Bruna Caroline Chaves Garcia, CARINA SOUSA SANTOS, Marina Luiza Baêta Costa et al. · Games for Health Journal ·
This study evaluated the effectiveness of a serious game, NutriGame—Your Food Guide, in communicating the NOVA food classification and healthy eating habits to adolescents. The study involved 65 adolescents of both sexes aged between 10 and 18 years. The intervention group ( n = 38) played the NutriGame for 14 days. They completed a food-related questionnaire that addressed issues of self-perception, self-efficacy, knowledge, and food attitude at three time points: Before (Pre), 14 (Post), and 90 days after NutriGame use (Post-90). The control group received no intervention. Following the use of NutriGame, adolescents reported an increased understanding of healthy eating (Pre 7.05 ± 1.83 points; Post 7.94 ± 1.33 points, P = 0.031) and considered their diet healthier (Pre 6.50 ± 1.64 points; Post 7.16 ± 1.11 points, P = 0.015). As did self-efficacy, the healthy eating knowledge score increased after playing NutriGame (27.82 ± 1.65 to 29.05 ± 1.45, P = 0.0001). There was also an improvement in food attitude (Pre: 20.58 ± 3.19 points; Post: 22.53 ± 3.12 points, P = 0.0009). These modifications resulted in the maintenance of the results 90 days post-intervention. These results…
Michal Krezalek, Clare Martin, David Duce et al. · Studies in health technology and informatics ·
Recognising carbohydrate content of food is an important part of diabetes self-management. This paper introduces an immersive virtual reality (VR) carbohydrate-sorting game as a design exploration aimed at supporting the cognitive skills involved in carbohydrate recognition. The design is informed by a cognitive-behavioural perspective focusing on visual categorisation, spatial estimation, and learning through feedback. An early VR prototype was developed using Unity 3D for Meta Quest 3, incorporating standardised food representations and interactive sorting tasks. Informal formative feedback from five domain experts was used to reflect on interaction flow and clarity of feedback, and to guide early design refinements. At this stage, no learning or behavioural outcomes were assessed. Future work will focus on empirical evaluation with people living with diabetes.
Haeril Haeril, Andi Atssam Mappanyukki, Nur Indah Atifah Anwar et al. · Universal Journal of Public Health ·
This study aims to analyze the effect of Virtual Reality (VR)-based games on the mental health, eating patterns, and body posture of children aged 13–15 years who actively play with gadgets. This study used a quasi-experimental design with a control group and an intervention group. The sample consisted of 66 respondents who were divided proportionally into two groups. The intervention in the form of VR games was given to the intervention group, while the control group did not receive any treatment. The results showed that VR games had a significant effect on improving mental health (p = 0.001) and eating patterns (p = 0.001) in the intervention group compared to the control group. Conversely, no significant differences were found in body posture variables in either the intra- group or inter-group analyses (p > 0.05). The conclusion of this study indicates that VR games have the potential to be an effective intervention medium in improving the mental health and eating behavior of children who actively play with gadgets but are not yet effective enough to influence changes in posture. This study recommends the development of VR interventions combined with structured physical…
Konstantinos Salomidis, Olga Malisova, Georgios Styliaras · Informatics ·
Childhood obesity has become a major public health concern worldwide, highlighting the need for innovative educational interventions that promote healthier dietary behaviors from an early age. Virtual reality (VR) serious games have emerged as a promising approach for supporting behavior change through immersive and interactive learning experiences. This paper presents the NutriQuest VR game, an immersive serious VR game designed to improve children’s nutritional decision-making through repeated food-selection tasks based on the Nutri-Score classification system. A total of 33 middle-school students participated in a six-week intervention consisting of six gameplay sessions. Children’s adherence to the Mediterranean diet was assessed before and after the intervention using the validated KIDMED 2.0 questionnaire, while participants’ in-game performance was recorded throughout the intervention. The results demonstrated a statistically significant improvement in children’s adherence to the Mediterranean diet, with mean KIDMED 2.0 scores increasing from 5.67 to 6.55 (p = 0.013, Cohen’s d = 0.459). Participants also showed a significant improvement in their in-game performance between…
Kamije Nkubili, Uwimana Bizhinda, Masudi Mpiranya et al. · Zenodo (CERN European Organization for Nuclear Research) ·
Virtual reality (VR) technology has shown promise in education settings, enhancing engagement and learning outcomes among diverse populations. This study focuses on its application in child nutrition education within pre-schools in Rwanda, a context where such interventions are underutilized. A mixed-methods approach was employed, involving a pilot study followed by a randomized controlled trial (RCT) with both control and experimental groups. Pre- and post-test assessments were conducted to measure learning outcomes, while qualitative data on participants' engagement levels were collected through interviews and observations. VR training significantly increased participant engagement in the educational sessions compared to traditional methods, with an average of 75% higher participation rates observed across all age groups. Post-intervention surveys revealed a notable improvement in nutritional knowledge among children exposed to VR (30% increase) relative to those in control groups. The findings suggest that VR can be effectively utilised as a tool for enhancing child nutrition education, particularly in pre-school settings where traditional methods may struggle to engage young…
Ruobing Wang, Jie Yao, Claudia Shu-Fen Leong et al. · Nutrients ·
Background: Childhood obesity is a growing public-health concern in China and globally, a trend influenced by multiple factors, including poor eating behaviors and insufficient physical activity. While interactive health games have shown promise in improving children’s nutrition education and healthy eating behaviors, few have been tailored for the Chinese context. This study aimed to develop and evaluate Happy Farm, Happy Meal (HFHM), an alternate reality game (ARG) integrated into Chinese elementary students’ daily routines to enhance their nutrition knowledge and improve their eating behaviors. Methods: This pilot study employed a quasi-experimental design with two third-grade classes, which were randomly assigned to the HFHM intervention group (n = 40) or a no-game control group (n = 39). The game design was informed by a pre-intervention survey and interviews with caregivers and teachers, which identified key dietary challenges such as picky eating, slow eating, and food waste. Over a two-week period, the HFHM group engaged in food- and nutrition-focused tasks that were incorporated into their lunchtime routines. Pre- and post-intervention data were collected on nutrition…
SoMi Park, ChaeWeon Chung, Gaeun Kim · Journal of Korean Academy of Nursing ·
PURPOSE: This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents. METHODS: This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors. RESULTS: This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).…
Dennis Wüppelmann, Sarah Claudia Krings, Carina Micheel et al. · Companion Publication of the 2026 18th ACM Web Science Conference (WebSci Companion '26) ·
Ruhollah Solat, Reza Pourhosein, Hadi Bahrami Ehsan et al. · JMIR XR and spatial computing. ·
Abstract Background Self-care plays an important role in improving health symptoms in patients diagnosed with chronic illnesses such as diabetes. Gamification is among the most effective methods for enhancing health monitoring by applying principles of behavioral economics and motivation. Objective This study aimed to develop an innovative self-care system using a virtual reality (VR)–gamified intervention and to evaluate its effects on patients diagnosed with diabetes metabolic symptoms and health-related behaviors compared to other standard interventions. Methods This study was a randomized controlled trial with a parallel-group design, conducted between December 2024 and February 2025. A total number of 78 patients diagnosed with diabetes were recruited from The Children’s Medical Center clinic in a closed, offline setting. Briefing, tutorials, and interventions were partly face-to-face. Eligible participants (n=68) were randomly assigned to the 4 groups using stratified block randomization based on age and sex, with allocation concealment ensured through a sequentially numbered process. Each group received a different type of self-care intervention for 6 weeks, which was…
Bianca Curi Braga, William Hurst, John Barrow et al. · Biochemistry and Molecular Biology Education ·
This randomized controlled trial assessed the comparative effectiveness of a biochemistry education program delivered through an immersive virtual reality (iVR) experience and traditional video-based instruction. Undergraduate students enrolled in three nutrition courses from a large R1 American university participated (n = 95). Students were randomly assigned to either an iVR condition (n = 48) or a video condition (n = 47). Students either viewed a nutritional biochemistry video or participated in an interactive iVR nutritional biochemistry experience. Nutritional biochemistry quiz scores improved, with a significant difference between the video condition and iVR condition (P = 0.05). Engagement scores were higher for the iVR (mean = 4.60) compared to the video (mean = 4.33; p = 0.02). Additionally, the total heuristic evaluation was higher for the iVR group compared with the video group (p = 0.01). Delivery of biochemistry education materials through iVR technology was shown to be more engaging than traditional video-based instruction.
Wael Osama Abd El-khalek, Radwa S. Abdul-Rahman, Hayam Mahmoud et al. · SPORT TK-Revista EuroAmericana de Ciencias del Deporte ·
Previous studies have demonstrated that aerobic exercise and dietary changes positively impact mental and physical health. This study aimed to assess and compare the effects of three interventions (dietary advice, aerobic exercise, and VR games) on the QoL of obese adolescent females. A total of 100 adolescent females aged 12-17 years with Class A obesity (BMI 30-34.9 kg/m²) were randomly assigned to two groups. Study Group (SG): 50 participants received a combination of diet advice, aerobic exercise, and VR games three times per week for 8 weeks. Control Group (CG): 50 participants received diet advice and aerobic exercise alone, without VR games, for the same duration. There was a significant increase in the QoL of the SG compared with that of the CG (p < 0.01). No significant differences in waist circumference, waist–hip ratio, fat mass, muscle mass, water content, depression and anxiety scores (p > 0.05). By comparing the interventions, the research provided insights into significant increase in QoL of SG compared with that of CG. These results could inform future health and education policies aimed at enhancing the health of teenagers in the digital era.
