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Game of Stones

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No negative views were expressed about the incentives in qualitative interviews. Only one man reported being motivated by the financial incentive, and many expressed indifference. Participants reported the weight loss and health benefits as sufficiently rewarding. In the above example, the game starts with 20 stones, 2 players, and each player can remove up to 3 stones in their turn. This three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver.

Dombrowski, S.U., McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, et al., Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT.

People with obesity are at greater risk of type two diabetes, some cancers, heart disease, stroke, infections like COVID-19 and mobility problems. However, men rarely take part in weight loss services. Together with men who have tried to lose weight, we designed a new weight loss service.

KEY QUESTIONS THIS STUDY WILL ANSWER: Do men lose weight and keep it off? What are the costs and benefits for men and the NHS? Does the service help men who are less well-off as well as the more well-off? What are men’s experiences?The average BMI and age of the study participants of around 35 kg/m 2 and 50–55 years is similar to UK weight management trials recruiting in the community, 34 primary care 42 or a combination of community and primary care. 12 Three international text message-based weight management studies examining outcomes after 12 months recruited younger participants with lower BMI. 43–45 However, three mixed sex weight management studies with financial incentives (two including text message components) reported broadly similar participant demographics to this study. 46–48 The Game of Stones Trial is funded by NIHR Public Health Research [REF 129703] and has been approved by the North of Scotland Research Ethics Committee (2) [IRAS REF 290955]. Overall, 177 men expressed an interest in the study. Baseline appointments were attended by 111 (63%), of which 6 (5%) were ineligible. All 105 men were willing to be randomised and consented to be randomised to the SMS+I (n=36), SMS only (n=33) and control (n=36) groups. We have handy hints available - a text hint and a photo hint. But beware! The more hints you use the more penalties added to your time! Where does the Game Start? In Bristol, the research fieldworker is Ms Hilary Taylor supported by the University of Bristol and NHS England.

The Game of Stones study adds to the evidence base demonstrating the feasibility of recruiting men for research on sensitive subjects, such as obesity, through community outreach and GP practice lists. 11–13 In Belfast, the research fieldworkers are Clare Jess and Christina O’Neill supported by Queen's University, Belfast and the Public Health Agency. Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.The use of a financial incentive strategy for weight loss in men with obesity across the socioeconomic spectrum was feasible and acceptable. Two previous incentive studies used text messages to inform participants about their incentive achievement of weight loss targets and found it acceptable. 46 47 This extends the evidence base on the use of financial incentives as a complementary behaviour change strategy alongside other components. 22 50 Some men sent spontaneous replies to the narrative texts (0–3 months n=25/69, 36%; 3–6 months n=8/69, 12%, 6–12 months n=13/69, 19%; see online supplementary 2). Most spontaneous replies were received between 0 and 3 months (n=370 replies) and decreased at 3–6 months (n=16 replies) and 6–12 months (n=39 replies). Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK Key questions this study will answer: Do men lose weight and keep it off? What are the costs and benefits for men and the NHS? Does the service help men who are less well-off as well as the more well-off? What are men’s experiences?

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