UK Study Explores Cash Prizes as Weight Loss Incentives for Men

Overview of the “Game of Stones” Trial

A recent study conducted in the UK and published in JAMA has revealed that offering cash prizes may significantly aid men in achieving a healthier weight. The “Game of Stones” trial involved 585 men suffering from obesity in Glasgow, Scotland, and was led by Dr. Hoddinott, a Professor of Primary Care at the University of Stirling. “Our primary research question was to find out whether text messages with or without financial incentives could help men living with obesity to lose weight over 12 months,” Dr. Hoddinott explained in an interview with the JAMA Network.

Trial Structure and Methodology

In this assessor-blind randomized trial, participants were divided into three distinct groups. One group received motivational text messages alongside cash prizes of up to £400 GBP (approximately $510 USD). A second group received only the motivational messages, while a third group served as a control and was placed on a waiting list without any interventions.

Monetary Motivation and Weight Loss Results

To qualify for the full cash prize, participants needed to achieve a 5% weight loss from their starting weight by the three-month mark, followed by a 10% loss at six months, and maintain that weight loss until the twelve-month period concluded. Successful participants received the cash directly in their bank accounts. Dr. Hoddinott noted, “[The idea] was based on behavioral economic theory around loss aversion. The prospect of losing money is more motivating than gaining it.”

Participants who received both text messages and cash incentives lost approximately 5% of their initial weight, a statistically significant difference compared to the other groups. Those who received only text messages lost about 3%, while the control group achieved a mere 1% weight loss. The variations in weight loss between the two groups without cash incentives were not statistically significant.

Supportive Text Messages

The trial also incorporated daily text messages designed to motivate and support participants. These messages, curated by a men’s health charity, provided practical tips and encouragement from peers. Suggestions included strategies like avoiding fast food temptations by taking alternate routes home or planning meals for the week ahead.

Addressing the Gap in Male-Centered Weight Loss Programs

Dr. Hoddinott emphasized the necessity for more weight loss initiatives tailored specifically for men. “This work all started with four systematic reviews we did back in 2010, called the Romeo reviews, that identified the enormous gaps in the evidence for weight management interventions in men and how very few are designed with men in mind,” she stated. This lack of focus leaves men at a significant disadvantage in health promotion efforts.

The research team was also taken aback by the prevalence of additional health issues among participants. “We were really struck by how unwell some of our participants were,” Dr. Hoddinott reported. Seventy-one percent of participants had at least one obesity-related condition, while 40% suffered from multiple long-term health issues.

Men’s Participation in Weight Management Programs

Dr. Hoddinott pointed out that men are often underrepresented in clinical trials for weight management and tend to engage less frequently in weight management services compared to women. This trend has been observed in UK diabetes prevention and cardiovascular programs, highlighting a significant challenge.

The researchers believe that financial incentive programs, such as the Game of Stones trial, could effectively engage men who might otherwise avoid traditional primary care programs.

Implications for Future Obesity Treatment

What do these findings suggest for the future? Dr. Hoddinott asserts that a multifaceted approach is essential to address obesity. “Obesity is a complex problem, and we need a toolbox with lots of different tools to meet everybody’s needs,” she stated. While weight loss medications are becoming more accessible, they may not be financially viable for everyone. Behavioral interventions, like the one evaluated in this study, offer an important alternative.

Dr. Hoddinott also believes that health service organizations or primary care institutions might find it worthwhile to fund these incentives, as they can yield meaningful results with minimal clinical assessments. “You don’t need any particular training, there’s no intervention delivered by the people weighing the participants and so it’s really very efficient from the point of view of primary care time,” she explained, calling it a “very new and innovative approach for the UK.”

References

Hoddinott P, O’Dolan C, Macaulay L, et al. Text Messages With Financial Incentives for Men With Obesity: A Randomized Clinical Trial. JAMA. Published online May 14, 2024. doi:10.1001/jama.2024.7064