Yin Yin Bashir, Rahaf AL-Huneiti, Anfal M. Al-Dalaeen et al. · Diseases ·
BACKGROUND: Obesity is a chronic, multifactorial disease that demands personalized and sustainable management approaches. Digital health technologies, such as artificial intelligence, wearable devices, mobile health apps, and virtual reality (VR), may support obesity care by providing enhanced behavioral monitoring, personalized feedback, and patient engagement. OBJECTIVE: This critical narrative review discusses the current evidence on artificial intelligence, wearable technologies, and VR in the context of precision nutrition and obesity management and their possible clinical applications and limitations. METHOD: A critical narrative review was conducted using peer-reviewed literature published between 2019 and 2026 and identified through PubMed and Google Scholar. Search terms included combinations of "precision nutrition," "personalized nutrition," "obesity," "weight management," "metabolic health," "digital health," "artificial intelligence," "machine learning," "mobile health," "wearable devices," and "omics" using Boolean operators. Evidence from randomized controlled trials, systematic reviews, meta-analyses, and key conceptual studies was critically synthesized due to…
Deepti Aggarwal, Thuong N. Hoang, Sze‐Yen Tan et al. · JMIR Human Factors ·
Background: Virtual reality (VR) systems offer promising potential as a controlled platform to investigate human behaviors specifically related to food choices. Yet, little is known about its viability for conducting food choice studies with children, thus limiting the development of public health research. Objective: This study aimed to investigate the viability of VR technology for understanding children's food choices, focusing specifically on perceptual differences between VR and real-life (RL) settings. We examined how children perceive and interact with food portion sizes and container sizes in VR as compared with an equivalent RL scenario. Methods: A within-subject, mixed methods study was conducted with 437 children aged 5-12 years at a science museum. Participants engaged in a standardized food selection task for a simulated breakfast scenario, choosing portions of cereal and milk in 2 conditions: a head-mounted VR environment and a corresponding RL physical setup. Children's food selection behaviors were quantitatively compared across 3 independent variables: condition (VR vs RL), food healthiness (healthy vs unhealthy options), and container size (small, medium, and…
Ahmed S. Alamer · International Journal of Child Health and Nutrition ·
Aim: This study presents a bibliometric analysis of the use of gamification in mental health research (GMHR), aiming to provide a comprehensive quantitative evaluation of publication trends, key contributors, collaboration networks, thematic development, and emerging research themes in this field. Methods: Relevant literature was retrieved from the Scopus database and analyzed using bibliometric tools, including VOSviewer and RStudio. The analysis focused on identifying publication outputs, author collaborations, co-word networks, and thematic evolution from 2013 to 2024. Results: A total of 276 documents were identified, with an annual growth rate of 32.98%. The average number of co-authors per document was 4.99, indicating robust collaborative activity, including international partnerships. Leading contributors included Cheng VWS, Hickie IB, and Fleisch E, who are affiliated with prominent research institutions. Key research themes included gamification, mHealth, anxiety, and ADHD. The findings revealed a dynamic and expanding field responding to contemporary societal mental health needs. Conclusion: Gamification is increasingly being integrated into mental health interventions,…
Sevgi Bektas, Ludovica Natali, Katie Rowlands et al. · Nutrients ·
The emotion of disgust is thought to play a critical role in maintaining restrictive eating among individuals with anorexia nervosa. This exploratory cross-sectional study examined correlations between food-specific trait and state disgust, eating disorder psychopathology, illness severity (body mass index: BMI), and interactions with virtual foods in people with anorexia nervosa. Food-specific trait disgust and eating disorder symptoms were measured before exposure to virtual foods in one of three virtual reality (VR) kitchens to which participants were randomly allocated. Food interactions (eye gaze and reaching towards virtual foods) were measured during the VR exposure. Food-specific state disgust ratings were collected after the VR exposure. In the entire sample, eating disorder symptoms correlated positively with food-specific trait disgust (rs (68) = 0.45, p < 0.001). We also found a significant association between food-specific state disgust and eating disorder symptoms in each virtual kitchen scenario: virtual kitchen only (rs (22) = 0.40, p = 0.05), virtual kitchen plus pet (rs (22) = 0.80, p < 0.001), and virtual kitchen plus avatar (rs (20) = 0.78, p < 0.001). No…
Nina Rosa, John William Long, Alexander Klippel et al. · Computers in Human Behavior Reports ·
Virtual reality (VR) has long been hailed as an effective tool for behavioral research studies combining experimental control with ecological validity. Two frequently used categories of behavioral studies using VR can be distinguished: behavior in VR is studied as a proxy for behavior in physical reality, or behavior change in physical reality is studied after experiencing interventions in VR. In this paper, we explore and discuss a third category: behavior in VR and behavior in physical reality are analytically combined to leverage the experiential differences between the two, and to better understand human behavior. For this approach, we coin the term cross-reality analytics, where behavior in multiple realities is observed, combined and analyzed. We place these three categories in a proposed conceptual framework, and discuss similarities and differences between cross-reality analytical studies, proxy and interventions studies. To illustrate cross-reality analytics, we also present hitherto unpublished results from a cross-reality study, analyzing food selection data collected in VR and connecting it with eating behavior data in physical reality. Results show that data on…
Yilin Yang, Mengying Liu, Minqi Lyu et al. · Games for Health Journal ·
OBJECTIVE: Cooking plays a crucial role in healthy eating, and food exposure during cooking significantly influences people's health and well-being. Given the challenges faced by novice cooks and the general lack of interest in cooking, this research proposes utilizing a highly engaging cooking game as an alternative to real-life cooking, allowing individuals to achieve the same health-boosting benefits as traditional cooking while enjoying the game. Additionally, this study will examine the moderating role of food type and cooking manner in this process. METHODS: = 54) were conducted to examine how using different types of food (healthy vs. unhealthy) in a cooking game affects subsequent food choices, and how the cooking manner (neat vs. messy) moderates this effect. RESULTS: Study 1 found that cooking healthy food led to healthier food choices after gaming. Study 2 revealed a significant moderating effect of cooking manner: When cooking healthy food, a neat cooking manner led individuals to subsequently choose fewer healthy foods, while a messy cooking manner led to an increase; conversely, when cooking unhealthy food, participants who cooked neatly chose more healthy food,…
Anna Felnhofer, Andreas Goreis, Lisa Weiss et al. · International Journal of Obesity ·
Abstract Objective Experiencing ostracism (i.e., social exclusion) may impact self-regulatory eating behaviors, particularly in youths with excess weight. Yet, research in pediatric patients with obesity is lacking. Hence, we examined the effect of Virtual Reality(VR)-based ostracism on motivation for food in children and adolescents with BMI ≥97th percentile. Methods In a randomized experimental between-subject design, forty-one patients (Mage = 13.37 years, 46% female) with a diagnosis of obesity (ICD-10: E66) were randomized to a social exclusion or inclusion condition in a VR-Cyberball-paradigm. Patients’ salivary cortisol, heart rate and heart rate variability were assessed. Furthermore, we measured patients’ motivation to consume high-calorie food, their prosocial behavior, their self-reported urge to eat and subjective stress. Results Results indicate that the experience of social exclusion in youths with obesity leads to a blunted salivary cortisol response; in contrast, no effects of social exclusion on the sympathetic nervous system were observed. Social exclusion was associated with an increased perceived threat to fundamental social needs. Similarly, ostracized…
Tatjana Anne Korbanka, Sandra Schild, Isabelle Mack et al. · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ·
Abstract Purpose Obesity is a major health challenge, requiring the development of more effective interventions. Setting realistic goals and developing detailed plans that anticipate potential challenges can be helpful strategies for bridging the intention–behavior gap. Immersive technologies, such as virtual reality (VR), are considered to further support closing this gap by reducing the distance to one's future self. Methods This study investigates a novel VR-supported reflection exercise as an additional treatment module within a conservative obesity treatment regime. It examines its feasibility, acceptance and short- and medium-term effects on participants' therapy motivation, body dissatisfaction, self-esteem, depressive symptoms, and eating behavior. 23 participants (BMI: M = 43.44 kg/m2, SD = 4.42) were presented with a real-time animated body avatar that had the average body shape for their individual height, initial weight, and realistic target weight (− 10%), and standard appearance matched in terms of hair and skin color. The avatar could be viewed from first-person and mirror perspectives. The exercise included reflective questions about their experience, well-being,…
Andrea Beth Goldschmidt, Adrian Ortega, Isabel R. Rooper et al. · Contemporary Clinical Trials ·
Background Pediatric overweight and obesity continue to be major public health issues. Loss of control (LOC) eating and overeating are two obesity-related phenotypes affecting approximately 30 % of adolescents with overweight/obesity that may undermine weight control treatment outcome. Cognitive-behavioral therapy (CBT) has promising effects on dysregulated eating, but effects on weight are modest, access is limited, and developmental changes in self-regulation (which may limit implementation of treatment skills) are often ignored. Methods: In the current proposal, we will apply human-centered design methods to design and test a novel CBT-based digital intervention, augmented with content and features to improve self-regulation, for weight gain prevention and dysregulated eating in adolescents. The first phase will involve design activities with adolescents ( n = 25–30) who have body mass index (BMI; kg/m 2 ) ≥ 75th percentile for age and sex and report dysregulated eating, to understand desired presentation, features, and barriers/facilitators to engagement. Research activities will include a needs assessment and iterative prototyping, usability testing, and refinement of the…
Makan Pourmasoumi, Sasan Pourmasoumi, Renée M. El-Gabalawy et al. · Diabetes Obesity and Metabolism ·
