How might avatar appearance influence health-related outcomes? A systematic review and narrative meta-review

Research has suggested that positive health behaviour change may be achieved using representations of the self in virtual environments (avatars) to alter self-perception, and model behaviours. This systematic review aimed to assess studies exploring role that avatar appearance plays in influencing health-related outcomes.Journal databases, author books and websites, and grey literature sources were searched for experimental studies in which avatar appearance was used to manipulate physical health-related outcomes in healthy populations. A total of 16 articles (17 studies, 39 effect sizes) addressing primary (e.g. ex- ercise, diet, and smoking), and secondary (e.g. body satisfaction) health related attitudes and behaviours were included.Eight studies reported significant main effects of avatar manipulation, which included avatar body type (varied by adiposity or muscularity), and Self Discrepancy Theory-based (SDT; e.g. actual, ideal, ought selves) customisa- tion.The review indicates a dearth of research on avatar appearance and health- related outcomes. The assignment of avatars with varying body types ap- peared to consistently affect immediate physical activity during exercise game play. The assignment of ‘obese’ avatars appeared to reduce positive behavioural outcomes: however the absence of control conditions make it unclear whether performance was improved in the thinner condition, or re- duced in the ‘obese’ condition. Results from this review indicate a need for a grounded, theory-driven approach to future avatar appearance-based studies.