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Randomized Controlled Trial
. 2025 Aug;33(8):1432-1446.
doi: 10.1002/oby.24316. Epub 2025 Jul 9.

Secondary analysis of the Game of Stones trial for men with obesity: examining moderator effects and exploratory outcomes

Stephan U Dombrowski  1 , Pat Hoddinott  2 , Lisa Macaulay  2 , Catriona O'Dolan  2 , James Swingler  3 , Seonaidh Cotton  4 , Alison Avenell  3 , Abraham M Getaneh  5 , Cindy Gray  6 , Kate Hunt  7 , Frank Kee  8 , Alice MacLean  7 , Michelle C McKinley  8 , Claire Torrens  2 , Katrina Turner  9 , Marjon van der Pol  5 , Graeme MacLennan  4
Affiliations
Randomized Controlled Trial

Secondary analysis of the Game of Stones trial for men with obesity: examining moderator effects and exploratory outcomes

Stephan U Dombrowski et al. Obesity (Silver Spring). 2025 Aug.

Abstract

Objective: The objective was to explore whether socioeconomic, health, and behavioral characteristics moderate the effectiveness of a text message intervention with or without financial incentives versus a control group and to examine differences in exploratory outcomes.

Methods: This three-group randomized trial including 585 men with obesity compared daily automated behavioral text messages alongside financial incentives, text messages alone, and a waiting list control for 12 months. Moderator analyses examined percentage weight change after 12 months for 9 socioeconomic and 11 health factors. Exploratory outcomes included the following: self-reported physical activity, sedentary behavior, smoking and alcohol behaviors, engagement in 15 weight-management strategies, and weight-management-related confidence.

Results: No moderator effects were found by any factors for either comparison versus control. There were no differences across groups for health behaviors. The texts with incentives group had higher levels of engagement in six strategies including weight goals, food changes, and self-weighing and higher levels of confidence compared with the control.

Conclusions: The Game of Stones interventions were equally effective across various subgroups based on socioeconomic, health, or well-being status. Texts with financial incentives group participants showed better engagement for some intervention elements. The implementation of Game of Stones is unlikely to increase health inequalities. Future studies should focus on increasing engagement.

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Conflict of interest statement

Dr. Pat Hoddinott reported serving as chair or member of Independent Trial Steering Committees unrelated to weight‐management trials and being a member of the National Institute for Health and Care Research (NIHR) School for Primary Care Research Funding panel. Dr. Kate Hunt reported serving as chair of the Health Improvement, Protection and Services Committee of the Chief Scientist Office, Scotland. Dr. Katrina Turner reported serving as a member of the NIHR HTA commissioning board, December 2017 to September 2020. The other authors declared no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Forest plot for subgroup analysis comparing percentage weight loss (99.5% CI) at 12 months from baseline between the texts with incentives group and the control group. EQ‐5D, EuroQol‐5 Dimension scale; MLTC, multiple long‐term conditions; PHQ‐4, Patient Health Questionnaire‐4; WEMWBS, Warwick‐Edinburgh Mental Well‐Being Scale; WSSQ, Weight Self‐Stigma Questionnaire.
FIGURE 2
FIGURE 2
Forest plot for subgroup analysis comparing percentage weight loss (99.5% CI) at 12 months from baseline between the texts alone group and the control group. EQ‐5D, EuroQol‐5 Dimension scale; MLTC, multiple long‐term conditions; PHQ‐4, Patient Health Questionnaire‐4; WEMWBS, Warwick‐Edinburgh Mental Well‐Being Scale; WSSQ, Weight Self‐Stigma Questionnaire.
See this image and copyright information in PMC

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