  Outcome-driven studies designed to evaluate potential effects of games and
apps designed to promote healthy eating and exercising remain limited either
targeting design or usability factors while omitting out health-based outcomes
altogether, or tend to be too narrowly focuses on behavioral outcomes within a
short periods of time thereby less likely to influence longitudinal factors
that can help sustain healthy habits. In this paper we argue for a unified
approach to tackle behavioral change through focusing on both health outcomes
and cognitive precursors, such as players' attitudes and behaviors around
healthy eating and exercising, motivation stage and knowledge and awareness
about nutrition or physical activity. Key findings from a 3-month long game
play study, with 47 female participants indicate that there are clear shifts in
players' perceptions about health and knowledge about eating. This paper
extends our current understandings about approaches for evaluating health games
and presents a unified approach to assess effectiveness of game-based health
interventions through combining health-based outcomes and shifts in players'
cognitive precursors.
