Examination of a board game approach to children’s involvement in family-based weight management vs. traditional family-based behavioral counseling in primary care
The most effective intervention model for childhood obesity is known as family-based behavioral group treatments. There are also studies that investigate the effects of educational games for children to gain healthy eating and physical exercise habits. The aim of this study was to compare the efficacy of a family-based group treatment with an educational game (Kaledo) intervention in childhood obesity. Kaledo is a board game that was designed to improve nutritional knowledge and healthy life style habits. It is played with nutrition and activity cards that players can select from, and a total score is calculated in the end of the game according to energy intake and expenditure. Obese children between 9 and 12 ages were involved in this study. Participants randomly divided into behavioral and game intervention groups. Clinical evaluation was performed in the first and second counseling in both groups. Marmara University Family Medicine Department Obese Children and Adolescents Interview Form, Physical Activity Evaluation Form, and Three-day Food Record Form were used for this purpose. Strengths and Difficulties Questionnaire-Parent Report Version and Children’s Depression Inventory were used for the assessment of psychiatric symptoms. After the clinical evaluation, an education session about healthy eating and physical activity was attended by both groups. After that, for the behavioral groups, parents and children were assigned to different groups, while for the game intervention group, parents were assigned to behavioral sessions and children were assigned to game (Kaledo) sessions. A total of six sessions with 1-h duration and 2-week interval were performed in both groups. Height and weight were measured in each session and analysis was performed on the data of the children who participated in all of the sessions. Although a total of 108 children were clinically evaluated, 52 children and their parents, 26 in the behavioral group and 26 in the game intervention group, participated in two or more sessions. Twenty-four participants, 12 in behavioral and 12 in the game intervention group, finished the study by participating in all of the six sessions. Thus, dropout rate was 74%. BMI and BMI z-scores decreased in both groups compared with the initial measures and these changes were statistically significant. For the behavioral group, these changes were − 1.01 (25.44 to 24.43, p = 0.03) and − 0.17 (2.07 to 1.90, p = 0.000) and for the game group, − 0.74 (26.98 to 26.24, p = 0.007) and − 0.09 (2.07 to 1.98, p = 0.003). There were no significant differences between behavioral and game intervention groups in point of BMI and BMI z-scores (p = 0.130 and p = 0.706).
What is Known:
- Family-based behavioral group treatment is known as the most efficient model for childhood obesity management.
What is New:
- In this study, for the first time, a game (Kaledo) intervention was found to be effective in childhood obesity management.
- Compared with family-based behavioral group treatment, there was no significant difference between the two interventions.
KeywordsObesity Childhood obesity Family-based group treatment Game intervention Kaledo
Body mass index
Strengths and Difficulties Questionnaire-Parent Report Version
Children’s Depression Inventory
Body Mass Index Standard Deviation Score
World Health Organization
Merve Sen and Arzu Uzuner conceived of the original idea and planned the research.
Mehmet Akman and Tugba Bahadir contributed to the planning of the research.
Arzu Uzuner, Merve Sen, and Nazire Oncul Borekci carried out the group sessions and performed the measurements.
Merve Sen, Arzu Uzuner, and Mehmet Akman performed the analysis of the data and interpretation of the results. Tugba Bahadir and Emanuela Viggiano verified the analytical methods and contributed to the interpretation of the results.
Merve Sen wrote the manuscript with support from Arzu Uzuner.
All authors provided critical feedback and helped shape the research, analysis, and manuscript.
All authors gave final approval of the version to be submitted.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.Sheila G (2010) Overweight and obesity. In: Ricard EB (ed) Nelson textbook of pediatrics, 19th edn. Saunders, Elsevier Inc., Philadelphia, pp 179–187Google Scholar
- 2.Irmak H, Kesici C, Kahraman N (2011) Monitoring of growth in school age children (6-10 age group) in Turkey (TOCBI) Project Research Report, Turkish Republic Ministry of Health, Ankara/TurkeyGoogle Scholar
- 3.Ozkan S, Ozcebe H, Yardım N, Bagci Bosi A (2013) Turkey childhood (ages 7-8) obesity surveillance initiative (cosi-tur)Google Scholar
- 4.Merder Coşkun D, Uzuner A. (2015) Relation of musculoskeletal findings in children and adolescents to obesity. Dissertation, Marmara University Faculty of Medicine. Turkish National Dissertation Center No: 388704Google Scholar
- 5.Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD (2009) Interventions for treating obesity in children. Cochrane Database Syst Rev (1):CD001872. https://doi.org/10.1002/14651858.CD001872.pub2
- 6.Kelishadi R, Azizi-Soleiman F (2014) Controlling childhood obesity: a systematic review on strategies and challenges. J Res Med Sci 19(10):993–1008Google Scholar
- 8.Colquitt JL, Loveman E, O'Malley C, Azevedo LB, Mead E, Al-Khudairy L, Ells LJ,MetzendorfMI, Rees K (2016) Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev (3):CD012105. https://doi.org/10.1002/14651858.CD012105
- 14.Amaro S, Viggiano A, Di Costanzo A, Madeo I, Viggiano A, Baccari ME, Marchitelli E, Raia M, Viggiano E, Deepak S, Monda M, De Luca B (2006) Kalèdo, a new educational board-game, gives nutritional rudiments and encourages healthy eating in children: a pilot cluster randomized trial. Eur J Pediatr 165:630–635CrossRefPubMedGoogle Scholar
- 15.Viggiano A, Viggiano E, Di Costanzo A, Viggiano A, Andreozzi E, Romano V, Rianna I, Vicidomini C, Gargano G, Incarnato L, Fevola C, Volta P, Tolomeo C, Scianni G, Santangelo C, Battista R, Monda M, Viggiano A, De Luca B, Amaro S (2015) Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion. Eur J Pediatr 174:217–228CrossRefPubMedGoogle Scholar
- 16.Viggiano E, Viggiano A, Di Costanzo A, Viggiano A, Viggiano A, Andreozzi E, Romano V, Vicidomini C, Di Tuoro D, Gargano G, Incarnato L, Fevola C, Volta P, Tolomeo C, Scianni G, Santangelo C, Apicella M, Battista R, Raia M, Valentino I, Palumbo M, Messina G, Messina A, Monda M, De Luca B, Amaro S (2018) Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial. Eur J Pediatr. https://doi.org/10.1007/s00431-018-3091-4
- 18.Güvenir T, Özbek A, Baykara B, Arkar H, Şentürk B, İncekaş S (2008) Psychometric properties of the Turkish version of the strengths and difficulties questionnaire (SDQ). Turk J Chıld Adolesc Ment Health 15(2):65–74Google Scholar
- 20.Oy B (1991) Children’s depression inventory: validity and reliability study. Turk J Psychiatry 2(2):132–136Google Scholar
- 22.Klish, WJ (2015) Comorbidities and complications of obesity in children and adolescents. In: UpToDate, Post TW(Ed), UpToDate, Waltham, MA. Accessed 4 Nov 2015Google Scholar
- 24.BMI-for-age (5–19 years) (2015). http://www.who.int/growthref/who2007_bmi_for_age/en/. Accessed 15 Apr 2018
- 25.Epstein LH, Squires S (1988) The stoplight diet for children: an eight-week program for parents and children. Little, Brown, BostonGoogle Scholar