Americans love to play video games. In 2010, the gaming industry generated more than $25 billion in revenue on digital games, which includes software and content sold for home-based consoles, portable gaming, and digital and social games, according to market research company the NPD Group. In the same year, 72% of American households reported playing computer or video games.
As the gaming industry has grown, so, too, has an interest in harnessing the power of play to help consumers improve their health. Finding entertaining ways of getting people to eat a healthier diet, exercise more or keep track of and treat chronic illness is becoming big business.
"It's clearly a growing market," said Bill Ferguson -- editor-in-chief of the Games for Health Journal: Research, Development, and Clinical Applications, a new peer-reviewed journal dedicated to game technology that improves physical and mental health and well-being.
Typically the market share dedicated to health-related games is about 4% or 5%, according to Ferguson. "One out of every 20 games has something to do with health care," he said.
Although games have been designed around a wide range of illnesses and conditions, the three areas in medicine getting the most attention today, Ferguson said, are childhood obesity, diabetes, and helping seniors maintain and improve their mobility. Games to treat other medical conditions, such as cystic fibrosis, cancer and injuries also are starting to work their way into the therapeutic process.
Debra Lieberman -- director of "Health Games Research," a national program funded by the Robert Wood Johnson Foundation -- said the most profitable games are those with a high entertainment value -- such as Dance, Dance Revolution, a game in which players stand on a stage and step on colored arrows to musical and visual cues, and "Brain Age," a Nintendo DS handheld game designed to exercise the mind.
Many companies, both new and established, have recently entered the market with health-related games that incorporate a social component, whereby people collaborate, compete and support one another in reaching a specific goal. In addition to startups, employers and health insurers have worked to capitalize on this popular trend.
"I see an increasing number of employers and health insurers seriously exploring the possibility of developing or purchasing games for the benefit of employees or health plan members," Lieberman said.
Health insurers, including Aetna, Cigna and UnitedHealth, have stepped into the market with games that allow members to earn points and badges that can be redeemed for rewards of consumer goods, credits to health savings accounts and other incentives.
In the last year, health insurer Humana launched HumanaVitality, a program that calculates a person's "Vitality Age" upon completion of a health risk assessment and then creates a personalized plan for a healthier lifestyle. Each action taken toward a health goal earns points that are redeemable in a rewards mall with more than 600,000 items.
Families also are encouraged to get active together at home by earning points playing the insurer's "Your Shape Fitness Evolved" on Xbox Connect. And, Humana members who get health insurance through their employer can hold company-wide challenges where groups compete to reach goals such as increasing levels of exercise or losing weight.
"We feel the aspect of challenge is a big part of building a community," said Joe Woods, chief operating officer of HumanaVitality. It's still early, according to Woods, but he said the company is seeing evidence that the program is encouraging people to have healthier behaviors.
A promising startup in the field of social health gaming is Keas, which provides employers with a gaming platform through which groups of employees compete with each other to get healthy. About a year old, the company has approximately 100,000 individual subscribers and is working with large employers, including Pfizer, Delta Dental and Novartis.
A few others new to market include Healthrageous, which uses gaming to inspire users to share challenges and progress with peer-to-peer support, as well as Healthpers and SuperBetter, which reinforce behavior for healthier lifestyles.
As an example of the power of games, Ferguson points to a game developed for children with cystic fibrosis -- an inherited disease in which mucus builds up in the lungs and blocks airways.
"The worst part of cystic fibrosis for many kids is the fact that they can't go outside and play, they don't have the same social network as other kids, they feel different and isolated," Ferguson said.
As part of the treatment-focused game, children exercise while virtually competing with other children, he explained. "Once it got be a game where they could compete, the kids didn't feel so isolated. Now they find they have a peer -- someone else who knows what they're suffering from and they can compete with them, and it's life changing," he said.
Another aspect of social gaming that researchers are exploring, according to Lieberman, is the use of interactive digital social characters. The digital characters provide players with individualized, useful feedback on their progress, and most players respond to these characters in many of the same ways they respond to real people.
"There is exciting new research on interactive social characters, and it finds that -- as a health coach, competitor, or collaborator, or even as a patient, the player must nurture back to health -- these characters elicit many of the emotions and social responses from players that we would expect to see in human-human interaction even though this is human-computer interaction, but with a social interface," Lieberman said. "This encourages us to design interactions and social experiences in the virtual world of digital games that can powerfully motivate players' real-world behavior change," she said.
Do the Games Work in the Long Run?
There's no doubt that using games to alter people's eating habits, how much they exercise and whether they properly manage their chronic illnesses is of widespread interest. What's less clear is how effective the games are in bringing about long-term changes in behavior.
"One of the things that we're seeing right now is a lot of breadth of research but not a lot of depth," Ferguson said. "There hasn't, to date, been a lot of longitudinal studies."
Tom Baranowski, a professor of pediatrics at Baylor University in Texas, has conducted numerous studies demonstrating the effectiveness of video games in influencing diet, and to a lesser extent, the exercise habits of kids. There are many studies, according to Baranowski, suggesting that gaming can be a useful tool for changing health-related behaviors for the better.
However, new games entering the consumer market haven't incorporated the same scientific principles known to affect behavior change, he said.
"There's very little research that shows yea or nay about whether they are achieving any change," Baranowski said. "But just by looking at the way they're designed and what they are trying to do, it seems unlikely. What I know about behavior change has not been incorporated into those games."
Although there is a lot of research currently under way in the area of health games, the general consensus seems to be that a deeper knowledge about their benefits and limitations, as well as what makes them truly effective, is needed.
Lieberman is optimistic about the future, though, given that decades of research has provided insights about how people learn and change their health behaviors. "We can integrate this understanding into the design of highly engaging health games that people will love to play and that, as game play influences their risk perceptions, knowledge, skills, and self-confidence, [it also] will change their health behaviors and health outcomes," she said.