Abstract Aims This study aims to clarify the effect of VR as an additional method to common treatments for weight management in adults using a systematic review and meta‐analytic design. Materials and Methods A comprehensive literature search was performed through Medline, Embase, CENTRAL, PsycINFO, CINAHL, and Web of Science Core Collection to identify the eligible studies that investigated the effect of VR ‐enhanced treatment (i.e., VR to deliver conventional treatment) on weight management among adults seeking weight loss compared to conventional treatments alone. The included studies were assessed by the INSPECT ‐ SR tool for trustworthiness and authenticity. Body weight and BMI data at baseline, post‐intervention, and at follow‐up (maintenance phase) were collected to estimate the effect size. Results Eleven studies met the criteria for inclusion in the systematic review, of which 10 studies were included in the meta‐analysis. The pooled effect size indicated that VR ‐enhanced treatment was equally effective as conventional treatment in managing body weight and BMI during the intervention. More interestingly, the results revealed that VR ‐enhanced treatment was more effective…
Eva Rahayu, Endang Triyanto, Ridlwan Kamaluddin · Jurnal NERS ·
Introduction: Unhealthy lifestyle behaviours in adolescence are major risk factors for non-communicable diseases. Digital interventions may provide age-appropriate support for preventive health efforts in this population. This review aimed to evaluate the effectiveness of digital interventions in improving adolescent lifestyle behaviours related to non-communicable disease prevention, particularly physical activity, dietary behaviour, sedentary behaviour, and weight-related lifestyle outcomes. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and ScienceDirect to identify randomised controlled trials evaluating digital health interventions in adolescents. Two reviewers independently performed study selection and data extraction in accordance with PRISMA guidelines. Data on intervention characteristics, technological platforms, behaviour change strategies, and reported behavioural outcomes were extracted. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Results: Eleven randomised controlled trials were included. Interventions were delivered through mobile health applications, wearable monitoring devices,…
Nutrition-related chronic conditions, particularly obesity, represent a major global public health challenge and highlight the limitations of traditional, population-based dietary recommendations. Personalized nutrition has emerged as a promising approach by integrating individual physiological, behavioral, and contextual factors into tailored dietary strategies. In this context, immersive virtual reality (VR) and smart digital technologies provide novel opportunities to investigate eating behavior beyond conventional self-report methods. This chapter presents a scoping review of current evidence on the use of virtual reality, wearable sensors, and physiological biofeedback systems to understand, monitor, and influence eating behavior within personalized nutrition frameworks. Particular emphasis is placed on VR-based studies examining food choice, eating microstructure, emotional and contextual modulation, interoception, and stress-related eating. The reviewed literature demonstrates that VR enables controlled yet ecologically valid simulation of eating environments, social stressors, and food-related decision contexts, while simultaneously eliciting measurable autonomic and…
BACKGROUND: The prevalence of overweight and obesity among children and adolescents is increasing around the world, and childhood obesity is associated with health status in adulthood. Although active video games (AVGs) have been proposed as a promising strategy to increase physical activity in youth, evidence regarding their impact on obesity-related anthropometric outcomes and nutritional behaviors, particularly among overweight or obese children and adolescents, remains inconsistent. This systematic review aims to summarize the current knowledge regarding the effects of AVGs on anthropometric indices and nutritional behaviors among children and adolescents. METHOD: A comprehensive systematic search was done on Web of Science, Scopus, PubMed, and Google Scholar databases without date restrictions until December 2025 by relevant keywords. All relevant original randomized controlled trials (RCTs) in English that evaluated the effects of AVGs on anthropometric indices and nutritional behaviors among children and adolescents were eligible for the present review. The quality of included RCTs was assessed by the Cochrane Handbook. The meta-analysis was conducted using the random model…
Christian Eichhorn, Martin Lurz, David Alexander Plecher et al. · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) ·
We want to understand the changing shopping behaviour, influenced by health-targeting nutrition apps on mobile devices. To achieve that, we have built a realistic Virtual Reality (VR) supermarket simulation and addressed core aspects such as handling virtual products, prevention of cybersickness, rounded off with an initial pilot study. On top of that, we built a virtual replica smartphone in VR with nutritionrelated functionality. This has been extended with an Augmented Virtuality (AV) feature, that enables us to track the screen of a participant's own smartphone, hence allowing us to integrate real-world apps and letting the user interact with them during the simulation. To achieve a high-quality tracking, we propose a hybrid approach, utilizing an add-on RGB camera on the VR headset fused with data provided through a WLAN connection in the case of self-made apps. This enables the users to manipulate the simulation from within the smartphone app, introducing a versatile, highly usability-centered controller because they can handle their phone naturally.
Virtual Reality (VR) is increasingly used in clinical, educational, and supportive-care contexts, but evidence on VR-based creative interventions for vulnerable populations remains fragmented. This article presents a scoping review and proposes VR-CREAT (Virtual Reality for Creative Resilience, Expression, and Social Integration) as an HCI-oriented conceptual framework for future design and evaluation. The review maps empirical and design-oriented literature on immersive VR, creative engagement, emotional resilience, and social connectedness, distinguishing direct creative-VR evidence from partial clinical, adjacent creative, and contextual sources. The evidence suggests that creative VR may support engagement, perceived agency, emotional expression, and social connectedness, but direct clinical evidence remains limited and preliminary. VR-CREAT translates the mapped evidence into candidate mechanisms, design requirements, testable propositions, and evaluation domains for future prototyping, usability testing, and controlled studies. The framework should therefore be understood as an unvalidated design and evaluation model, not as evidence of clinical effectiveness,…
Serena Wellbelove, John Gieng, Valerie A. Carr et al. · Foods ·
Regular consumption of excess sugar is linked to nutrition-based diseases, including gut problems, Non-Alcoholic Fatty Liver Disease, and Type 2 Diabetes Mellitus. Increasing sweetness perception is a novel technique to decrease sugar consumption. This experiment compared the sweetness perception of sweetened and unsweetened almond milk in response to different virtual environments with music and visuals. Two music types, the classical song Goldberg Variations, BMV. 998-Variation 13 and a jazz song generated by AI were used. Additionally, fall and spring forest backgrounds were generated by the Blockade Labs 3D image generator. Each participant tasted sweetened and unsweetened almond milk in music-only, background-only, and combination music and background environments. Results revealed significant differences in sweetness ratings for music type (p = 0.015) and between milk types (p < 0.001). Viscosity rating differed significantly between backgrounds (p = 0.04) and by milk type (p < 0.001). Liking ratings varied significantly between backgrounds (p < 0.001) and between music genres (p = 0.011). The results suggest that altering music and background may be a strategy to change…
Diana Stratulat, Mathilde Botella, Kaylee Novack et al. · Clinical Child Psychology and Psychiatry ·
ObjectiveThe development, implementation, and study of virtual day treatment programs for adolescents with eating disorders (EDs) was accelerated by the onset of the COVID-19 pandemic. As we transition into a post-pandemic period, it is necessary to analyze how adolescents, parents, and healthcare professionals experience such programs in a context where pandemic-related challenges are less relevant.MethodSemi-structured interviews were conducted with 25 individuals including eight adolescents with EDs, nine parents, and eight healthcare professionals who participated in the Intensive Ambulatory Care Program (IACP). The IACP is a 6 to 8-week virtual day treatment program for EDs, offered alongside usual in-person care. Phenomenology was adopted as the guiding qualitative theory, and interviews were analyzed using a six-step thematic analysis.ResultsThree themes emerged across all groups: (1) the positive impact on adolescents' well-being; (2) improved access to care through the virtual format; and (3) challenges encountered due to the program's virtual and intensive format. An additional theme, the positive impact on parents' well-being, was identified among parents and healthcare…
Shaoru Cheng, Chunyu Yang, Qi Wang et al. · Materials Horizons ·
Human-machine interfaces (HMIs) have received significant attention for their potential in augmented reality (AR) and virtual reality (VR). Perception of food is an important component of human sensations closely related to healthcare and overall quality of life, which, however, is an underrepresented area in current VR/AR technologies. This review summarizes recent progress in simulating chemical and physical sensations for enhancing eating experiences by utilizing emerging wearable electronics. We start with a brief overview of the key sensory components that shape eating-related perceptions, including the widely studied physical cues (auditory, visual, tactile) as well as the often-overlooked chemical senses (olfactory, gustatory). Then, we review prior work on eating experience-related HMIs, organizing them according to two main categories: sensors used for information capture and actuators used for the simulation of sensations. In the following section, we further discuss the integration of these wearable electronics with hardware and software to build Internet-of-Things and advanced HMIs for human-in-the-loop interactions. The final section summarizes remaining challenges…
Reema Joshi, Mansi Bhatt · European Journal of Clinical and Experimental Medicine ·
Introduction and aim. Obesity and overweight, defined by excess body fat, are major global public health challenges. Virtual reality (VR) is emerging as a novel tool for health promotion and weight management. This scoping review aimed to map existing research on VR applications in overweight and obese populations. Material and methods. Following PRISMA-ScR guidelines, systematic searches were conducted in PubMed, SCOPUS, EBSCO, Pedro, Embase, Web of Science, and Google Scholar up to March 2025. Keywords included ‘obese’, ‘overweight’ and “virtual reality.” Eligible studies were cross-sectional, experimental or randomized controlled trials involving overweight or obese individuals exposed to VR-based interventions targeting physical health, behavior change, or weight control. Two reviewers independently screened and extracted the data. Results. Ten studies published between 2012 and 2025 were included. Most involved adolescents and women, with limited representation of men and older adults. VR interventions varied in immersion, platform, and focus, targeting physical activity, behavioral change, and nutrition. Outcomes commonly included body composition, physical activity,…
