Offering cash to obese people in text messages could help them to lose more weight, study suggests

Approach could also help target more people on lower incomes, according to researchers

Offering cash incentives to obese people in text messages could help them to lose more weight, a trial has found.

Researchers suggested this approach could be cheaper for the health service than traditional weight management programmes as it requires fewer staff.

It could also help reach people from more deprived areas, they added.

The year-long study – known as Game of Stones – included 585 men from Bristol, Belfast and Glasgow with an average body mass index (BMI) of 37.7, who were split into three groups.

We designed the Game of Stones trial, which uses an endowment incentive, where the money is put in an account at the start, allowing men on low incomes to join

Prof Pat Hoddinott

One of the groups was told £400 was being held for each of them in an account and would be transferred over at the end of the trial.

However, money would be taken off the total if they failed to meet weight loss goals.

The group were also sent daily texts that included motivational messages, tips on lifestyle changes, links to information online and access to a study website on weight management with information about local services and an online tracker to monitor changes in weight.

The second group was sent the same messages but with no financial incentive, while the third group was only granted access to the weight management information.

Some 426 men included in the study logged their weight after 12 months.

Those in the financial incentives group lost 4.8 per cent of their body weight on average, compared to 2.7 per cent in the group who were sent the same messages but with no financial incentives and 1.3 per cent in the third group.

Professor Pat Hoddinott, of the nursing, midwifery and allied health professions research unit at the University of Stirling led the study, which has been presented at the European Congress of Obesity (ECO) in Venice.

She said it was inspired by “behavioural economic theory which proposes that people are more motivated by the prospect of losing money than the prospect of gaining money”.

“However, not everyone can afford to deposit their own money, so we designed the Game of Stones trial, which uses an endowment incentive, where the money is put in an account at the start, allowing men on low incomes to join,” Prof Hoddinott added.

“A text message-based programme, meanwhile, costs less and is less labour-intensive than a traditional weight loss programme.

“Men who were living with obesity helped design the structure of the incentives and helped us write the text messages.”

We reached an underserved group of men who seldom take part in health promotion activities

Prof Pat Hoddinott

Prof Hoddinott also stressed the study was able to recruit people from areas “normally under-represented in weight management trials”.

She added: “Some 39 per cent of the men lived in less affluent areas, 71 per cent reported a long-term health condition, 40 per cent reported two or more long-term conditions and 29 per cent reported that they were living with a disability.

“In addition, 25 per cent of the men told us they had a doctor-diagnosed mental health condition and a further 24 per cent reported low mental health scores.”

Men included in the financial incentives group received £128 each on average at the end of the study, with 27 receiving the full £400.

Prof Hoddinott said: “We reached an underserved group of men who seldom take part in health promotion activities.

Men and NHS staff really valued this low burden approach and it has the potential to address health inequalities. It was a win-win for all

Prof Pat Hoddinott

“Weight management programmes are traditionally intensive, often with a weigh-in every week or two.

“In Game of Stones, there are just four brief ten-minute weigh-ins over a year.

“No intervention is delivered by the staff at the weigh-ins, so minimal staff training is required.  No referral is needed to join.

“Men and NHS staff really valued this low-burden approach and it has the potential to address health inequalities. It was a win-win for all.”