Get in the GROOVE: Using a Virtual World to Promote Health

Get in the GROOVE: Using a Virtual World to Promote Health

Mary Kate Clennan (University of Miami, USA), Daniella S. Carucci (University of Miami, USA), Marissa D. Alert (Johns Hopkins School of Medicine, USA), Shannon Collins (SEC Prestige Consulting, USA), Erin N. Etzel (VA Maryland Health Care System, USA), Alyssa LaRoche (Aimee Weber Studio, USA), Maria I. Leeder (Miami-Dade County Public Schools, USA) and Patrice G. Saab (University of Miami, USA)
DOI: 10.4018/978-1-5225-9679-0.ch008


Over the last few decades there has been a rise in the prevalence of overweight and obesity in American youth. This chapter describes the rationale for the virtual world features of an obesity prevention project that engaged middle-school-aged girls in a 3-week summer science enrichment program. The Get in the GROOVE! program was designed to promote self-efficacy for health behavior change, increase health knowledge, facilitate healthy behaviors related to physical activity and nutrition, encourage a healthy body image, and promote the development and consolidation of a health self-identity. The virtual world, which was explored by the girls via realistic and healthy avatars, supplemented experiences and reinforced curriculum and concepts learned in the physical world component of the program. Findings suggest that a virtual world is a promising platform to promote a health self-identity and healthy lifestyle in children.
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While the prevalence of adult obesity has nearly doubled since 1980, the prevalence of childhood obesity has nearly tripled (Ogden, Carroll, Kit, & Flegal, 2014). Overweight and obesity prevalence is 33.4% among children and adolescents age 2-19 years and 69% among adults (Benjamin et al., 2017). The high prevalence of excess weight in youth is not unique to the United States but is also observed in many other countries contributing to a global epidemic (Friedrich, 2017; Wang & Lim, 2012). This situation is of considerable public health concern due to the well-documented health and psychosocial consequences associated with excess body weight together with the fact that overweight and obesity during childhood is likely to persist into adulthood (Haslam & James, 2005; Poirier & Eckel, 2002; Pulgaron, 2013; Thompson et al., 2007; Ward et al., 2017; Williams, Mesidor, Winter, Dubbert, & Wyatt, 2015).

The determinants of excess body weight are multifactorial and overweight and obesity have been linked to a number of lifestyle factors. Among children and adolescents, overweight and obesity have been associated with the consumption of sugar sweetened beverages, refined grains and high-calorie foods, and other poor nutrition choices, physical inactivity, and high levels of sedentary behavior (Bourke, Whittaker, & Verma, 2014; Drewnowski, 2004; Maher, Mire, Harrington, Staiano, & Katzmarzyk, 2013; Mitchell, Pate, Beets, & Nader, 2013). While data indicate engaging in healthy lifestyle behaviors such as improving diet, increasing physical activity, and decreasing sedentary behavior may contribute to a more optimal weight status and decreased cardiometabolic risk (Hagobian & Phelan, 2013), most American children and adolescents do not meet dietary (Banfield, Liu, Davis, Chang, & Frazier-Wood, 2016) or physical activity recommendations (Olvera, Kellam, Menefee, Lee, & Smith, 2010) and spend up to 8 hours each day in various sedentary pursuits (Lou, 2014; Tremblay et al., 2011).

Virtual reality technologies have the potential to improve eating habits, increase physical activity, and promote healthy lifestyle choices. A decade ago, experts identified several research and education priorities involving virtual world technologies to prevent and treat obesity and type 2 diabetes. These priorities include but are not limited to “making smarter food choices,” “improving self-efficacy by virtual reality-guided practice of desired behaviors,” and “using virtual reality to make behavior change more reinforcing and participatory” (Ershow, Peterson, Riley, Rizzo, & Wansink, 2011, p. 217). Virtual reality technologies, in general, and virtual world technologies, in particular, have the potential to augment learning experiences as they can immerse users in social learning environments (Johnson & Levine, 2008). Additionally, children of all ages enjoy engaging in virtual activities and are often familiar with virtual worlds and similar technologies (Coles, Strickland, Padgett, & Bellmoff, 2007; Prensky, 2001).

Key Terms in this Chapter

Eating Behavior: The patterns of an individual’s food and beverage consumption habits, indicated by food choices, meal frequency, and portion size.

Go, Slow, Whoa Foods: The U.S. National Heart, Lung, and Blood Institute (NHLBI) groups food into three broad categories: Go Foods (healthy foods that should be eaten often), Slow Foods (foods that should only be eaten a few times a week), and Whoa Foods (foods that are high in fat, calories and/or sugar and should only be eaten once in a while).

Pedometer: A device that can be worn to track activity (i.e., steps and distance walked, calories burned), such as a Fitbit.

STEM Fields: The academic disciplines of science, technology, engineering, and math.

Body Image: A subjective opinion an individual has about her or his own body and appearance.

MyPlate: A healthy nutrition guide published by the US Department of Food and Agriculture. The five core food groups (fruits, vegetables, grains, protein, and dairy) and the suggested portion sizes for each group are displayed on a place setting.

Theory of Meaning Behavior: A theory that proposes that incentives, either internal or external, imbue personal meaning to behaviors.

Modeling: A learning process that occurs through the observation and replication of others’ behaviors. It can occur “in-vivo” or symbolically.

Healthy Lifestyle: A consistent pattern of behaviors, including a nutritious diet, high levels of physical activity, and low levels of sedentary behavior, which lower the risk of health problems.

Presence: The degree to which individuals believe that the virtual technology experience is “real” for them.

Health Self-Identity: When an individual incorporates health-related features as part of their personal identity, for example, “I am someone who is healthy.”

Middle-School-Aged Girls: Girls aged 11-14.

Self-Efficacy: The personal belief that one can successfully perform and sustain desired behaviors.

Behavioral Intention: An individual’s expected probability of carrying out a behavior.

Virtual World: A digital environment that allows users to engage with their virtual surroundings, various activities, and interact with other users.

Social Cognitive Theory: Bandura’s theory that suggests behavior is a result of an interaction between environmental and social, cognitive, and personal factors.

Physical Activity: Movement of the body and muscles that results in an expenditure of energy.

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