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Since age 7, Tanya Jessen had been overweight. Nothing anyone could say ordo compelled her to slim down—until Konami's "Dance DanceRevolution" (DDR) came along. DDR players spring to the direction ofcolored arrows scrolling up the screen and step on a "dance pad"to the boom of a dance-club beat.
DDR joins a new generation of "active video games" that hastransformed couch potatoes into workout buffs. With active video games,physical activity is part of thestrategy.
A visit to a well-appointed arcade reveals video games that simulate snowand water skiing, surfing, and a variety of activities that force players tomove, flex, twist, or otherwise exert themselves.
Konami also makes a boxing video game in which the player wears gloves andstands in a frame equipped with motion sensors, the digital opponent dodgingand weaving in response to the position and movement of the human player. Afew rounds of virtual boxing can leave a player winded, with a racing pulseand damp with perspiration—a sneaky way of getting people to pay toexercise.
Although active video games appear to create the opportunity for injury,untoward reports involving the machines are scant. Unlike thumb and handinjuries documented with video game controls, to date the medical literaturecontains no citations of trauma associated with active video games.
Last June, a teenage girl in Omaha, Neb., collapsed and went into cardiacarrest while playing DDR. She was hospitalized after a successfulresuscitation. However, the 15-year-old girl was reportedly later diagnosedwith hypertrophic cardiomyopathy.
WEIGHT-LOSS SUCCESS STORIES
In Jessen's case, excess weight—235 pounds on her 5-foot 8-inchframe—peeled off. She lost 60 pounds without dieting. Once sheplateaued, healthful eating habits helped her shed the rest. By August2003—3 years after DDR made exercising so easy—she hit the stable145-pound mark.
"I would play for 3 or 4 hours. It was constant cardio," saidJessen, 22, a Microsoft recruiter at Volt Technical Services in the Seattlesuburb of Redmond. "The neat thing is that you lose weight withouttrying."
Scores of young people tell similar success stories. If there was ever away to lose weight while having fun, this Japanese innovation is it. And kids,teens, and 20-somethings aren't the only ones saying so. Doctors, physicaleducation teachers, and fitness center directors are touting active videogames as an effective means to reverse obesity and prevent diabetes—tworelated conditions that have escalated to epidemic proportions.
"A lot of people, as you know, have blamed McDonald's and BurgerKing," said Richard Adler, MD, of University of Tennessee Health ScienceCenter in Memphis. "But the problem with obesity is not just thefood—it's the lack of physical activity."
DDR AS MEDICAL INTERVENTION
Adler will conduct a pilot study to test his point. The 6-month projectwill follow 70 Memphis-area obese girls ages 12 to 14. Half will play the gameand keep a record of it. The other half won't play—they'll watch theirdiet and increase their exercise however they choose.
That's "the standard prescription physicians give to people who areoverweight," Adler said. He's hoping nonprofit foundations in Tennesseeand elsewhere will fund the study and provide a push in the oppositedirection.
Meanwhile, at the health science center, scores of overweight kids are on awaiting list for nutrition and exercise counseling. "There is no way anyclinic in any city can handle all the obese children," he said."There are so many now."
Sophia Yen, MD, is witnessing the obesity crisis from firsthand experienceas well. She's a consultant to the University of California at San FranciscoWATCH clinic—Weight Assessment for Teen and Child Health. And she'schair of the Task Force on Obesity at the American Academy of PediatricsCalifornia Chapter 1.
Yen plans to launch two 6-month studies involving boys and girls ages 10 to18. The initial pilot study aims to recruit 50 patients with a body mass indexgreater than the 95th percentile for their age and sex. Kids will beencouraged to use the video game and dance pad for 30 minutes three timesweekly. In the second study, 150 kids will be divided into 3 categories: acontrol group, a second group that plays the game on a dance pad, and a thirdthat wears pedometers on their waists to monitor activity.
