilot studies and are preparing for peer reviewed publications. Hundred of millions own game consoles and we need to know what happens when families switch to these games. The way to do this is to work in Maine, where we were the first state to have all of our middle school youth issued a laptop computer. Exergames are feasible in this population of 22,000 youth, a subset of whom could be randomized to different conditions or rotating games. For instance, youngsters could be instructed to get up and do the dance mat game after certain number of minutes or keystrokes. We could tailor health messages on these laptops. Our state’s laptop program and our work with schools make it possible to work with a larger population over time and track effects on health. We have colleagues at the CDC and in West Virginia who are wiling to work with us as well.

Provide one sentence describing your impact.

Design experiments to test the optimal placement of various Exergames for combating childhood obesity and translate these findings into real world settings.

What impact has your innovation had to date? Exactly who are the beneficiaries of your innovation?

The impact of our team efforts thus far have been on youth and families who have enrolled in our IRB approved studies in three settings (in 60 NC homes, a minority serving afterschool program in NC, and schools in 3 rural Maine Middle Schools.) The key beneficiaries are these schools and afterschools who get equipment and expertise to afford them opportunities for physical activity and to help youth with mastery of skills. Youth in our first two studies got to keep all 90 Playstation2s and setups including 2 padded dance mats. We do not know how many parents and siblings still play. Youth take to the games quickly so we can rapidly assess who is gaining skill and provide alternative supports for those who need more help. The scientific community may benefit if our papers are chosen for peer reviewed publication and are disseminated through credible channels. Industry has gained from seeing the health benefits studied by scientists so they can use this as a potential market.

How many people have you served directly?

To date, we have randomized and studied 172 youth and their families who volunteered as research subjects in our pilot studies and consented to individual measures. We also offer DDR in our overweight clinic patients in pediatrics. I serve families who are combating mental illness each day in my work as a child and adolescent psychiatrist and use DDR to help mitigate the adverse weight gain effects of the medications I prescribe for mood and thought disorders. We have given out equipment to several schools and clinics for use by at-risk youth outside clinical trials for demonstration. We have shown early results of Exergaming in statewide meetings for, national conferences and are starting to publish findings. We are using DDR as lottery prizes for incentives for learning conferences. We are setting up equipment in schools with long winters and few PE teachers in rural settings. We share measures, consents and protocols.

How many people have you served indirectly?

Several schools, families and organizations as well as physician offices from Caribou to York County in Maine have started Dance Dance Revolution clubs, demonstrations, official study sites or have used DDR informally. In one school in Saco, Maine, there are older youth mentoring younger kids and in other schools we are using same-age mentors. Along with Judy Shasek from Generation Fit coming to train youth and teachers in Maine, we have distributed another dozen dance mat set ups for the game in various settings (with and without the PS2 console). Since I give talks and presentations at national meetings and local chapters, it is also possible that some individuals are influenced and take these ideas to families. I could not guess at the number, but I have regular e mail and calls about DDR and press inquiries. Publication of papers (in progress) will have the highest yield in academia, but less in other lay settings.

Please list any other measures reflective of the impact of your innovation

Our team is generating a series of papers on main outcomes on health, working in schools and communities. Perhaps with synergies, like connecting multiple settings and contexts for youth success we will substantially be able to increase youth physical activity. We are working with data which includes but is not limited to: end-of-grade tests scores and changes, fitness, BMI, fasting labs (lipids and glucose), body fat, how "fun" Exergaming is, and other psychiatric measures.

What are the main barriers to creating your impact?

Time and money limit our team’s effectiveness to study the next steps. If we show in pilot studies interesting and feasible effects of Exergaming, we need to go to the next level of Evidence Based Thinking and replicate and modify the intervention based on insights gained. One barrier is in perceptions of adults and bias against games they think are the culprit for overweight status. Creating impact is slow due slow grantmaking and publications cycles in academic medicine.

How is your initiative financed?

I have obtained pilot funding from a foundation, NIH, equipment donations from RedOctane and consulting assistance by Judy Shasek, a dedicated colleague. I have been trained by my mentors and have received pilot funding for junior faculty from the Maine Medical Center Research Institute. My department has sponsored some protected time for me to do these formative studies and exploratory work. I have several incredibly dedicated data managers, post-docs and doctoral candidates who help and have had support from at least 15 colleages at UNC Chapel Hill to help with the pilot studies.

