The Farmville of Health?

Can you play your way to better health? That was the question kicked around (har!) at the gaming health session at Health 2.0 in San Francisco this week. 

Taking one step every day is the key to enduring change, which requires sustained engagement. Many of the health improvement tools that exist today are not engaging. The core goal for health game inventors is to make life change fun and engaging.

Chris Hewett's demo of Mindbloom had the room packed. He began by talking about the difference between being motivated by fear or purpose. You're either running away from something, or toward something. Mindbloom is about spending two minutes every day looking at images that mean something to you, and that motivate you.

As a gamer, Hewett wants to make behavior change appealing and authentic. I think that he is trying to make Mindbloom into the Farmville of health – a pervasive and widely appealing game, but one that happens to have a positive effect on people's health and life. People use Mindbloom to discover what's most important to them. The key reason why most people want to be healthy is to spend more time with their relationships.

Mindbloom's central visual image is a tree, with each of the leaves representing an area of life that means something to you (such as spirituality or finances). The sun represents inspiration, and rain represents the steps that you are going to take today to nourish what is important to you. Users can upload their favorite images, as well as sayings and songs that inspire them. As you follow provide information, you earn points and a visual response (the tree grows a bit, the sun glows).

Making it rain requires taking simple steps that can  improve your life. If you keep your tree green, you produce more "seeds," and the seeds can then unlock features and content, as well as action packs for different areas of your life. Game items include the ability to purchase sun and rain for your friends' trees.

The social element is a crucial part of personal growth. It is supported here by the ability to add friends and  encourage people who may not be doing so well. The worst that happens to the tree is that the leaves turn brown (they don't fall off). Coaches are able to invite clients to participate and can monitor their progress. Mindbloom's beta data showed that people, on average, visited three times a week and spent 15 minutes at the site. 

Mindbloom's goal is to create a fun and simple interface with sophisticated gaming mechanics. The gaming elements provide positive feedback that helps people feel effective. Mindbloom just finished its beta phase with 15,000 users and plans to release a mobile application in about a month. Aetna is a major sponsor, with plans to integrate it into Web offerings to employees. The  split of users in the beta phase was about 55 percent women and 45 percent men, but the goal is build a tool for everyone.

A panel called "Game On: Massively Multiplayer Approaches to Behavior Change" addressed questions like why do behavior change games work, how do they keep people on track, and how they are changing the approach to behavior change? The panel included people from Zamzee, ShapeUp, and Livn.it.

ShapeUp's CEO talked about how successful patients often leverage their existing social networks to create enduring change. ShapeUp began as a 12-week shapeup challenge in Rhode Island, funded by a non-profit. People could form teams and compete to lose weight, increase their exercise, or increase walking. In Rhode Island, the game went viral. Studies showed that 10 percent of the population  participated in this game. The studies also found that the game had the same impact on health as intensive lifestyle interventions. They found sustained change at 10 weeks, and, on average, seven pounds of weight loss and a 1.2 point BMI reduction.

ShapeUp then moved to employer-based programs. ShapeUp today creates social networks from an employer pool. The company has found that employees who participated in ShapeUp also increased their use of other existing health benefits that had previously been  underutilized (like counseling). The gaming engine encouraged people to change their health behavior across a variety of dimensions. ShapeUp now reaches more than 2 million users across a wide range of employers. 

Jonathan Attwood of Zamzee spoke about his company's approach to behavior change among kids. The typical kid's activity level falls about 60 percent from age 9 to 15. Zamzee's goal was to "ignite a lifetime of activity." Its inventors realized that technology was part of the problem, so they decided to make it part of the solution. 

To participate in Zamzee, a kid wears a movement monitor, similar to a pedometer, and then ANY sort of movement gets him points. He can then redeem those points for rewards that kids care about (let's just say Angry Birds was mentioned). An integral part of the Zamzee program is that you can go social and share or support others with the program.

A comparison trial found that kids participating in Zamzee increased their movement by 30 percent, or about a marathon a month!  In addition, kids reported that they began to move "not because I had to, but because I want to." The trial also found staggering rates of referral – 50 percent of participants told someone else about it. In addition, when a kid enrolled, the parents often also wanted to use it, resulting in behavior change for a family. Activity increased 42 percent in the average family that got involved.

Livn.it's presentation was by Michael Kim, the CEO of Kairos Labs, which designed it. (Kairos in Greek represents the moment when effort turns into achievement.) Livn.it is a multi-player mobile habit gaming network. Now in beta testing, it is a training program for progressively mastering sustainable daily habits via smartphone. The first version was purely text-based, and the current version provides virtual goods and micropayments to support enduring change. 

The company's early research found that self-tracking loses 90 percent of participants. It's a single-player game. It is "autonomous, disconnected, you get narrow (to zero) feedback, and it's basically a form of journaling or accounting." (Maybe quantification isn't enough in itself.) Kim believes "we need massively multi-player behavior-change games."

So what is the smallest step that will impact behavior? According to Kim, it's habit-formation, where falling "off the wagon" over and over stops.

The basis behind Livn.it is PERMA - Positive Emotion, Engagement, Relationships, Meaning, and Achievement, as explained in Martin Seligman's book, "Flourish." It's a definition of wellness. Gaming provides many of these elements –with the possible exception of meaning.  But behavior change deliberately incorporates meaning. Using these criteria, mobile social behavior change apps might work for behavior change. 

Nike Plus contends that the social aspect of its "Cheer Me On" function on Facebook boosts enduring change. Alcoholics Anonymous can be seen as another form of multi-player game; so can Tai Chi in the park for the elderly. What is the largest behavior change game in the world today? Kim says religion. He quoted an African proverb: "If you want to go fast, go alone. If you want to go far, go together."

The "4-Hour Body," Tim Ferriss's best-selling guide to rapid weight loss, is the basis for one of Livn.it's approaches. Livn.it slowly increases the level and intensity of the habit a person is trying to master. In the beginning, it seems as though it's not doing so much, but then, once mastery is beginning to solidify, the intensity increases. In a 100-day player test, 90 percent fell off the wagon, but 83 percent "bounced back," a recovery rate attributed to the design, which deliberately makes it very easy to get back on track. "The distance from the ground to the wagon is really small," Kim said. 

Please note that Doc Gurley cannot answer every question or respond to all unsolicited requests, and she cannot practice medicine through a keyboard (not even with her stethoscope pressed firmly against the monitor). Specifically, Doc Gurley cannot dispense medical advice via email - if you have health concerns you should see your doctor.

You can read more from Doc Gurley at the San Francisco Chronicle's SFGate and at www.docgurley.com.