Jessica Gutheil, Oliver Kratz, Martin Diruf et al. · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ·
PURPOSE: Anorexia nervosa (AN) is a severe eating disorder characterized by perceptual distortions and restrictive eating behaviours. This pilot study examines portion size estimation in adolescent AN patients using a mixed-reality (MR) approach. The objective is to evaluate the potential of this method for the assessment and treatment of AN, with a particular focus on its ecological validity and its applicability for investigating portion size estimation. METHODS: A total of 30 female participants were recruited: 15 adolescent AN patients and 15 healthy adults as pretest. Participants engaged in a simulated meal assembly task within an MR environment, adjusting portion sizes of virtual food components to match a "typical" meal size (100%). Decision-making patterns and self-reported eating disorder symptoms were recorded. Statistical analyses included descriptive statistics, group comparisons and correlation analysis to examine associations between clinical variables and portion sizes, decision-making time and other decision parameters. RESULTS: AN patients consistently selected significantly smaller portion sizes than healthy adults, particularly for high-calorie foods. No…
Abstract Background Virtual reality (VR) has emerged as a promising tool in health promotion and prevention psychology. Its ability to create immersive, engaging, and standardized environments offers unique opportunities for interventions and assessments. However, the scope of VR applications in this field remains unclear. Objective This scoping review aims to identify and map the applications of VR in health promotion and prevention psychology, focusing on its uses, outcomes, and challenges. Methods A systematic search was conducted across 3 electronic databases (PubMed, PsycINFO, and Scopus) for studies published between 2010 and 2024. Eligibility criteria included empirical studies using immersive VR for health promotion and prevention, while studies using nonimmersive VR, lacking health-related applications, or focusing on clinical interventions were excluded. The review followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guidelines, and 4295 records were initially identified, with 51 studies included after screening. Data were synthesized qualitatively to identify key applications, limitations, and emerging…
Wafa Abdulrahman Alharbi, Johanna Louise Keeler, Yasmin Benbow et al. · Reviews in Endocrine and Metabolic Disorders ·
Obesity and eating disorders (EDs) are major public health challenges associated with high morbidity and mortality. This systematic review evaluated the effects of immersive virtual reality (VR) interventions on clinical outcomes and biomarker-domain outcomes in obesity and EDs. Following PRISMA 2020 guidelines, PubMed, Web of Science, and PsycINFO were searched through to April 2025. Eligible studies included immersive VR interventions targeting obesity or EDs and reporting at least one biomarker-domain outcome (anthropometric, physiological/autonomic, endocrine/metabolic, or neurocognitive/eye-tracking). Risk of bias was assessed using Joanna Briggs Institute tools. When at least three RCTs reported comparable outcomes, random-effects meta-analyses were performed. Twenty-three studies met the inclusion criteria (11 obesity, 12 EDs). ED studies included anorexia nervosa, bulimia nervosa, and binge-eating disorder. In obesity, VR-enhanced cognitive-behavioral therapy (VR-CBT) was associated with weight-loss maintenance, while VR-based exercise interventions were associated with short-term reductions in BMI and body weight. A meta-analysis of four RCTs showed a significant pooled…
John William Long, Travis Masterson, Paige Cunningham et al. · OSF Preprints (OSF Preprints) ·
To determine the effects of increasing the variety of foods on food selection (g), energy selection (kcal), and variety-seeking behaviors in an immersive virtual reality buffet.
Rosalba Hernández, Killivalavan Solai, Soonhyung Kwon et al. · Frontiers in Digital Health ·
Virtual Reality (VR) has evolved from entertainment to a versatile platform for clinical and public health innovation. In medicine, VR supports pain management, rehabilitation, and cognitive training, and shows growing promise for addressing chronic diseases linked to modifiable risk factors. To support this expansion, we introduce the Transcend Framework, the Translational Engineering of Behavioral Interventions into Immersive Contexts for Engagement and Design framework, a systematic model for adapting evidence-based behavioral interventions into VR platforms, illustrated by Joviality™, a positive psychological intervention designed for use during hemodialysis. The aim of this paper is to outline a clear, reproducible process for translating behavioral interventions into immersive digital formats that supports broader research, clinical, and implementation applications. The framework comprises five stages: (1) identifying the target population; (2) assessing feasibility and adapting the curriculum for VR; (3) pre-production planning, including storyboarding and design specification; (4) previsualization and asset creation of immersive environments; and (5) iterative VR…
Antonio Derossi, Mohammed Abdullah Bareen, Maria Grazia Corradini et al. · Future Foods ·
• Serious Games can increase nutrition knowledge and support healthy eating • Serious Games enhance engagement and promote reflection on food choices • Well-designed Serious Games can also foster sustainability awareness • Serious Games may complement or substitute traditional in-person training In an era of rapid technological advancement, global food systems continue to fall short at addressing complex challenges such as malnutrition, food waste, and sustainability. While policy interventions have partially succeeded in addressing these challenges, persistent citizen behavior and systemic barriers necessitate innovative approaches. This review analyzes the role of serious games (SGs) as innovative tools to support a healthier and more sustainable food sector. We conducted a literature search identifying a total of 270 publications. Bibliometric analysis underscores the great diversity of SGs and their effectiveness. A total of twenty-seven serious games were described. Educational role-playing games, simulation-based planning tools, and persuasive mobile applications have been leveraged to support food behavioral change, nutritional education, resource conservation, and…
Supporting type 1 diabetes (T1D) self-management in young children remains a major challenge. Traditional education often fails to sustain attention or meet developmental needs. This study introduces Tangbao Superman Transformation, a narrative-driven virtual reality (VR) serious game developed through participatory Human-Computer Interaction (HCI) methods, to enhance pediatric T1D self-management. A four-week single-group pre-post feasibility study was conducted with 54 children aged 4-9 years recruited from four pediatric hospitals in eastern China. The intervention translated the Chinese Diabetes Society's seven-domain (CDS-7) framework into VR modules co-designed with children, parents, and clinicians. Quantitative measures included the Self-Management Scale for T1D Children (SMS-T1DC), the System Usability Scale for Children (SUS-C), and an Engagement and Motivation Questionnaire (EMQ). Attendance logs and field notes documented adherence and safety, while semi-structured interviews with children, parents, and providers provided qualitative insights. Children showed significant improvements across all seven self-management domains (p < 0.001; Cohen's d = 0.78-1.27). Usability…
Nanna Sklander Hansen, Emma Slebsager Ries, Katrine Rasmussen et al. · JMIR Formative Research ·
BACKGROUND: There is a growing interest in developing novel psychological interventions for eating disorders, with an emphasis on targeting maintaining factors. One hypothesized mechanism underlying illness maintenance is the experience of an "inner eating disorder voice," which reinforces maladaptive thoughts, emotions, and behaviors. Preliminary studies suggest that the eating disorder voice is common among patients and is linked to greater illness severity. OBJECTIVE: This single-arm, mixed methods pilot feasibility study aimed to evaluate a novel virtual reality (VR)-based therapy targeting the eating disorder voice. The intervention was adapted from AVATAR therapy for psychosis and was examined as an adjunct to treatment as usual in individuals with eating disorders. In this adaptation, participants engaged with a therapist-controlled avatar representing their inner eating disorder voice in VR. The primary objectives were to assess the feasibility, acceptability, and safety of the intervention and to provide preliminary estimates of its clinical efficacy. METHODS: Adults with anorexia nervosa (9/10, 90%) or bulimia nervosa (1/10, 10%) took part in a 7-session VR-based therapy…
Hyeong Ha Kim, HeungSik Yoon, Sang Hee Kim · Frontiers in Psychiatry ·
Combining cognitive inhibition training with brain stimulation techniques has received increasing attention as a potential approach to modulating maladaptive food craving and food intake. Building on previous work in this line of research, the current study examined whether virtual reality (VR)-based no-go inhibition training paired with repetitive transcranial magnetic stimulation (rTMS) modulates implicit food-related attitudes, craving and food-choice behaviors. Healthy women with high trait food cravings and a preference for high-calorie foods were assigned to one of four groups in a 2 (rTMS: active vs. sham) × 2 (training: no-go vs. neutral) between-subjects design. High-frequency rTMS was applied over the left dorsolateral prefrontal cortex (DLPFC), and no-go training was implemented in a VR environment using food stimuli tailored to participants' self-reported preferences. Implicit attitudes and food craving were assessed before and after the intervention, while food choice was measured post-intervention only. Following training, the no-go group showed reduced positive implicit attitudes toward high-calorie foods and increased craving for low-calorie foods compared to…
Virginia Quick, Barbara Chamberlin, Devon L. Golem et al. · International Journal of Environmental Research and Public Health ·
Virtual Reality (VR) simulations provide immersive, realistic educational experiences that are increasingly used to enhance teaching and learning in nursing and medicine; however, use in dietetics lags. To fill this gap, four Nutrition Counselor VR simulations were developed collaboratively with the goal of building confidence in dietetic students’ nutrition counseling skills. After formative testing, pilot testing, and refinements, simulations were field tested with 34 dietetic students (91% women; age 25.67 ± 3.79 SD years; 68% White) from four supervised practice programs using a standard protocol administered by trained researchers (N = 5). Students completed a pre-survey, one VR simulation (≥2 times w/varying outcomes), and a post-survey. Online pre- and post-surveys examined changes in nutrition counseling skills, knowledge and self-efficacy, and comfort in using nutrition counseling skills. Paired t-tests revealed significant (p < 0.05) mean differences in nutrition counseling skill self-efficacy (medium effect size, d = 0.46) and comfort in using nutrition counseling skills (large effect size, d = 0.96) between the pre- and post-survey. At post-survey, >75% agreed the…
