Impact of Game-Based Health Promotion Programs on Body Mass Index in Overweight/Obese Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Sedentary lifestyle is growing among children and adolescents that may contribute to problems such as overweight and obesity. Consequently, interventions to improve weight loss in this population are necessary. The aim of this current review was to evaluate the effectiveness of game-based interventions to reduce body mass index (BMI) among children who were overweight or obese.

Methods: All randomized controlled trials with a game-based approach for lowering weight in obese/overweight youths aged 5-18 years old were identified from January 2005 to June 2017 across PubMed, Web of Science, Embase, Scopus, and ScienceDirect. Two independent reviewers completed data extraction sheets on information such as sample size, country of origin, age of participants, type of interventions, and BMI change from pre- to posttest. A consensus on collected data was obtained, and a final list of studies meeting inclusion and exclusion criteria was arrived at. Data were analyzed using Comprehensive Meta-analysis software, and effect size was measured by standardized mean difference (SMD) and Hedges' g measure. Heterogeneity and publication bias were also examined using I² index and funnel plot.

Results: A total of 388 articles were identified from electronic and manuals' searches. After deletion of duplicated articles, 138 articles remained that were then screened in terms of relevance. Of those, 41 articles were examined to determine eligibility. Finally, 10 articles met inclusion/exclusion criteria and were entered into the quantitative meta-analysis. Results indicated a small but significant effect size in terms of BMI reduction [SMD, -0.234; standard error (SE), 0.069] among included studies. The average BMI z-score reduction was -0.181 (SE, 0.071). Trials which used other types of interventions along with active game-based approaches achieved greater effect sizes than single game-based interventions. There was a significant difference between studies based on their country of origin, BMI value, and intervention type. Those conducted in United States, those including participants with BMI ≥30, and studies with multicomponent intervention reported a higher reduction of BMI than others. However, no significant difference in BMI was found in terms of variables such as age, sample size, type of participant (overweight/obese), intervention duration, or participant gender. No publication bias was identified, and studies were homogenous (I² = 22.5%).

Conclusions: Interventions that involve active gaming may produce small effects in terms of improving BMI among children who are overweight/obese. Therefore, we recommend that supplemental interventions be used to enhance the effectiveness of game-based interventions.

Keywords: body mass index (BMI); game-based interventions; obesity; weight-loss management.