Diabetes Forecast

Can Video Games Help People Lose Weight?

Researcher: Stanley Hsia, MD, FRCPC, FACE
Occupation: Endocrinologist, Charles R. Drew University of Medicine & Science
Focus: Endocrinology
ADA Research Funding: Clinical Translational Research Award

There's an old saying: If work were fun, it wouldn't be called work. For many people, the same holds true for exercise. If working out was fun, it wouldn't be called working out.

But what if there was a way to take the work out of working out? In the past decade, a handful of researchers have pioneered something called "exergaming." The idea is to harness the immersive, addictive power of video games to help people have fun while losing weight.

On the surface, it seems counterintuitive: playing video games to shed pounds? After all, video and computer games, with their handheld controllers encouraging seemingly endless hours parked motionless in front of the television, have earned their reputation as a contributor to the global obesity epidemic.
But as video game manufacturers looked for new ways to suck players into increasingly elaborate, interactive worlds, they began thinking about how to bring more than a player's thumbs into the equation—and stumbled upon a new frontier in game design. "Exergaming came out of the whole idea of the video game industry wanting to take things to the next level," says Stanley Hsia, an endocrinologist at both the Charles R. Drew University of Medicine & Science and the University of California–Los Angeles. "Why don't we use the same psychology you'd use to immerse people in a virtual world to get them to exercise?"

One of the original full-body video games came out back in 1998. Called Dance Dance Revolution, it has players stand on a mat with large, colored arrows. On a screen in front of them, the game flashes the arrows in a certain sequence; to play, you have to move your feet to touch the arrows in time. As the game gets harder, the players must move faster. "Every time you go to an amusement park, you have the standard games I wasted a chunk of my youth on, and then you have Dance Dance Revolution," Hsia says.

Dance Dance Revolution (or DDR, for short) may be the best-known "exergame," but the field is getting crowded. There are racing games that require players to spin the pedals of an exercise bike to move their virtual car or bike ahead, for example, and Nintendo sells the popular Wii system, in which players use a handheld controller to mimic actions like swinging a golf club or tennis racket on screen. That type of game is not nearly as aerobic as Nintendo would like people to think, Hsia says. "There are no published studies that the Wii system leads to a change in BMI," or body mass index, he adds. "If you really want to burn calories, you have to move your whole body."

Hsia's not the only one to see the potential for weight loss using DDR. The game has been adopted by schools in West Virginia as part of physical education classes and registered as an official sport in Norway. But it turns out that there's very little data on whether exergaming is an improvement over more traditional forms of exercise, or just a fad. "Everybody likes to talk about it as having a lot of potential, but when you look at the scientific literature, there's not a lot there," Hsia says. "No one's actually shown it leads to something positive like weight loss."

With a grant from the American Diabetes Association, Hsia is exploring the power of exergaming. He's trying to get beyond the hype and see if sugarcoating a workout can make it more appealing. "There's a lot about lifestyle modification that we don't understand and don't have evidence for," Hsia says. "To what extent are adult diabetic patients going to take to a dance-based game?"

To find out, Hsia set up a simple experiment at his clinic in South Los Angeles, which serves a largely low-income minority population disproportionately affected by type 2 diabetes. He is recruiting 160 people with type 2 for three-month stints. Half are randomly assigned to come into Hsia's clinic to play Dance Dance Revolution whenever they want. The other half are invited to work out on treadmills, again on their own schedule. "They're allowed to come in and stay as long as they want," Hsia says. (After the study period is up, people who ended up assigned to treadmills can try out DDR, and vice versa.)
Participants are given a thorough medical exam at the beginning and the end of the study to see whether the people who played Dance Dance Revolution had better glucose control than the people consigned to run-of-the-mill treadmills. They are all asked not to make any other lifestyle changes or start any new exercise regimens at home for the course of the study, to make sure any weight loss is the result of the experiment.

So far, Hsia says, the people he has recruited for the study have been enthusiastic about DDR. One woman even went and bought herself a DDR game to play at home (and was disqualified from the study as a result). But people have been surprisingly eager to work out on the treadmills, too. It turns out that the biggest barrier to exercise may not be working out, but just plain work. "People work three jobs to make ends meet, people don't have cars, our female subjects have child-care issues," Hsia says. "It's the universal problem of exercise: Life takes over."

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