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

Stephan U Dombrowski; Pat  Hoddinott; Lisa Macaulay; Catriona O’Dolan; James Swingler; Seonaidh Cotton; Alison Avenell; Abraham Getaneh; Cindy Gray; Kate Hunt; Frank Kee; Alice MacLean; Michelle C  McKinley; Claire Torrens; Katrina Turner; Marjon Van der Pol; Graeme MacLennan

doi:10.1002/oby.24316

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

Stephan U Dombrowski^* (Corresponding Author)
, Pat Hoddinott
, Lisa Macaulay
, Catriona O’Dolan
, James Swingler
, Seonaidh Cotton
, Alison Avenell
, Abraham Getaneh
, Cindy Gray
, Kate Hunt
, Frank Kee
, Alice MacLean
, Michelle C McKinley
, Claire Torrens
, Katrina Turner
, Marjon Van der Pol
, Graeme MacLennan

^*Corresponding author for this work

University of New Brunswick
University of Stirling
University of Glasgow
Queen's University Belfast
University of Bristol

Research output: Contribution to journal › Article › peer-review

Abstract

Objective
To explore whether socio-economic, health and behavioural characteristics moderate effectiveness of a text message intervention with or without financial incentives versus a control group, and to examine differences in exploratory outcomes.

Methods
Three-group randomized trial including 585 men with obesity comparing daily automated behavioural text messages for 12-months alongside financial incentives; text messages alone; or a waiting list control. Moderator analyses examined percent weight change after 12 months for 9 socio-economic and 11 health factors.
Exploratory outcomes included: self-reported physical activity, sedentary behaviour, smoking and alcohol behaviours, 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 between groups for health behaviours. 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 to controls.

Conclusion
The Game of Stones interventions were equally effective across various sub-groups based on socio-economic, health or wellbeing status. Texts with financial incentive 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.

Original language	English
Pages (from-to)	1432-1446
Number of pages	15
Journal	Obesity
Volume	33
Issue number	8
Early online date	9 Jul 2025
DOIs	https://doi.org/10.1002/oby.24316
Publication status	Published - Aug 2025

Bibliographical note

We thank all the trial participants, general practitioners and supporters who made this research possible. We also thank the following: Kathryn Machray, PhD, and Norelle Calder-McPhee, MSc, University of Stirling; Clare Jess, LLB, Christina O’Neill BSc(Hons), Angela Mullan, HND, Queens University Belfast; Hilary Taylor, MSc, Jack Brazier MSc, and all the students who assisted; Matthew McDonald, PhD, Curtin University, Australia, and other team members from the feasibility trial who shared their experiences of recruiting and collecting data; the Men’s Health Forum in Great Britian and Ireland since 2010 for invaluable contributions to the design and conduct of this study; Martin Tod, BSc(Hons) and Jim Pollard, MA, Men’s Health Forum, London; Colin Fowler, BA(Hons), Men’s Health Forum in Ireland, Dublin, Ireland; Paula Caroll, PhD, South East Technological University, Waterford, Ireland; Michael McKeon, MEd, Dublin City University, Ireland; the Trial Steering Committee: Edmund Juszczak, MSc, University of Nottingham; Emma Frew, PhD, and Kate Jolly, PhD, University of Birmingham; Graham Jameson (lay member and participant in the Football Fans in Training trial); David Gardner (lay member and Chairman of Scottish Men’s Sheds), the Scottish Men’s Sheds Association, Banchory, for their oversight and guidance; the trial protocol contributors who are no longer involved with the study: Andrew Elders, MSc, Glasgow Caledonian University, and Beatriz Goulao, PhD, Centre for Healthcare Randomised Trials, University of Aberdeen for statistics contributions; Mark Forrest, BSc, Connor Keegan, BSc(Hons), and the team at the Centre for Healthcare Randomised Trials Centre for Healthcare Randomised Trials, University of Aberdeen, for technical administrative support and database and website development; Fiona M. Harris, PhD, University of the West of Scotland, for process evaluation contributions; Claire Jones, PhD, Jack Gilmore, BSc, Ross Teviotdale, BSc(Hons), and Keith Milburn, BSc(Hons), Health Informatics Centre, University of Dundee, who developed the participant tracker software and delivered the text intervention. Finally, we acknowledge the earlier work of I. K. Crombie, MSc, University of Dundee. Mr Gardner and Mr Graham received compensation for their contributions.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

National Institute for Health and Care Research. Grant Number: 129703

Funders	Funder number
National Institute for Health and Care Research	129703

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

obesity
behaviour change
financial incentives
secondary analysis

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Cite this

Dombrowski, S. U., Hoddinott, P., Macaulay, L., O’Dolan, C., Swingler, J., Cotton, S., Avenell, A., Getaneh, A., Gray, C., Hunt, K., Kee, F., MacLean, A., McKinley, M. C., Torrens, C., Turner, K., Van der Pol, M., & MacLennan, G. (2025). Secondary analysis of the Game of Stones trial for men with obesity: Examining moderator effects and exploratory outcomes. Obesity, 33(8), 1432-1446. https://doi.org/10.1002/oby.24316

Dombrowski, SU, Hoddinott, P, Macaulay, L, O’Dolan, C, Swingler, J, Cotton, S , Avenell, A , Getaneh, A, Gray, C, Hunt, K, Kee, F, MacLean, A, McKinley, MC, Torrens, C, Turner, K, Van der Pol, M & MacLennan, G 2025, 'Secondary analysis of the Game of Stones trial for men with obesity: Examining moderator effects and exploratory outcomes', Obesity, vol. 33, no. 8, pp. 1432-1446. https://doi.org/10.1002/oby.24316

