Non-communicable diseases, such as cardiovascular diseases, diabetes type II, certain types of cancer and mental health problems are widespread in developed countries. Unhealthy lifestyle behaviors, such as insufficient levels of physical activity, high levels of sedentary behavior, high-fat diet, or risktaking behaviors are modifiable contributors to these non-communicable diseases. In contrast, healthy lifestyle behaviors, such as consuming regular meals or performing daily physical activity contribute to positive general health and reduce the risk of developing overweight or obesity. Non-communicable diseases are increasingly prevalent among youth, accounting for a large proportion of morbidity and mortality causes, and health care costs worldwide. Unhealthy lifestyle behaviors are prevalent among youth as indicated by two thirds of youth, showing more than one unhealthy lifestyle behavior. This makes it highly relevant to promote these healthy lifestyle behaviors and reduce the risk of noncommunicable diseases, already in adolescence.

Numerous health interventions are implemented with the aim to promote healthy lifestyle behaviors, which show significant, yet often small-to-moderate overall effects on health outcomes. Interventions are needed that can motivate youth to adopt and maintain health behavioral change in the long-term. Serious digital games tap into the benefits of the popularity of digital games, by designing games that are both intended for entertaining and educational purposes. While serious digital games show promising results for some behavioral determinants and outcomes of healthy lifestyle behaviors, and while exergames show effects on light to moderate physical activity, serious games and exergames currently do not succeed in behavioral change in the long-term or in reaching daily physical activity or sedentary behavior guidelines in youth. An important contributor to the effectiveness of games is fun, a positive affective state otherwise referred to as enjoyment. This drives engagement which is the involvement and motivation of the player in gameplay. A limitation in many serious games is the lack of immersive game features contributing to engagement.