Cash incentives drive weight loss in men

A major UK study led by health experts at the University of Stirling has found that offering 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% weight loss at three months, 10% at six months and maintain 10% weight loss at 12 months – at which point the cash was paid to the group offered the monetary incentive.
The research 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 1000 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 5% of their starting weight.”

A unique group of participants

The Game of Stones project was able to recruit a particularly unique group of participants, who are underserved by health promotion activities. The men who participated in the research had a mean age of 51, with 39% living in areas with lower socioeconomic status. 29% reported a disability, 40% had multiple long-term conditions and 25% told researchers they had been diagnosed with a mental health condition. 426 (73%) 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% weight loss) but not as much as the first group who received texts and monetary incentives (5% 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%), 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 took part in the study, he 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.”

"A service like this could pay for itself over the long term"

The Health Survey for England 2021 found that 25.9% 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 Queens 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. 

Professor Katrina Turner, Head of the Centre for Academic Primary Care, University of Bristol and a co-investigator on the study, said: “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% 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 research ‘Text messages with financial incentives for men with obesity, a randomized clinical trial’ is published in JAMA (The Journal of the American Medical Association) and was presented at the European Congress for Obesity in Venice.

Funded by the National Institute for Health and Care Research (NIHR), the research was led by the University of Stirling in partnership with the University of New Brunswick, Canada, University of Aberdeen, University of Glasgow, Queens University Belfast and the University of Bristol.