Video Games Play or “Playlike Activity”? Brian A. Primack, MD, EdM, MS W hat made the most money on its first day of release—the last Harry Potter book, the most recent Star Wars movie, or Halo 3 ? The surprising answer is Halo 3. 1 Have you even heard of Halo 3 ? If not, it may be because it is not a book or a movie but a video game. In this issue of American Journal of Preventive Medicine, Weaver et al. 2 should be applauded for reminding us that video games are currently popu- lar not only among young people but also among adults. Indeed, the average video-game player in 2009 is aged 35 years. 3 In their cross-sectional study, Weaver et al. 2 find that video-game playing was associated with higher BMI among men and depression and poorer overall health status among women. As the authors appropriately acknowledge, further study will be necessary to deter- mine whether these findings are causal given the study methodology. But do these relationships make theo- retic sense? Playlike Activities How might video games be like food? Michael Pollan, in his recent book In Defense of Food: An Eater’s Manifesto, describes how many 21st-century health woes may be related to eating less “food” and more edible “foodlike substances.” 4 Like food, foodlike substances stimulate the right taste buds and provide calories. However, foodlike substances do not provide many other things for which we do need food (e.g., vitamins, minerals, and micronutrients)—and they often provide extra things that we really do not need (e.g., trans fats). Like food, play is essential to human development; it is through play that we develop crucial physical, emo- tional, social, and moral skills necessary to be func- tional beings. 5–7 It is not an accident that the more advanced a species is, the more it plays. 8 However, just as there are differences between the actual foods to which our bodies have become accus- tomed during the past 200,000 years of being Homo sapiens and the foodlike substances introduced during the past 100 years, there are noteworthy differences between the oldest forms of play (e.g., chase games) and today’s “playlike activities.” These playlike activities may stimulate the right parts of the brain to be engag- ing—and they may even provide other values of play, such as improving hand– eye coordination and under- standing of rules. However, the differences between today’s playlike activities and original forms of play may illuminate some of the observed health-related corre- lates discovered by Weaver et al. 2 Original forms of play were highly physical, whereas today’s playlike activities are often sedentary. The first board game (probably senet) apparently did not appear until about 5000 years ago. 9 But the real increase in time with sedentary game-playing has come only in the past 40 years, as advances in technology and marketing have enabled video games to become more compelling and more stimulating. 3 It is not surprising that this increased time may be associated with increases in BMI. 10 –12 With regard to their finding of increased psychopa- thology among women, Weaver et al. 2 offer the hypoth- esis that women may self-medicate for psychopathology via video games. This is certainly possible. It is also possible that while original forms of play strongly facilitate human interaction, relationship, and bond- ing, today’s playlike activities are more commonly used in isolation, minimizing some of the original value of these activities. And even during many “social” and “interactive” games, such as World of Warcraft, the par- ticipants are separated by hundreds of miles, pretend- ing to be violent creatures completely different from themselves. Displacement of pro-social relationship- building play with these activities may hinder appropri- ate social and emotional development and contribute to depression. Serious Games But what about the ingenuity of role-playing games such as World of Warcraft and The Sims? What about the ability of Where in the World Is Carmen Sandiego to educate and encourage love of learning? And what about the potential value of interactive multiplayer plat- forms that bring people together from all over the globe to play? From the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Address correspondence and reprint requests to: Brian A. Primack, MD, EdM, MS, University of Pittsburgh School of Medicine, 230 McKee Place 600, Pittsburgh PA 15213. E-mail: bprimack@pitt.edu. 379 Am J Prev Med 2009;37(4) 0749-3797/09/$–see front matter © 2009 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2009.07.001