Cash incentives drive weight loss in men

The Game of Stones research study offered men £400 for losing weight

Weighing scales.

A major UK study led by health experts at the University of Stirling in partnership with the universities of Bristol; New Brunswick, Canada; Aberdeen; Glasgow and Queen’s University Belfast, has found that offering text messages with financial incentives is effective in helping men to lose weight.

585 men living with obesity across Scotland, England and Northern Ireland, took part in the research and were randomly split in to three groups. One received daily supportive text messages plus the opportunity to earn £400 for meeting weight loss goals, the second received only text messages, and the third received no extra support or financial incentive.

The men were given targets of 5 per cent weight loss at three months, 10 per cent at six months and maintain 10 per cent weight loss at 12 months – at which point the cash was paid to the group offered the monetary incentive.

The research, funded by the National Institute for Health and Care Research (NIHR), found that after one year the men receiving both text messages and the opportunity to get cash lost the most weight.

Professor Pat Hoddinott, of the Nursing, Midwifery and Allied Health Professions Research Unit at the University of Stirling, who led the study, said: “Losing weight can make people feel better, reduce their risk of many health problems such as diabetes, and helps the health service with their aim to keep men well. However, we know men often don’t like to go to traditional weight loss groups.

“This was a very carefully planned study, created for men with men. We worked closely with various men’s health groups and charities, including Men’s Health Forum in the UK and Ireland, with more than 1,000 men living with obesity informing the design of the incentive structure.

“The research showed that offering cash incentives was a popular and effective way of helping men to lose weight. This initiative would be a low-cost solution for the health service to offer to men, requiring only four short weight appointments, and with money paid out only at the end to those who lose over five per cent of their starting weight.”

Professor Katrina Turner, Head of the Centre for Academic Primary Care at the University of Bristol and a co-investigator on the study, added: “It’s been great to work on a study that was focused on men’s health and which has shown a low cost intervention, with little impact on NHS resources and low burden for patients, can help men lose weight and maintain weight loss.

“As men could access the study via their GP or directly through the study website, it is also an intervention that cuts across primary care and public health. When around 25 per cent of men in the UK are living with obesity, we need effective weight loss interventions that can be implemented at scale and across different health settings.”

The Game of Stones project was able to recruit a particularly unique group of participants, who are often underserved by health promotion activities. The men who participated in the research had a mean age of 51, with 39 per cent living in areas with lower socioeconomic status. Twenty nine per cent reported a disability, 40 per cent had multiple long-term conditions and 25 per cent told researchers they had been diagnosed with a mental health condition. 426 (73 per cent) completed the 12-month follow up.

The research showed that the men in the second group, who received text messages only lost some weight (3 per cent weight loss) but not as much as the first group who received texts and monetary incentives (5 per cent weight loss). The men in the third group, who weren’t sent text messages or given the cash incentive lost a very small amount of weight (1 per cent), but not as much as the other groups. The randomised trial found that the difference in weight loss was statistically significant for the comparison between text messaging with financial incentives and the control group, but not between the text messaging alone and the control group.

Nevil Chesterfield, 68, from Bristol who took part in the study, said: “Game of Stones was a real success for me. It has a number of elements which make it stand out; the fact that it is aimed at men only was an important draw for me, the specific targets meant there was a focus with reasonable goals to aim for and I think the competitive element was helpful as was the series of boosts to self-esteem provided by hitting each target.

“The financial incentive was important – it did give the project tremendous credibility when I explained it to my peer group. Partaking in a university study sounds worthy, and the fact that it is intended to inform future health policy gives seriousness, but the payments for hitting targets takes it to new heights, particularly with male friends. To them it becomes something more than some sort of diet.”

Research participant Ciarán Gibson, 35, from Belfast, said: “After struggling for many years with losing and keeping off weight through diet and exercise, I thought I might benefit from being part of the study to keep me motivated to reach my goals.

“The appointments were infrequent and easy to attend but regular enough to keep me feeling accountable for my weight loss. I didn’t want to go to my next appointment having put on more weight!

“I was very happy with my progress. I believe I lost just shy of two stone over the course of the study. It’s helped with my arthritis and overall, I’m much happier with having a more healthy BMI.”

The Health Survey for England 2021 found that 25.9 per cent of adults in England are obese with men more likely to be overweight or obese than women, while a recent report estimates the annual NHS spend on obesity related diseases at £6.5 billion.

Professor Frank Kee, a public health physician and co-Investigator from Queen’s University Belfast, said: “Given the huge cost imposed upon the health service of overweight and obesity, and their consequences, we believe that investing in a service like this could pay for itself over the long term if the impact we observed in the trial is sustained. We are currently examining this health economic question in more detail.”

Researchers hope the findings will help inform policy makers and be adopted by NHS organisations to support action to tackle obesity.

The research is being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May).

Paper: Text messages with financial incentives for men with obesity: a randomized clinical trial by Pat Hoddinott et al. in JAMA (The Journal of the American Medical Association)

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow on X: @capcbristol and LinkedIn

About the NIHR

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

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