A common media narrative has it that screen time in front of TV and video games is a big contributor to inaction and obesity. But people following mobile health know that video games have the potential to impact fitness in a positive direction as well. In 2010, MobiHealthNews wrote about the potential for virtual avatars to improve fitness feedback. Now, a recent study from the University of Missouri shows support for these ideas, suggesting that social engagement with avatars can improve self-image and engagement in a health context.

Elizabeth Behm-Morawitz, study author and Assistant Professor of Communication at U of M, looked at self-reported data from 279 users of the game Second Life, where players create virtual avatars and interact in an online, social context with other players. She had participants report on how fit or idealized their avatar was and report their own height and weight.

"Taking on a different persona online can have real effects on your offline health when you’re embodying this avatar that you’ve created," Behm-Morawitz told MobiHealthNews. "Oftentimes that physical or virtual embodiment is idealized in nature. And rather than having a negative impact on self-esteem, this was motivating."

Behm-Morawitz found that in general, Second Life players used their avatars to test out new looks or styles in a low risk environment. She also believes the social nature of Second Life enhances the sense of identification users have with their avatar. Because it's a medium through which they interact with others, she suggests, people are more prone to identify strongly with their avatar.

"For health-related behaviors (i.e. diet and exercise), the avatar may serve as a source of motivation or inspiration to take better care of the body offline," Behm-Morawitz writes in the study. "Indeed, virtual world users who perceived their avatar to be more attractive than their offline self and representative of their ideal appearance were more likely to report avatar effects on offline appearance and health behaviors. Health and fitness providers may consider having clients use virtual worlds in conjunction with specific health-related education and wellness programs."

Despite the press garnered by products like WiiFit, Behm-Morawitz suggests the potential for harnessing virtual play to improve health is largely unrealized.

"When your looking at something like WiiFit," Behm-Morawitz told MobiHealthNews, "the avatar selection is rudimentary compared to something like Second Life." She suggested that a successful pro-fitness game would need to incorporate a social element as well. For an avatar to be a really successful feedback mechanism, this study suggests it needs to be visible to others.

But the real market here might be expanding beyond the fitness buffs who already use health apps. This technology has the potential to engage a group of people, gamers, who often aren't already invested in fitness.

"Even with the absence of a directed [health-related] presence online, the participants were still realizing a positive effect on their offline health," Behm-Morawitz said. "And that's sort of a different take."