Promoting Learning About Nutrition and Healthy Eating Behaviors in Chinese Children Through an Alternate Reality Game: A Pilot Study

<b>Background</b>: 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. <b>Methods</b>: This pilot study employed a quasi-experimental design with two third-grade classes, which were randomly assigned to the HFHM intervention group (<i>n</i> = 40) or a no-game control group (<i>n</i> = 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 knowledge, food waste, picky eating, and meal duration, with daily progress tracking in the HFHM group. <b>Results</b>: Compared to the control group, the HFHM group showed a significant increase in nutrition knowledge (<i>p</i> < 0.05), reduced food waste (<i>p</i> < 0.01), decreased picky eating (<i>p</i> < 0.01), and improved meal duration (<i>p</i> < 0.05). However, the small sample size and short intervention period limit generalizability. <b>Conclusions</b>: These findings suggest HFHM is a promising tool for improving nutrition education and dietary behaviors in Chinese children. Future research should validate these findings in a larger sample and assess long-term impacts.