To go forward, I will need a budget to carry out a fourth and larger study using

Provide information on your finances and organization: annual budget, annual revenue, number of staff:

I have no working budget for this work now. Residents, department offices and other sources have helped in poster costs and travel to meetings. MMCRI and University of Southern Maine colleagues also assist me, as do leaders from UNC in project completion.

My salary is paid by MMC and MMCRI as I grow as a junior investigator and publish enough to be able to get independent funding.

I work with a team of several Healthy Maine Partnership school health coordinators and school nurses, I work with my Portland-based team for data gathering, and with excellent colleages at the Maine Harvard Prevention Research Center and Maine Center for Public Health for matching me with capable and dedicated "Take Time" schools throughout Maine who volunteered for school based studies.

What is the potential demand for your innovation?

There is a concern that up to half of minority youth and up to a third of Caucasian youth may have diabetes in their lifetime. Millions of children are overweight or obese and suffer emotional and medical consequences, not to mention the financial cost. In Maine, counting only insured adults who are innactive cost our state $2.13 Billion per year. We do not have projections about obese youth and "diabesity" but we are certain to have unsustainable rates of weight related conditions in the US.

What are the main barriers to financial sustainability?

Ultimately, to be financially sustainable, there needs adoption by schools, families, recreation centers, clinics and other places youth gather to really increase access to Exergaming. After an initial investment, youth play the games well by themselves but need monitoring and encouragement. Staff and teachers are expensive in the NCLB environment. For severely overweight kids, someday there may be a push to have 3rd party payers reimburse for Exergaming-based interventions.

The Story
What is the origin of this innovation? Tell us your story.

I was watching the Today Show prior to Christmas a few years ago and they were featuring the DDR games. Meanwhile, I was learning how to do studies in youth with early onset schizophrenia spectrum disorders and as a physician was concerned about the weight gain I observed week by week. Kids were gaining about a pound a week and I wondered if DDR may be able to fight this additionally stigmatizing adverse effect of my prescribed medications. I asked my mentor if she could purchase a set and try it on her kids That worked and we went on to do focus groups and pilot work. From there, with much help in competing for grants, we went on to economically do two pilot studies in NC and one in Maine to test the feasibility of the dance games in various settings. We continue to absorb all we can about what works and does not work in prevention and treatment of pediatric obesity.

I work as a consultant to a teaching hospital clinic for obese youth and watch them struggle to perform basics like sit ups, step testing and baseline activity for our program. This is a very difficult thing to observe, the youth who are in such poor health at such young ages, so confused and scared by their comorbid conditions and diagnoses. We really have to shift to more prevention and more action when weight is climbing quickly, since taking weight off is very difficult.

Please provide a personal bio. Note this may be used in Changemakers marketing material

Ann Maloney, MD is a Clinician Scientist jointly appointed to the Departments of Pediatrics and Psychiatry at Maine Medical Center. As a researcher in the Child and Adolescent Division, she completed NIH funded fellowships in research of neurodevelopmental disorders and treatments. Her psychobiological research experiences uniquely qualify her to run studies of vulenerable youth. Her key interest area is pediatric obesity prevention and treatment and consequences of obese status.

How did you hear about this contest and what is your main incentive to participate? (this is confidential)

1--Chinwe Onyekere, 2, 3,4, 5--Ben Sawyer, RWJ Foundation, 6, CDC this summer and multiple list serves and e mail reminders. I have judged for the last G4H contest and will judge for Ruckus Nation, so I am disqualified from entering them.

Incentives--I need resources to get to the next, much more effective place in my career. Peer reviewed papers and resources to do studies are necessary so that I can launch my Exergaming studies with passion.

With proper mentoring and a patient referral pool, I am confident that I can be a good return on investment for Changemakers and RWJ. I look for guidance in multidisciplinary ways. I am prepared to travel, call parents the night before their child is to have fasting labs at school, talk to the PTA and administrators, press, etc about the obesity epidemic and our chance to make an impact. Mostly, however, I must focus on the academic pursuit of new knowledge and do this is the traditional study designs.