Childhood overweight and obesity have seriously
risen worldwide in the past decades and represent a worrisome socio-economic
and public health problem. The prevalence of pediatric overweight and obesity
in Europe has been estimated being above 20% and the number of overweight
children has been expected to increase by nearly 1.3 million units per year 1. In Italy, approximately more than
35% of children are overweight or obese, an alarming level, higher than the
average value of most of the developed countries 2. Childhood obesity is associated
with an additional increasing risk of non-communicable diseases, such as
cardiovascular diseases, type 2 diabetes, and certain types of cancer, later in
life. Moreover, obese children are more prone to social problems and poor
self-esteem, and to become obese adults 3. These strong consequences expedite
the need for programmes and policies aimed at preventing pediatric overweight
and obesity.

Schools have been proved to play a vital role
in the promotion of weight management and healthy lifestyles for school-age
children and, thus, to help in the prevention and treatment of childhood
obesity. Actually, school interventions based on nutritional education seem to
be effective in making children more aware and responsible, and in enhancing
their knowledge, skills and attitude. To be effective, nutritional education
should have a secure position in school curriculum, to help in the development
of healthy eating behaviors and an of adequate nutritional knowledge.

A suggested method for reducing obesity,
especially for children, are serious games 4. Game-based nutritional learning is
an effective approach to enhance children’s knowledge, behavior, and healthy
dietary habits. Therefore, playful and creative methodologies should be
included into nutritional education programmes for children. Actually,
game-based educational tools can represent the best choice for enhancing the
efficacy of nutritional education during the learning process. Other serious
games present relevant educational content on healthy eating and exercise,
whilst ensuring that all user interaction required physical movement 4 5. In this way, they convert
sedentary screen time into a more active form. So, one variety of serious games
is direct, where healthy activity within the game or healthy choices (e.g.
real-time exercising) result in better game outcomes and the other variety is indirect,
where real-world activity that is otherwise unrelated to the game (e.g.
walking, consuming less calories) is measured and used as game input 6. In this sense, new technologies allow
the use of more interactive tools to drive information and implement the
learning process in an educational context.

Among new technologies, information and
communication technologies (ICTs) represent a powerful strategy when teaching
nutrition. ICT can help the users to achieve changes to lifestyle habits and provide
a new channel for the promotion of healthy lifestyles and the enhancement of public
health. They also seem to be more effective than traditional printed materials
to produce a change in dietary behavior 7. ICT has remarkable salience, such
as providing immediate information to users, reminding them of daily tasks
(physical exercise, diet, etc.) and giving guidance and advice (e.g., how to
control snacking, how to manage urges to eat, etc.). Clinicians cannot provide this
immediate information to each patient every day, but ICT can. Therefore, ICT
may be a very useful way of increasing obesity treatment efficacy. These
systems often use the behavior modification to assist the intervention of
childhood obesity 8.  

A number of technology interventions, including
the use of mobile apps and wearable computing have arisen to motivate children to
start and continue improving their health and become physically active 9. Meanwhile, wearable sensors
provide new opportunities for obesity research and monitoring. These sensors
can be divided in three categories which are physical activity, physiological
monitoring and food intake sensors 10.

The first type of sensors actually uses accelerometers
and gyroscopes and they are based on inertia, assessing level and intensity of
physical activity. Recent developments in these technologies have brought focus
to devices capable of monitoring daily physical activity while providing
valuable feedback to the user. Latest generation of smartphones are already
equipped with high quality inertial sensors. That allows unobtrusive monitoring
of user’s activity using smartphone as a sensor device. The idea behind these
approaches is to maximize activity throughout the day even if no single period
is exclusively designated for exercise. Through this approach, the user is
encouraged either directly (through activity indicators) or indirectly (through
animations or games) to make more active choices throughout the day.

 The second
type of wearable sensors provide unobtrusive assessment of energy expenditure
through analysis of physical activity, body temperature, galvanic skin response
or heart rate and oxygen levels in the blood. In this way, critical
physiological parameters of each individual can be acquired and recorded
unobtrusively as well as continuously and then be stored for future observation
and assessment.

Lastly, miniature devices have been developed
which can detect ingestion events and then further characterize the ingested foods,
regardless of how short or insignificant they may seem. A wearable sensor could
potentially capture timing, duration, and microstructure of food intake
episodes, characterize rate of ingestion, ingested mass and nutritional and
energy contents of food, without creating a reporting burden for the user 10. Monitoring of daily food intake
and ingestive behavior is not only important for obesity monitoring, but for
other conditions such as malnutrition and underweight. Traditionally,
monitoring relies on self-reporting. However, self-reports tend to under-report
20% on average, and as high as 50%. Understanding ingestive behavior is also a
key in diagnosis and treatment of eating disorders such as anorexia, bulimia
and binge eating.

Food recognition is a special case of category
recognition for visual object recognition in computer vision. The appearance of
any particular meal is affected by many factors such as ingredients, cooking
methods, cutting patterns, ingredient positions, occlusions, and lighting
conditions. These factors are complex such that even meals of the same category
may have different appearances. Many works address the challenges in the
recognition of food by developing recognition strategies that differ in terms
of features and classification methodologies. The majority of the proposed
methods takes an image as input, finds the regions of interest, and predicts
the corresponding food class for each region, via different classification
strategies using several visual descriptors.

Generic approaches to prevention and treatment
of obesity have limited success due to the disparities by race/ethnicity,
neighborhood, socioeconomic status, and access to health care. Therefore, most
successful approaches take into account the physical and social environment to influence
behaviors and sustain changes in behavior of participants and their families.
Social networks supported by social media (Web-based and mobile technologies)
are commonly used for interaction and communication within the network.
Social-media based interventions have been frequently used in social networks
for health and obesity applications.

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