Americans spend billions of dollars annually trying to lose weight. Making behavioral changes that become lifelong habits is difficult. With advances in digital technology, researchers have been able to fine-tune the most effective ways to take advantage of apps, widgets, and gaming technology to promote healthy behavior.

The “Gamification” of Weight-Loss

The Robert Wood Johnson Foundation's Pioneer Portfolio has created a national program called Health Games Research. They are offering grants to find ways that “gamification” can improve the effectiveness of traditional health interventions for motivating behavior changes that will lead to better health outcomes and lower health care costs. 

As part of the Health Games Research initiative, researchers from the University of Southern California published a study on April 18, 2013 which found that adding social gaming to a behavior tracking program helped people to exercise more frequently and decrease body-mass index (BMI).

The researchers studied young and middle-aged adults from a broad range of lifestyles, from sedentary to very active. The study participants were asked to invite friends, family members, or colleagues to participate with them in the study.

"A big part of its success is that this program required the engagement of friends and family in tracking open-ended health goals," said lead researcher Marientina Gotsis, director of the Creative Media & Behavioral Health Center at USC. "We wanted to see how different people would react to it and the results demonstrate that there is great potential in using even casual digital games to promote healthy lifestyles."

"The game itself was designed to inspire wellness through participation in outdoor activities. We featured the virtual character participating in activities like going snorkeling, playing in the park, raking a zen garden and many other ideas that could increase physical activity," she added.

In the 10-week study, one group of participants was asked to keep an online diary of physical activity, a commonly used strategy for activity adherence and weight management. A second group was asked to keep a version of the diary that included social gaming such as earning points for reporting their exercise, redeeming them for animated activities performed by their virtual character, collecting memories and earning gifts they shared with other participants in their network.

After five weeks, the groups switched programs. The results revealed that a combination of the diary and social gaming helped the participants exercise more frequently, leading to decreased body-mass index. The effects were stronger in the group that started with gaming but were sustained in both groups after gaming elements were removed.

The 4 Keys to Creating Healthy Behavior

In 2012, researchers at Northwestern University found that using a mobile app that tracks eating and physical activity could help people lose an average of 15 pounds and keep it off. However, the researchers found that the digital technology was only effective when users also participated in education classes and had a human support network. The app alone did not result in sustained weight loss.

"The app is important because it helps people regulate their behavior, which is really hard to do," said Bonnie Spring, lead investigator of the study and a professor of preventive medicine. "Most of us have no idea how many calories we consume and how much physical activity we get. The app gives you feedback on this and helps you make smart decisions in the moment." 

The researchers at Northwestern University used a specific method based on four validated techniques to help participants make healthy behavioral changes. These are:

  1. Self-monitoring 
  2. Goal setting 
  3. Feedback 
  4. Social support

All participants in the study were offered health education classes on nutrition, exercise and how-to make behavior changes twice a month during the first six months and once a month through the end of the year. Each participant received weekly calorie goals based on his or her current weight and were given weekly activity goals based on their current level of activity. Participants in the study also recorded their daily activity and food consumption in a diary.

People in the study transmitted their data to a behavioral coach regularly via a mobile device. The coaches monitored their information and provided scheduled telephone coaching for 10 to 15 minutes twice a month. The participants who used the mobile app and attended 80 percent of the health education sessions had the greatest success losing an average of 15 pounds and maintaining the weight-loss for one year.

Although the time people spent interacting with the remote coaches was very minimal it made a huge difference. "The coaches' most important role was being in the wings," Spring said. "The patients know the coaches are hovering and supportively holding them accountable. They know somebody is watching and caring and that's what makes a difference."

Spring added that participants, who were older, or did not have prior experience with mobile phone technology easily mastered the technology. "Some people think older people won't use technology interventions, but that isn't so," she said.

"This approach empowers patients to help themselves on a day-to-day basis," according to Bonnie Spring. "We can help people lose meaningful amounts of weight and keep it off. To do that we need to engage them in tracking their own eating and activity, learn how that governs weight, and take advantage of social support."

Conclusion: The Human Connection

There are hundreds of new digital technologies that can help you stay motivated to exercise more, eat healthier, and balance your calories-in with calories-out. Using a digital app is a terrific way to monitor and track activity. However, these apps are much less effective in a "cyber vacuum." To improve your odds of success it is important to include a social component.

Having a support network of family and friends committed to a healthy lifestyle makes everyone more likely to stick with it. The daily habit of being physically active and eating better rubs off on the people around you. Being healthy is contagious. Also, working out with other people makes it more fun, which will help you and your loved ones stay healthy and happy for the long run.