Can games change children's eating behaviour? A review of gamification and serious games

Gamification and serious games have increasingly been used in dietary interventions for children. This review evaluates these game-based interventions by examining the following questions: Can game-based approaches change children's eating behaviour (positively or negatively)? If yes, what game elements are characterised among the effective interventions? and, What are the potentials of applying game-based approaches to improve children's eating behaviour? Medline (Ovid), Scopus and PSYCINFO were used to identify experimental studies. Forty-three studies, including video or physical games and gamification, were identified and presented in four topics according to the study aim and eating behaviour target: 1) increase fruit and vegetable intake, 2) modify snacking behaviour, 3) encourage food exploration, and 4) promote healthy eating. Both gamifications and serious games can enhance children's fruit and vegetable intake, and promote healthy eating behaviour by improving their nutritional knowledge and attitudes. They may also encourage children's food exploration to increase novel food acceptance and reduce picky eating behaviour. However, playing snack-promoting games (advergames) significantly increases children's subsequent snack intake, and profound effects were found for unhealthy snacks. As game elements, rewards were repeatedly used across studies to incentivise behaviour change. The combination of narrative context, feedback, progress and challenge was frequently used to motivate and engage children to establish healthy eating behaviour. In conclusion, game-based interventions have potential for increasing fruit and vegetable intake and educating children about healthy eating. Further research is needed to examine long-term effects and the underlying mechanisms for behavioural change.