Engaging men in weight loss with a game-based mHealth and neurotraining program

摘要 美国男性超重和肥胖的患病率特别高，即，71.3%， 42%的男性目前正在尝试减肥。然而，男性在体重方面的代表性明显不足， 损失计划。男性找到传统的减肥计划（即，以团体为基础的教育和咨询- 导向，饮食/卡路里为重点）没有吸引力，因为他们涉及接受咨询，重点是取代 “阳性”食物（例如，肉）与“女性”的（例如，沙拉），并提供最小的个性化或 自治因此，已作出努力，通过有针对性的培训， 招募和适应标准减肥计划。然而，这些努力 失望移动的应用程序（mHealth应用程序）具有吸引人的功能，但男性注册率较低， 如常规递送的效果差。一个游戏化的移动健康计划提供了吸引男性的可能性， 并且提高了功效，因为（1）视频游戏对男性具有高度吸引力;（2）游戏化特征（例如， 用于获得“连胜”和里程碑、竞争的数字奖励）已知增强了享受， 激励和促进期望的行为;（3）“神经训练”视频游戏，具有重复动作 力学、适应难度和反馈可以训练抑制控制，这是大脑抑制的基本能力。 内在产生的方法反应，这是密切相关的身体质量和消费的高， 高热量食物抑制控制训练（ICT）游戏已经成功地减少了目标消费量。 食物/饮料和改善短期减肥。例如，在我们的初步工作中， 一个减肥研讨会加上一个简短的，每天的信息和通信技术产生更大的体重损失的个人与高- 对高糖食物的平均内隐偏好，与鲁棒注意力控制（即，的 研讨会加假培训），我们发现添加游戏化元素（例如，故事、音乐、关卡）， 一个基本的游戏产生额外的8周的体重减轻男性（4.1%对2.5%）。该项目延伸 通过评估游戏化和ICT对长期参与的独立影响， 成果。因此，将招募243名BMI ≥ 25的男性，其中15名参与可用性测试，228名参与可用性测试。 被分配参加为期12个月的mHealth减肥计划，该计划规定数字自我监测和饮食， 身体活动目标。采用有效的2 x 2析因设计，受试者将随机接受 无论是标准的还是完全游戏化的程序，包括一个行为改变程序， 竞争，以及实现条纹和里程碑的数字验证，并随机接受 无论是假的还是主动的抑制控制神经训练。目的包括评估游戏化的功效， 12个月时ICTon体重减轻、饮食和体力活动，以及评估假设的介质 （参与和抑制控制）和主持人（视频游戏的基线频率和内隐 对信通技术目标食品的偏好）。

Abstract Men in the United States have an exceptionally high prevalence of overweight and obesity, i.e., 71.3%, and 42% of men are currently attempting weight loss. However, men are dramatically underrepresented in weight loss programs. Men find conventional weight loss program (i.e., group-based, education and counseling- orientated, dietary/calorie-focused) unappealing because they involve receiving counseling, focus on replacing “masculine” foods (e.g., meat) with “feminine” ones (e.g., salad), and provide minimal personalization or autonomy. As such, attempts have been made to increase recruitment and appeal through targeted recruitment and adaptations to standard weight loss programs. However, these efforts have been disappointing. Mobile applications (mHealth apps) have attractive features, but have low male enrollment and poor efficacy as conventionally delivered. A gamified mHealth program offers the possibility of engaging men and enhancing efficacy given that (1) video gaming is highly appealing to men; (2) gamification features (e.g., digital rewards for attaining “streaks” and milestones, competition) are known enhance enjoyment and motivation and facilitate desired behaviors; and (3) “neurotraining” video games featuring repetitive action mechanics, adaptive difficulty, and feedback can train inhibitory control, a basic brain capacity to inhibit intrinsically-generated approach responses that is strongly linked to body mass and the consumption of high- calorie foods. Inhibitory control training (ICT) games have been successful at reducing consumption of targeted foods/beverages and improving short-term weight loss. For instance, in our preliminary work we demonstrated that a weight loss workshop plus a short, daily ICT produced greater weight loss for individuals with higher- than-average implicit preferences for high-sugar foods, compared to a robust attention control (i.e., the workshop plus a sham training), and we found that adding gamification elements (e.g., story, music, levels) to a rudimentary game produced additional 8-week weight loss for men (4.1% vs 2.5%). This project extends previous work by evaluating the independent effects of gamification and ICT on long-term engagement and outcomes. As such, 243 men with BMI ≥ 25 will be recruited, with 15 participating in usability testing and 228 assigned to a 12-month mHealth weight loss program that prescribes digital self-monitoring and dietary and physical activity targets. Utilizing an efficient 2 x 2 factorial design, participants will be randomized to receive either a standard or fully-gamified program, comprised of a behavior change program featuring team-based competition, and digital reinforcers for attainment of streaks and milestones, and also randomized to receive either sham or active inhibitory control neurotraining. Aims include evaluating the efficacy of gamification and ICTon weight loss, diet and physical activity at 12 months, as well as evaluating hypothesized mediators (engagement and inhibitory control) and moderators (baseline frequency of video game play and implicit preferences for ICT-targeted foods).