"We're going to follow them to see if their biologicalmarkers—glucose and insulin—improve with the intervention,"said Yen, who hopes to receive a grant from the National Institutes of Healthto fund the larger study. "It would be great to give children any toolspossible to help them have healthier lives and to prevent diabetes and otherdiseases related to being overweight."
Since the early 1970s, the prevalence of obesity has quadrupled among boysand girls and more than doubled among adolescents. About 30.3% of childrenages 6 to 11 are overweight and 15.3% are obese, according to the AmericanObesity Association. Among adolescents (ages 12 to 19), 30.4% are overweightand 15.5% are obese. In the younger group, the incidence is higher in boys(32.7%) than in girls (27.8%). But in adolescents, it levels off to 30.5% formales and 30.2% for females.
SCHOOLS JUMP ON DDR BANDWAGON
DDR's quick interactive reward system gives kids a full-body workout. Fitkids are exercising more, while inactive classmates have become active, saidPhil Lawler, a physical education teacher at Madison Junior High School in theChicago suburb of Naperville. The Naperville Community United School District,which serves 18,000-plus kids, has offered DDR in the fitness centers at thejunior and senior high schools for more than a year.
"We've been able to reach the students that we weren't reaching withthe other equipment," Lawler said. "Our guys enjoy it just as muchas the girls do. It gets them exercising when they don't even realize they'redoing it. I guess it's a technology version of rollerblading."
Tim McCord, director of the PE4life Institute in Titusville, Penn., hasseen how well DDR works because it caters to youngsters' interests.
"Kids live for video games," he said. "Most of the time,kids sit around and do nothing while they're playing video games. This givesus a way to integrate physical activity into the games kids like."
Physical education teachers and school administrators from across thecountry have visited Titusville Area School District to model their programsafter it. Students at Titusville Middle School have been using DDR in thefitness center since January 2003, said McCord, chairman of the health andphysical education department at the district. The Parent Teacher Group fundedthe video game systems—about $75 for two used ones—whileRedOctane, a company that makes dance pads for this purpose, donated two gamesand pads.
At the Downey Family YMCA in Los Angeles County, the response from parentshas been overwhelmingly positive. Executive Director George Saikali said theYMCA began offering DDR almost a year ago as part of an expanded menu ofoptions for kids. In the evening, it's the most popular activity among 40 orso youngsters who take over the kids' zone.
Several parents told Saikali that their children are losing weight."I've noticed that the kids are not interested in the same type ofmachines as we are as adults," he said. "We needed to create theright atmosphere and the right environment for them to get fit—to dosome exercise in addition to diet and nutrition."
Saikali was sold on the idea after consulting with experts such as DanLatham, a physical education teacher at West Middle School in Downey. Lathamruns a business on the side called New Frontier Fitness, which is best knownfor Cyberobics—a cardiovascular program that blends computer technologywith exercise. The program includes video game bikes, among other equipment,but DDR has captivated youth unlike anything else.
"That is the number one thing that we have. The kids love DDR,"Latham said emphatically before a trip in August to another YMCA thatexpressed interest.
His staunchest supporter is the Mary R. Stauffer Foundation, which providesmini-grants to teachers at Downey Unified School District. He applied for a$2,000 grant and got it. Later, Stauffer became a frequent contributor toCyberobics and the Downey YMCA. 
Footnotes
Dance Dance Revolution is available for Playstation 2 and Xbox video gamesystems, with versions of the game selling for $20–$50. The game uses adance pad, which is available from several makers, priced starting at $20.
GetUpMove.com—asite operated by dance pad maker RedOctane—provides information andforums for people interested in using DDR for weight loss.
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  S. R.S. Stender, G. A. Burghen, and J. T. Mallare The Role of Health Care Providers in the Prevention of Overweight and Type 2 Diabetes in Children and Adolescents Diabetes Spectr, October 1, 2005; 18(4): 240 - 248. [Abstract] [Full Text] [PDF]
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