INTRODUCTION: Individuals living with obesity often experience body image (BI) disturbances, which can negatively affect their quality of life and treatment outcomes. Virtual reality (VR) has emerged as a promising tool for enhancing psychological interventions, but no comprehensive review has specifically focused on VR-based studies addressing BI disturbances in this population. METHODS: This comprehensive review examined studies utilizing VR for the assessment and treatment of BI disturbances in individuals with obesity. Twelve studies met the inclusion criteria. RESULTS: Studies were categorized into three groups: (i) VR in psychological interventions for individuals with obesity, (ii) VR interventions following metabolic and bariatric surgery, and (iii) VR-based full-body illusion experiments. The primary clinical application was experiential cognitive therapy, which demonstrated greater efficacy in reducing negative BI compared with standard cognitive behavioral therapy and other treatments. Studies involving post-metabolic and bariatric surgery adults also supported VR's efficacy in reducing BI dissatisfaction, though long-term benefits were inconsistent. Full-body illusion…
Clara Talens, N. da Quinta, Folasade Abiola Adebayo et al. · Journal of Medical Internet Research ·
BACKGROUND: Childhood and adolescent obesity is a growing global health issue linked to noncommunicable diseases such as cardiovascular disease and type 2 diabetes. Digital health technologies, including mobile apps and web-based programs, offer scalable tools to improve health behaviors, but their effectiveness in young populations remains unclear. OBJECTIVE: This systematic review aimed to evaluate the effectiveness of mobile and web-based digital interventions in promoting healthy diets, reducing obesity risk, increasing physical activity, and improving nutrition-related knowledge and attitudes among children and adolescents. METHODS: A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar databases, along with hand-searching reference lists of key systematic reviews. The search encompassed records published up to September 30, 2024. Eligible studies were randomized controlled trials targeting dietary intake, anthropometric measurements, physical activity, or nutrition-related attitudes and knowledge among participants aged ≤18 years. Screening, full-text eligibility assessment, and data extraction were done partly in duplicate (20%; κ=0.86…
INTRODUCTION: Obesity is a complex and multifactorial disease that has affected many adolescents in recent decades. Clinical practice guidelines recommend exercise as the key treatment option for adolescents with overweight and obesity. However, the effects of virtual reality (VR) exercise on the physical and brain health of adolescents with overweight and obese remain unclear. This study aims to evaluate the effects of physical and VR exercises on physical and brain outcomes and explore the differences in benefits between them. Moreover, we will apply a multiomics analysis to investigate the mechanism underlying the effects of physical and VR exercises on adolescents with overweight and obesity. METHODS AND ANALYSIS: This randomised controlled clinical trial will include 220 adolescents with overweight and obesity aged between 11 and 17 years. The participants will be randomised into five groups after screening. Participants in the exercise groups will perform an exercise programme by adding physical or VR table tennis or soccer classes to routine physical education classes in schools three times a week for 8 weeks. Participants in the control group will maintain their usual…
Mariona Arrom-Llabrés, María Teresa Mendoza‐Medialdea, José Gutiérrez‐Maldonado · Applied Sciences ·
This systematic review investigates the effectiveness of virtual reality as a tool in the treatment of eating disorders, either alone or in combination with other therapies. The limitations of traditional therapies, along with the high prevalence of eating disorders, have driven research into the use of virtual reality techniques as a new approach to treatment. The review includes studies published between November 2021 and February 2025, focusing on virtual reality-based interventions for anorexia nervosa, bulimia nervosa, binge eating disorder, and body image disturbances. A total of 228 articles were screened, with eight meeting the inclusion criteria. The studies show that virtual reality interventions, particularly when combined with other therapeutic techniques, can significantly improve psychological and behavioral factors related to eating disorders. Virtual reality exposure and inhibitory control training were the main interventions. The results indicate that virtual reality exposure is effective in reducing body concerns, food anxiety, and attentional bias, while inhibitory control training shows mixed results in binge eating disorder treatment. Despite the promising…
Martin Dobricki, Michael Rihs, Sina Shahmoradi · Frontiers in Virtual Reality ·
Introduction It has not yet been investigated whether virtual reality (VR) may be useful to support the learning of eco-friendly food choice by enabling human individuals to experience motivational behavior-environment associations that depending on the carbon footprint of their food choice affect them negatively or positively. It is, accordingly, an open question if the viewer-including environment of VR can serve for this purpose better than a viewer-excluding PC version of it. We have, therefore, started to investigate this potential utility of VR in an exploratory investigation on the level of lower secondary education. Methods For this purpose, we have developed both a VR and a PC version of a task involving the following experience: the problem that choosing environmentally harming food with a high carbon footprint is accompanied by climate-related environmental alterations that are affecting oneself negatively can be solved by replacing this food with eco-friendly food with a low carbon footprint, which is accompanied by a reversal of such environmental alterations that is affecting oneself positively. In a first experiment, we have asked experienced lower secondary school…
Irene Capecchi, Tommaso Borghini, Michael Bellotti et al. · Sustainability ·
Background/Objectives: The integration of Augmented Reality (AR) and Artificial Intelligence (AI) in educational applications presents an opportunity to enhance learning outcomes in young users. This study focuses on ARFood, a serious game designed to teach Generation Alpha about nutritional health and environmental sustainability. The objective is to evaluate and improve the effectiveness of the app’s AI-driven feedback mechanisms in achieving specific educational goals in these domains. Methods: ARFood features two AI-powered Non-Player Characters (NPCs), each programmed to evaluate virtual shopping carts created by users. The nutritional NPC provides feedback on dietary choices, while the sustainability NPC assesses environmental impacts. Ninety-three participants were involved, generating 83 virtual carts evaluated by both NPCs. Each NPC’s feedback was assessed for alignment with five predefined educational objectives per theme, using a zero-shot RoBERTa classifier. An iterative process was employed to refine the NPC prompts, increasing the weight of underrepresented objectives, and re-evaluating the virtual carts until all objectives were satisfactorily addressed. Results:…
Shelley Woodall, Jennessa Sharratt, James Hollis · Virtual Worlds ·
Dietitian-led grocery store tours (GSTs) educate consumers about nutrition. Virtual GSTs could increase access to nutrition education. A feasibility study was conducted to determine participant acceptability and their physiological responses to a virtual GST using immersive virtual reality (IVR), a desktop monitor (PC), or a tablet. Participants were asked to report to the laboratory on three occasions to view a virtual GST. Physiological measurements were collected, and participants completed questionnaires about their feelings of presence, nausea, mood, and enjoyment during the virtual GST. Participants experienced a greater sense of presence (IVR = 5.8, PC = 2.6, tablet = 2.6; p < 0.05) with a greater feeling of nausea (IVR = 1.7, PC = 0.4, tablet = 0.4; p < 0.05) in the IVR treatment. Participants enjoyed the IVR GST more than the tablet GST (IVR = 5.3, PC = 4.6, tablet = 4.1; p < 0.05). There were marginal effects of treatment on heart rate (p < 0.05) but not on other physiological measures. There were no differences in the participants’ willingness to recommend a virtual GST given the use of different technologies to a friend or in the participants’ reported mood. Virtual…
SoMi Park, Yun Jeong Hwang, ChaeWeon Chung · Journal for Specialists in Pediatric Nursing ·
ABSTRACT Purpose This study aimed to develop a virtual reality (VR) intervention for reducing exposure to endocrine disruptors (EDs) and examined the effect of the intervention among Korean adolescent girls. Design and Methods A methodological design was employed involving five phases for developing the VR tool and its evaluation of validity testing. The five development phases were conducted through (1) a literature review and surveys to select appropriate VR content for adolescents’ snack shopping, (2) a VR scenario composition based on the information‐motivation‐behavioral (IMB) skills model, (3) implementation of the VR tool using Oculus Quest 2, (4) heuristic and usability evaluations of the VR tool, and (5) the confirmation of final maintenance. For the evaluation, a one‐group pre‐ and post‐test design was utilized with a convenience sample of 19 adolescent girls who were recruited from a high school located in W city. Knowledge about EDs and sensitivity to women's reproductive health problems were measured using a self‐administered questionnaire. Results The prototype of a 15‐min VR intervention was developed based on the waterfall model and evaluation criteria yielded…
Lidia Sarrió Colás, Sílvia Reverté‐Villarroya, Anna Belén Castellà-Culvi et al. · Applied Sciences ·
Technological innovation in immersive virtual reality is fostering the development of novel psychotherapeutic interventions in mental health, particularly benefiting populations with limited access to specialized services. This pilot study explores the feasibility, tolerability, and therapeutic potential of an immersive virtual reality-based psychotherapeutic intervention for adolescents and young people with eating disorders in a rural setting. A quasi-experimental pre-test/post-test design was used, with a control group (n = 5) and an experimental group (n = 5), applying weekly immersive virtual reality sessions focused on body perception and food exposure. Preliminary results showed good acceptance and a low incidence of cybersickness. However, a reduction in anxiety levels was observed in the experimental group after immersive virtual reality exposure, particularly in trait anxiety, suggesting a potential effect of the intervention on emotional regulation. While these changes were not statistically significant, the direction and magnitude of the effect warrant further investigation. Changes in body mass index were also noted during the intervention. The remotely guided…
Caroline A. Klein, Oyewole Oyekoya, Margrethe Horlyck-Romanovsky · ACM Conference on Interactive Surfaces and Spaces (ISS) ·
The increasing global prevalence of obesity and related health issues underscores the need for innovative dietary interventions. This paper explores the potential of combining gamification and Virtual Reality (VR) to promote healthier eating habits among young adults. By creating an interactive VR food environment with engaging game elements, we aim to assess the impact of gamified VR intervention on nutritional knowledge and attitudes. Preliminary results show an increase in nutritional understanding and awareness, though further research is necessary for statistical validation. This study suggests that VR-based gamified interventions could be a promising tool for nutrition education, behavior modification, and virtual food selection.
