Project in the spotlight: Ball & Whip: e-health game creates awareness of obesity in a playful way

The research group 'healthy storytelling' won the Onze Taal (Dutch Language Society) @DRONGO prize at the end of October with the e-health game ‘Bal en Spriet’, translated: ball and whip. Researchers* from TU Delft, Erasmus MC and Radboud University developed the game to make adults with low health skills and low literacy aware of prejudices about people with obesity and to make obesity discussable. The game is now also offered to children.

The prototype of the game will be tested and evaluated in the coming weeks. Project leader Dr. Valentijn Visch (TU Delft) and professor Prof. Andrea Evers (LU), both Scientific Leader at Medical Delta eHealth & self management for a healthy society, are involved in healthy storytelling research. The Pharos Foundation and the Red Cross Hospital are also involved in the development.

Make obesity discussable

Prejudice and shame are oppressive for obese people. The game makes the subject open for discussion and thus raises awareness about related stigmatization. This opens the discussion about causes of weight problems and prevention, which is a first step to prevent obesity.

The game ‘Bal en Spriet’ combines a board game - a sort of Chutes and Ladders - with an app full of assignments and stories. The stories are about situations that have been experienced by overweight people, creating more understanding for them. “For example, the stories are about an obese person who, instead of taking the stairs, takes the elevator to the first floor. In first instance you would think that it would have been better for him to take the stairs, until he says he has knee problems and cannot do otherwise," says Visch. "Players are challenged to move in characters both being overweight and not being overweight and have to think about how they treat each other."

Not every ripple of fat starts off as a tasty snack

The stories were collected by conversations with overweight people and supplemented with stories from literature and the media and compiled on the basis of conversations with experiential experts and experts. The researchers concluded from these stories that weight and body size are often taboo subjects and that overweight people regularly feel stigmatized. Visch: “The general assumption is that we can fully control our weight ourselves, but that is only partly true: genetic predisposition, hormones, medication, stress and a seductive environment, for example, can be very determining. In the meantime, overweight people are being looked at. Stigmatization, exclusion and shame then provide a threshold for talking about it and doing something with it. A vicious circle is created that is difficult to get through without help. The game tries to break that cycle."

Storytelling gives people who are stigmatized the opportunity to share their perspective and experiences. This ensures that obesity can be talked about and that others can adjust their beliefs and misconceptions (for example that you can lose weight with a strict diet). "In addition, stories are recognizable and understandable as a source of information for everyone," says Visch. “We use proven storytelling techniques for the game. It enables us to convey health information in a more comprehensible and empathizing way."

The game breaks the vicious cycle that’s hard to break without help.

In the coming weeks, the game will be tested by players at festivals and in an obesity clinic. Among other things, it is investigated whether the game actually causes self-reflection: with regard to one's own prejudices and with regard to (well-intentioned) behavior that can appear stigmatizing. After an evaluation, it is ultimately the intention that the game is introduced on a large scale. For example, the City of Rotterdam is involved in the project and it is being examined whether the final version of the game can follow the 'Nice and Fit' program of this city.

The Healthy Storytelling research group is funded by ZonMW. More information can be found via this link.

* TU Delft (Niko Vegt, Postdoc; Annemiek van Boeijen, Cultural Sensitive Design; Valentijn Visch, project manager), Erasmus MC (Liesbeth van Rossem, obesity expert), LU (Andrea Evers, eHealth specialist), Radboud University (Wilbert Spooren, storytelling specialist).