In a new UK study published in JAMA, researchers found that offering cash prizes might be the key to helping men drop down to a healthy weight. The “Game of Stones” trial was conducted with 585 men with obesity in Glasgow, Scotland.
Dr. Hoddinott, Professor of Primary Care at the University of Stirling in Scotland, led the study. “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,” she explained in an interview for the JAMA Network.
In this assessor-blind randomized trial, the participants were divided into three groups: one received motivational text messages with cash prizes of up to £400 GBP (roughly $510 USD) while another group received just the text messages. A third control group was placed on a waiting list and did not receive any interventions.
Monetary motivation
To earn the full cash prize, the men had to lose 5% of their starting weight at three months, 10% at six months, and maintain the 10% weight loss until they hit the twelve month mark. If they met their goals, the money was transferred into their bank accounts. “[The idea] was based on behavioral economic theory around loss aversion,” Dr. Hoddinott explained. “The prospect of losing money is more motivating than gaining it.”
Men who received both the motivational text messages and cash prizes lost about 5% of their starting weight. The difference between the group who got a cash incentive and the groups who didn’t was statistically significant. This means the difference was big enough and consistent enough that it was unlikely to have happened by chance. Those who only got the text messages lost about 3%, and the control group lost just 1%. The difference in weight loss for the two groups without a cash incentive was not considered statistically significant.
The study also used daily text messages to support and motivate the participants. These messages, edited by a men’s health charity, were presented as tips and encouragement from other men. Some examples included tips like avoiding fast food temptation by taking a different route home or meal prepping for the week ahead.
Men underserved in weight loss industry
Dr. Hoddinott points out the need for more male-centered weight loss programs. “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.”
This leaves men at a crucial disadvantage in basic health promotion. The research team was surprised by how many of the participants had other health issues besides obesity. “We were really struck by how unwell some of our participants were,” Dr. Hoddinott shared. Seventy-one percent of the participants had at least one obesity-related condition, and 40% had multiple long-term conditions.
According to Hoddinott, men are, “seldom included in clinical trials for weight management and also they don’t attend weight management services as frequently as women do. This is a finding in the UK with the diabetes prevention programs and the cardiovascular prevention programs as well, and so it’s quite a big problem.” The researchers hope financial incentive programs like Game of Stones could help reach men who may not participate in other primary care programs.
Cashing in: a future tool for obesity treatment?
So, what does this mean for the future? Dr. Hoddinott believes that a variety of tools are needed to tackle obesity. “Obesity is a complex problem, and we need a toolbox with lots of different tools to meet everybody’s needs,” she said. While medications for weight loss are becoming more available, they might not be affordable for everyone. Behavioral interventions, like the one tested in this study, provide an important option.
Dr. Hoddinott believes health services organizations or primary care institutions might choose to pay for the incentives because meaningful results can be achieved with only a few short weight assessments required in the clinic setting. “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,” says Hoddinott, “and so I think it’s a very new and innovative approach for the UK.”
ReferencesHoddinott 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