Omni L. Cassidy, Emma Jane Boyland, Susan Persky et al. · JMIR Research Protocols ·
BACKGROUND: Black communities, compared to White communities, are disproportionately targeted with more unhealthy food advertisements on television and social media. Exposure to unhealthy food and beverage marketing is associated with appetitive sensations, purchase intention, and intake behaviors, which may contribute to poor overall diet quality and worsening nutritional disparities in Black communities. Despite the negative effects, food and beverage companies are expanding their reach and harnessing advanced technology to create immersive experiences using virtual reality (VR). Black young adults may be uniquely vulnerable. OBJECTIVE: We aim to explore the effect of a VR-based fast-food marketing experience (compared with a VR-based nonfood control) on purchase intention, arousal, and hunger in a sample of Black and White young adults. METHODS: We will recruit 200 Black and White young adults (aged 18-24 years) from the New York City metropolitan area for a 1-time, 2-hour laboratory-based study. After screening and obtaining informed consent, eligible participants will be randomized to 1 of 2 VR conditions: a VR-based fast-food marketing experience (Wendyverse; experimental)…
Yuqi Zhang, Amirrudin Kamsin, Nur Amani Ahmad Tajuddin et al. · Digital Health ·
Background Childhood obesity significantly impacts health, making the promotion of healthy behavior (HB) among children crucial to address this issue. Virtual reality (VR) has emerged as a promising tool for encouraging HB in children. Objective This systematic review aims to evaluate the literature on the application of VR in promoting healthy dietary habits and physical activity (PA) among children. Method A systematic search was conducted across Web of Science, PubMed, and Scopus databases in January 2024 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on English-language studies published between 2013 and 2023. The quality of the studies was assessed using the Cochrane Risk of Bias 2 and Risk of Bias in Nonrandomized Studies of Interventions tools. This review is registered at PROSPERO, CRD4202347801. Result A total of 25 studies involving participants aged 4–15 years were assessed. Sixteen studies focused on increasing PA through VR interventions, and six studies focused on healthy eating. Most studies utilized nonimmersive ( n = 11) or semi-immersive ( n = 10) VR technologies. Six theories were employed across the studies,…
Enes Yigitbas, Janet Mazur · International Conference on PErvasive Technologies Related to Assistive Environments (PETRA) ·
A healthy diet is becoming more difficult due to the increasing amount of processed foods, misinformation, or inadequate education about nutrition, which can lead to a variety of diseases in the long term. Supporting people with proper nutrition and diet education is therefore indispensable. As Augmented and Virtual Reality have become promising technologies for education, they are also becoming more common for diet and nutrition education and have been featured in several studies. Both technologies can display additional product information to the user or educate them through new learning applications to support healthy eating. As recent papers only address the use of AR or do not include current research findings, this paper provides a new systematic literature review with recent studies on AR/VR for nutrition and diet education. This paves the way for new research and approaches in this field and suggests future research directions. Overall, 41 out of 375 articles were extracted, categorized, and analyzed. The findings reveal that, especially for the nutritional education of children, AR games have a promising application. VR, on the other hand, is increasingly utilized for…
Jihong Wang, Yiming Qin, Qian Wu et al. · Nature Medicine ·
Adolescents with obesity face numerous health risks and encounter barriers that lead to physical inactivity. We developed a virtual reality sports system, named REVERIE (Real-World Exercise and VR-Based Exercise Research in Education), which used deep reinforcement learning to train transformer-based virtual coaching agents, offering immersive and effective sports guidance, with biomechanical performance comparable to real-world physical sports. We integrated REVERIE into a randomized controlled trial involving an 8-week intervention in adolescents with excess body weight (n = 227). Participants were randomized (1:1:1:1:1) to physical table tennis, physical soccer, REVERIE table tennis, REVERIE soccer or control. REVERIE sports intervention was effective in reducing primary outcome fat mass (mean -4.28 kg (95% confidence interval (CI) -6.35 to -2.22), relative to control), with no significant difference compared with physical sports (mean -5.06 kg (95% CI -7.13 to -2.98), relative to control). For secondary outcomes, decreases in liver enzymes and low-density lipoprotein cholesterol levels were found in physical and REVERIE sports groups compared to control. Physical and REVERIE…
Cristiana Amalia Onita, Daniela-Viorelia Matei, Elena Chelarasu et al. · Nutrients ·
Background/Objectives: Acute stress is known to influence food-related motivation and decision-making, often promoting a preference for energy-dense, palatable foods. However, traditional laboratory paradigms have limited ecological validity. This study examined the relationship between stress-induced physiological changes, eating behavior traits, and food cravings using a virtual reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) followed by a VR supermarket task in adolescents. Methods: Thirty-eight adolescents (mean age 15.8 ± 0.6 years) participated in the study. Physiological parameters (HR, QT, PQ intervals) were recorded pre- and post-stress using a portable ECG device (WIWE). Perceived stress and eating behavior traits were evaluated with the Perceived Stress Scale (PSS) and the Three-Factor Eating Questionnaire (TFEQ-R21C), respectively. Immediately after the VR-TSST, participants performed a VR supermarket task in which they rated cravings for sweet, fatty, and healthy foods using visual analog scales (VAS). Paired-samples t-tests examined pre–post changes in physiological parameters, partial correlations explored associations between ECG responses and…
Florian Ramousse, Pierre Raimbaud, Patrick Baert et al. · Frontiers in Virtual Reality ·
Introduction: Studies into food-related behaviors and emotions are increasingly being explored with Virtual Reality (VR). Applications of VR technologies for food science include eating disorder therapies, eating behavior studies and sensory analyzes. These applications involve 3D food stimuli intended to elicit cravings, stress, and/or emotions. However, the visual quality (i.e., the realism) of used food stimuli is heterogeneous, and this factor’s influence on the results has never been isolated and evaluated. In this context, this work aims to study how the visual quality of food stimuli, exposed in a virtual reality environment, influences the resulting desire to eat. Methods: 28 subjects without eating disorders were included in this protocol, who evaluated the desire to eat induced by 10 3D food stimuli, each duplicated in 7 quality levels (for a total of 70 stimuli). Results: Results show that visual quality influences the desire to eat, and this effect depends on the type of food and users’ eating habits. We found two significant thresholds for visual quality: the first provides the minimal quality necessary to elicit a significant desire to eat, while the second provides…
Bianca Curi Braga, Pejman Sajjadi, Mahda M. Bagher et al. · PLoS ONE ·
OBJECTIVE: To understand the impact of fidelity and perceived realism on virtual reality food choices, and task motivation, engagement, and interest. DESIGN: Randomized controlled trial. SETTING: Online. PARTICIPANTS: 84 participants recruited from Amazon Mechanical Turk. INTERVENTION: Participants were randomly assigned to either a high- (n = 43) or a low- (n = 41) visual fidelity environment and were asked to select foods to have a meal with a friend. MAIN OUTCOME MEASURES: Food choice, motivation of food choices, engagement, and interest. ANALYSIS: Simple linear regressions between visual fidelity and perceived realism, and log-linear regressions for visual fidelity or perceived realism on either motivation, interest, or engagement. Poisson models between visual fidelity or perceived realism, and food selections. RESULTS: Manipulating visual fidelity was not associated with perceived realism, motivation, interest, or engagement in the food selection task. Perceived realism increased motivation by 0.3% (SE 0.056; p = 0.022), interest by 1.4% (SE 0.002; p<0.001), and engagement by 0.9% (SE 0.001; p<0.001) in the food selection task. High visual fidelity decreased the total number…
Caroline A. Klein, Oyewole Oyekoya, Margrethe Horlyck-Romanovsky · ACM Conference on Interactive Surfaces and Spaces (ISS) ·
The increasing global prevalence of obesity and related health issues underscores the need for innovative dietary interventions. This paper explores the potential of combining gamification and Virtual Reality (VR) to promote healthier eating habits among young adults. By creating an interactive VR food environment with engaging game elements, we aim to assess the impact of gamified VR intervention on nutritional knowledge and attitudes. Preliminary results show an increase in nutritional understanding and awareness, though further research is necessary for statistical validation. This study suggests that VR-based gamified interventions could be a promising tool for nutrition education, behavior modification, and virtual food selection.
Omni L. Cassidy, Marie A. Bragg, Brian D. Elbel · JMIR Public Health and Surveillance ·
Unlabelled: Exposure to unhealthy food and beverage marketing is a major contributor to excessive weight gain among young people and it may disproportionately affect Black and Latinx communities. Appropriate and comprehensive regulations on food and beverage companies are essential, particularly as companies expand their reach and leverage the latest technologies to create marketing experiences using immersive virtual reality (VR). Although immersive VR technology is in its infancy, the potential effects of immersive VR food and beverage marketing on consumption, coupled with the history of racially targeted marketing by food and beverage corporations toward Black and Latinx communities, and the heightened burden of diet-related illnesses in Black and Latinx communities underscore a critical need to investigate immersive VR marketing targeting young people of color. This viewpoint will provide a brief description of VR food and beverage marketing as the newest food and beverage marketing frontier, highlight key concerns and knowledge gaps, and underscore future directions in research.
Marie Balfour, Joseph Benbow, Bethany Korom et al. · Humanities and Social Sciences Communications ·
Abstract As obesity rates continue to rise, comprehensive nutrition education for children needs to be further expanded and optimized. Due to the COVID-19 pandemic, more virtual nutrition programs emerged to bridge the gap of social distancing and continue health education endeavors remotely, but there is conflicting data on preferred formats and elements that make these innovative programs most impactful. To identify community and pedagogical factors that define successful virtual elementary school nutrition education partnerships between academic medical centers and elementary schools, an existing in-person nutrition program in Milwaukee County was adapted to a virtual format during the COVID-19 pandemic. The first virtual learning program was conducted wIth 3rd grade students (N = 109) at two urban Milwaukee County elementary schools during the school year, and the second was conducted with students and families (N = 7) from the same schools during the summer with live virtual cooking sessions and farmers market stipends. Focus group discussions from teachers (N = 7) and families (N = 8) and nutritional knowledge quizzes from students (N = 80) were obtained. Statistical…
Li‐Ling Liao, Chia‐Kuei Lee, I‐Ju Lai et al. · Nutrition Journal ·
BACKGROUND: College students are at a critical stage for forming long-term dietary habits. Nutrition literacy (NL) plays a key role in enabling informed food choices and supporting overall health. Virtual reality (VR) offers emerging opportunities for nutrition education by providing immersive and interactive learning experiences that may enhance engagement and behavior change. This pilot randomized controlled trial examined the preliminary effectiveness of a VR-enhanced nutrition education program in improving NL, self-efficacy, and dietary behaviors among college students, by comparing outcomes between app-based interventions with and without VR components. METHODS: This pilot randomized controlled trial was conducted from March to June 2023 and approved by the institutional review board (IRB No. NCKU HREC-E-111-022-2). Participants were recruited from a private university in Southern Taiwan and randomly assigned to one of three groups: Control (n = 51), App (n = 48), and App + VR (n = 52). The App group received a 5-week mobile app-based NL program, while the App + VR group received the same program plus three additional VR-based challenge tasks. NL, self-efficacy, and dietary…
Lauren Adele Fowler, Melissa M. Vázquez, Bianca DePietro et al. · mHealth ·
Background: Virtual reality (VR) shows promise for supporting behavior change in children. This study used user-centered design to translate key tenets of behavioral health interventions into VR for children aged 6–12 years and their caregivers and examined the feasibility, acceptability, and preliminary efficacy of the VR experience in a pilot parallel, two-group randomized controlled trial (RCT). Methods: The VR experience incorporates psychoeducational content from evidence-based behavioral health interventions using voiceover and an interactive go-kart game related to the concepts of “food as fuel” and nutrition guidelines. Study 1 involved usability testing with n=5 child-caregiver dyads, which informed technical and content refinements to the experience. Study 2 involved children aged 6–12 years with body mass index (BMI) ≥85th percentile for age and sex who were comfortable speaking English and their caregivers with BMI ≥25 kg/m2. After participants completed baseline assessments in lab on eating-related behavioral cognitions and behaviors, participants were randomly assigned to the 10-minute VR experience or a control condition (i.e., nutrition education video and mobile…
Marwa Abu El Haija, Nicole Barsanti, Elizabeth Cotter et al. · Journal of Human Nutrition and Dietetics ·
BACKGROUND: Pediatric obesity is associated with increased morbidity. One common therapy within multicomponent treatment for obesity is nutrition counselling and dietary education led by a Registered Dietitian (RD). Virtual reality (VR) improves engagement when used as an educational adjunct. METHODS: The primary aim investigated immediate dietary choices when pediatric patients with obesity engaged in traditional RD nutrition counselling compared to VR-supplemented nutrition counselling. Secondary aims explored food likability, knowledge, and satisfaction. Patients, 6-20 years old, presenting for obesity counselling were recruited. The primary aim was measured by after-visit food choice. Secondary aims were measured with the Pediatric Adapted Liking Scale, an assessment of nutritional facts, and a VR satisfaction survey. Statistical analysis included Chi-square, Wilcoxon and t-tests. RESULTS: Forty participants were enroled and divided into two groups described above. There were no differences in food choice (p = 0.90). Regarding likability, the VR group liked vegetables more than those in the standard of care group (p = 0.045). CONCLUSION: There were no differences in…
Nikita Harris, Robert W. Lindeman, Clara Shui Fern Bah et al. · Frontiers in Psychology ·
In this paper, we explore the current technical possibilities of eating in virtual reality (VR) and show how this could be used to influence eating behaviors. Cue-based exposure therapy is a well-known method used to treat eating disorders. There are several benefits to using VR in combination with cue-based therapy. However, before VR-based cue-exposure can be used for therapeutic purposes, the ability of the VR environment to elicit craving responses in participants must be assessed. This was the objective of the first part of the study, where we assessed whether our VR environment elicited food craving responses in participants. Results showed that our VR environment elicited food craving responses: Salivation Magnitude, Food Craving State and Urge to Eat was significantly different from the neutral baseline. In addition, results showed that food cravings measured through the salivation magnitude in response to the virtual condition were not significantly different from the real condition, thus showing that VR had a comparable effect on producing food cravings. The second part of the study was conducted to determine whether the addition of olfactory and interaction cues in VR…
John William Long, Bart Masters, Pejman Sajjadi et al. · Frontiers in Nutrition ·
Introduction: The modern eating environment has been implicated as a driving force of the obesity epidemic. Mixed reality applications may improve traditional methodological assessments of eating behavior by improving the ecological validity of the laboratory setting. Methods: Research experts evaluated the utility and ecological validity of a mixed reality application that allowed immersion within virtual environments through utilizing the passthrough cameras of the head mounted display to view and interact with real foods. An initial evaluation was conducted that involved three virtual environments: a traditional laboratory booth, a non-textured restaurant, and a full-textured restaurant. The feedback from the initial evaluation was used to create a new virtual restaurant environment and a subsequent evaluation was conducted. Results: Nearly all research experts suggested adding social cues such as people and background noise to create a more authentic and ecologically valid experience. The experts scored the new virtual restaurant environment to be more acceptable than eating or conducting research in a sensory booth but scored lower when compared to conducting research in a…
Cristiana Amalia Onita, Daniela-Viorelia Matei, Elena Chelarasu et al. · Nutrients ·
Background/Objectives: Acute stress is known to influence food-related motivation and decision-making, often promoting a preference for energy-dense, palatable foods. However, traditional laboratory paradigms have limited ecological validity. This study examined the relationship between stress-induced physiological changes, eating behavior traits, and food cravings using a virtual reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) followed by a VR supermarket task in adolescents. Methods: Thirty-eight adolescents (mean age 15.8 ± 0.6 years) participated in the study. Physiological parameters (HR, QT, PQ intervals) were recorded pre- and post-stress using a portable ECG device (WIWE). Perceived stress and eating behavior traits were evaluated with the Perceived Stress Scale (PSS) and the Three-Factor Eating Questionnaire (TFEQ-R21C), respectively. Immediately after the VR-TSST, participants performed a VR supermarket task in which they rated cravings for sweet, fatty, and healthy foods using visual analog scales (VAS). Paired-samples t-tests examined pre–post changes in physiological parameters, partial correlations explored associations between ECG responses and…
Cristiana Amalia Onita, Daniela-Viorelia Matei, Laura Mihaela Trandafir et al. · Nutrients ·
Background/Objectives: The aim was to identify patterns of autonomic and neuroendocrine reactivity to an immersive virtual reality (VR) social-emotional stressor and explore their associations with perceived stress and eating behavior. Methods: This one-group pretest–posttest study included 30 children and adolescents with obesity (15 boys and 15 girls), aged 8 to 17 years. The VR protocol consisted of two consecutive phases: a 5 min relaxation phase using the Forest application and a 5 min stimulation phase using a cognitively engaging VR game designed to elicit social-emotional stress. Physiological responses were measured using heart rate variability (HRV) indices and salivary stress biomarkers, including cortisol and alpha amylase. Subjective stress and eating responses were assessed via visual analogue scales (VAS) administered immediately post-exposure. The Three-Factor Eating Questionnaire (TFEQ-R21C) was used to evaluate cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Results: The cortisol reactivity was blunted and may reflect both the attenuated HPA axis responsiveness characteristic of pediatric obesity and the moderate psychological…
Zeph M. C. van Berlo, Robert G. Belleman, Joey van der Kaaij et al. · Environmental Communication ·
Mitigating climate change requires systemic policy reforms complemented by shifts in individual behaviors, particularly in adopting climate-friendly food choices. Adolescents, an influential yet understudied demographic for dietary change interventions, represent a critical target group. This study explores the potential of virtual reality (VR) to initiate and maintain climate-friendly food choices among adolescents, leveraging exemplification and construal level theory to test whether tangibility increases psychological proximity, and whether this pathway relates to behavior. A mixed-design field experiment (N = 150) across nine high schools tested VR (vs. control) as a between-subjects factor and time (T1, T2, T3) as a within-subjects factor. Results show that VR interventions promote and sustain climate-friendly food choices, with tangibility and proximity operating as serial mechanisms of change. These findings offer insights for researchers, policymakers, and NGOs, highlighting VR’s potential as a tool for fostering sustainable consumption patterns and advancing global climate change mitigation efforts.
Qutaibah Oudat, Sarah Elizabeth Messiah, Alia Dawlat Ghoneum · International Journal of Environmental Research and Public Health ·
Childhood obesity is a critical public health issue linked to long-term complications like type 2 diabetes and cardiovascular disease. This narrative review aimed to examine the effectiveness of virtual reality (VR)-based interventions in supporting key components of obesity treatment-physical activity (PA), nutrition education, and behavior change-particularly in children under 12. Using the intensive health behavior and lifestyle treatment (IHBLT) approach, we synthesized findings from studies published between 2014 and 2024. Of the studies reviewed, only one study met inclusion criteria, showing that VR-based interventions effectively increased light-intensity PA and reduced sedentary behavior in children, though these effects were not sustained long-term. The scarcity of studies limits the generalizability of these findings, emphasizing the need for caution in interpretation. Our review highlights a significant gap in the literature regarding VR's role in childhood obesity treatment. Future research should explore the efficacy of VR in promoting PA, enhancing nutrition education, and supporting sustained behavior changes. Expanding this evidence base is vital for developing…
Cristiana Amalia Onita, Daniela-Viorelia Matei, Ilie Onu et al. · Nutrients ·
According to "The World Health Organization", obesity during childhood is directly associated with multiple complications and with an increased risk of the installation of various pathologies. Considering the increase in this pathology among children and teenagers, new instruments of prevention are needed. Virtual reality is an innovative tool that offers several advantages over classical therapies, becoming important in various medical fields, starting from phobia treatment, pain relief, and body image perception to education. This technology has been successfully used to study the influence of virtual cues on behavioral responses and can be useful in nutritional education as well as understanding eating behavior. The objective of this scoping review study is to understand the impact of virtual supermarket exposure on individuals' food choices and to explore the potential of technology on nutrition education in the general population. It seeks to explore purchasing based on product appearance and placement, food prices, nudging conditions and under-pressure decision making. A manual literature search was conducted using the databases Web of Science, SCOPUS and Google Scholar.…
Yelly Sari Arifin, Dessie Wanda, Ayu Widya Lestari et al. · Indonesian Journal of Global Health Research ·
Hospitalized children often experience decreased appetite, which is influenced by stress and anxiety. This decrease in appetite can worsen the recovery process and increase the risk of complications. VR technology has emerged as one of the promising innovations to reduce anxiety and improve nutritional fulfillment in children during medical treatment. Objective: To evaluate the effectiveness of Virtual Reality (VR) in improving nutritional fulfillment in hospitalized children. Method: A literature search was conducted on four major databases: PubMed, ProQuest, ScienceDirect, and Scopus. Three articles with Randomized Controlled Trial (RCT) design that met the inclusion criteria were selected and analyzed in this review. The articles were evaluated using the Joanna Briggs Institute (JBI) form to assess risk of bias and methodological quality. Results: This study shows that VR is more effective than animated videos in reducing anxiety, increasing appetite, and motivating children to eat nutritious food. In addition, VR also provides benefits as an interactive educational tool that appeals to children. Conclusion: VR is a promising intervention in improving nutritional fulfillment in…
Marion Ann Waite, Olga Kozłowska, Clare E. Martin et al. · Diabetic Medicine ·
AIMS: Diabetes is a condition of global concern that can be mitigated through self-management education. Virtual reality (VR) technology offers an immersive and interactive approach. It may promote self-care and access to healthcare information. This study aimed to explore the experiences of adult participants with Type 1 or Type 2 diabetes during the piloting of a 3D Automatic Virtual Reality Environment (VR-CAVE) approach to diabetes education. The study objective was to capture the participants' ideas for the future development of VR technology as a diabetes educational tool. METHODS: We recruited fifteen adults with type 1 or 2 diabetes and invited them to a short diabetes education module in the VR-CAVE. Subsequently, we undertook qualitative focus group interviews to elicit and evaluate the participants' experiences of various design elements and their considerations for future development. RESULTS: Three categories emerged: 'Experience of an immersive learning environment for diabetes education', 'Comparison with prior diabetes educational experiences' and 'Imagined development of the VR-CAVE technology'. The participants reported a novel experience and a better…
Mara Sînziana Sîngeap, Cristiana Amalia Onita, Daniela Viorelia Matei et al. · Frontiers in Psychiatry ·
Background/Objectives: Virtual reality (VR)-based stress paradigms are increasingly used to induce stress in controlled yet ecologically valid settings. However, the diversity of VR-based stress paradigms and their differential engagement of stress-response systems remain insufficiently synthesized. This scoping review aimed to map VR stress paradigms and examine how they engage subjective, autonomic, endocrine, neural, and behavioral responses, while considering the role of early adversity. Methods: A structured literature search was conducted across Web of Science, ScienceDirect, SpringerLink, and Google Scholar for studies published between January 2012 and June 2026. Eligible studies used VR to induce stress and assessed psychological and/or physiological outcomes. After screening, 21 studies were included and grouped into clusters based on shared mechanisms and methodological features. Results: Five clusters were identified: (1) social-evaluative, (2) cognitive/performance-based, (3) threat/fear-based, (4) analogue trauma, and (5) complex ecologically valid paradigms, with implications for stress-related behavioral outcomes, including eating behavior. VR consistently elicited…
Canneysha Lathiefa Zahra, Fatimah Nur Fadillah, Trias Mahmudiono · Media Gizi Kesmas ·
Background: The Double Burden of Malnutrition (DBM) remains a major global public health problem, particularly in low- and middle-income countries. Children and adolescents increasingly experience undernutrition (such as stunting and micronutrient deficiencies) and are overweight or obese. Poor diets, low nutritional knowledge, and high consumption of ultra-processed foods contribute to this problem. Schools are strategic settings for intervention; however, evidence on the effectiveness of school-based nutrition education remain limited. Objectives: Evaluating the impact of school-based nutrition education interventions on nutrition knowledge among children and adolescents. Method: A systematic review and meta-analysis were conducted using studies from PubMed and Scopus. Eligible studies included randomized controlled trial or pre-post intervention in school-aged children (9–17 years). Standardized mean differences (SMD) were used to estimate pooled effect. Results: Of the 1,253 studies identified, three studies met the inclusion criteria, with participants from Ghana and Malaysia. Two studies reported an increase in nutrition knowledge, while one study showed no effect.…
Mehrnaz Hosseinzadeh, Morteza Naserbakht, Mehrnoush Amini et al. · Computers in Human Behavior Reports ·
Background Immersive VR, especially head-mounted displays, allows ecologically representative research in human psychology, behavioral sciences, and cognitive neuroscience. Custom VR environments provide considerable experimental control, but their development is often resource-intensive. Virtual reality research is now more accessible thanks to software development kits and platforms. Despite their growing use, these toolboxes lack a systematic overview of their usability and application, hindering informed decision-making by researchers. Objective The current scoping review maps the landscape of existing VR toolboxes for immersive cognitive, behavioral, and psychological research. Unlike previous reviews that focus on specific experimental niches, this study provides a comprehensive evidence map and a practical decision support framework specifically tailored for non-programmer researchers. Methods In December 2024, we searched scientific databases and grey literature using PRISMA-ScR principles. We found peer-reviewed English-language papers on immersive VR authoring tools for human behavioral research using a preset search strategy and a multi-reviewer method to assure…