@article{fdf563d003fb4b2d981ac0e1b8bf4e90,

title = "Secondary analysis of the Game of Stones trial for men with obesity: Examining moderator effects and exploratory outcomes",

abstract = "Objective To explore whether socio-economic, health and behavioural characteristics moderate effectiveness of a text message intervention with or without financial incentives versus a control group, and to examine differences in exploratory outcomes. Methods Three-group randomized trial including 585 men with obesity comparing daily automated behavioural text messages for 12-months alongside financial incentives; text messages alone; or a waiting list control. Moderator analyses examined percent weight change after 12 months for 9 socio-economic and 11 health factors. Exploratory outcomes included: self-reported physical activity, sedentary behaviour, smoking and alcohol behaviours, 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 between groups for health behaviours. 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 to controls. Conclusion The Game of Stones interventions were equally effective across various sub-groups based on socio-economic, health or wellbeing status. Texts with financial incentive 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. ",

keywords = "obesity, behaviour change, financial incentives, secondary analysis",

author = "Dombrowski, \{Stephan U\} and Pat Hoddinott and Lisa Macaulay and Catriona O{\textquoteright}Dolan and James Swingler and Seonaidh Cotton and Alison Avenell and Abraham Getaneh and Cindy Gray and Kate Hunt and Frank Kee and Alice MacLean and McKinley, \{Michelle C\} and Claire Torrens and Katrina Turner and \{Van der Pol\}, Marjon and Graeme MacLennan",

note = "We thank all the trial participants, general practitioners and supporters who made this research possible. We also thank the following: Kathryn Machray, PhD, and Norelle Calder-McPhee, MSc, University of Stirling; Clare Jess, LLB, Christina O{\textquoteright}Neill BSc(Hons), Angela Mullan, HND, Queens University Belfast; Hilary Taylor, MSc, Jack Brazier MSc, and all the students who assisted; Matthew McDonald, PhD, Curtin University, Australia, and other team members from the feasibility trial who shared their experiences of recruiting and collecting data; the Men{\textquoteright}s Health Forum in Great Britian and Ireland since 2010 for invaluable contributions to the design and conduct of this study; Martin Tod, BSc(Hons) and Jim Pollard, MA, Men{\textquoteright}s Health Forum, London; Colin Fowler, BA(Hons), Men{\textquoteright}s Health Forum in Ireland, Dublin, Ireland; Paula Caroll, PhD, South East Technological University, Waterford, Ireland; Michael McKeon, MEd, Dublin City University, Ireland; the Trial Steering Committee: Edmund Juszczak, MSc, University of Nottingham; Emma Frew, PhD, and Kate Jolly, PhD, University of Birmingham; Graham Jameson (lay member and participant in the Football Fans in Training trial); David Gardner (lay member and Chairman of Scottish Men{\textquoteright}s Sheds), the Scottish Men{\textquoteright}s Sheds Association, Banchory, for their oversight and guidance; the trial protocol contributors who are no longer involved with the study: Andrew Elders, MSc, Glasgow Caledonian University, and Beatriz Goulao, PhD, Centre for Healthcare Randomised Trials, University of Aberdeen for statistics contributions; Mark Forrest, BSc, Connor Keegan, BSc(Hons), and the team at the Centre for Healthcare Randomised Trials Centre for Healthcare Randomised Trials, University of Aberdeen, for technical administrative support and database and website development; Fiona M. Harris, PhD, University of the West of Scotland, for process evaluation contributions; Claire Jones, PhD, Jack Gilmore, BSc, Ross Teviotdale, BSc(Hons), and Keith Milburn, BSc(Hons), Health Informatics Centre, University of Dundee, who developed the participant tracker software and delivered the text intervention. Finally, we acknowledge the earlier work of I. K. Crombie, MSc, University of Dundee. Mr Gardner and Mr Graham received compensation for their contributions.",

year = "2025",

month = aug,

doi = "10.1002/oby.24316",

language = "English",

volume = "33",

pages = "1432--1446",

journal = "Obesity",

issn = "1930-7381",

publisher = "John Wiley and Sons Inc.",

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T1 - Secondary analysis of the Game of Stones trial for men with obesity

T2 - Examining moderator effects and exploratory outcomes

AU - Dombrowski, Stephan U

AU - Hoddinott, Pat

AU - Macaulay, Lisa

AU - O’Dolan, Catriona

AU - Swingler, James

AU - Cotton, Seonaidh

AU - Avenell, Alison

AU - Getaneh, Abraham

AU - Gray, Cindy

AU - Hunt, Kate

AU - Kee, Frank

AU - MacLean, Alice

AU - McKinley, Michelle C

AU - Torrens, Claire

AU - Turner, Katrina

AU - Van der Pol, Marjon

AU - MacLennan, Graeme

N1 - We thank all the trial participants, general practitioners and supporters who made this research possible. We also thank the following: Kathryn Machray, PhD, and Norelle Calder-McPhee, MSc, University of Stirling; Clare Jess, LLB, Christina O’Neill BSc(Hons), Angela Mullan, HND, Queens University Belfast; Hilary Taylor, MSc, Jack Brazier MSc, and all the students who assisted; Matthew McDonald, PhD, Curtin University, Australia, and other team members from the feasibility trial who shared their experiences of recruiting and collecting data; the Men’s Health Forum in Great Britian and Ireland since 2010 for invaluable contributions to the design and conduct of this study; Martin Tod, BSc(Hons) and Jim Pollard, MA, Men’s Health Forum, London; Colin Fowler, BA(Hons), Men’s Health Forum in Ireland, Dublin, Ireland; Paula Caroll, PhD, South East Technological University, Waterford, Ireland; Michael McKeon, MEd, Dublin City University, Ireland; the Trial Steering Committee: Edmund Juszczak, MSc, University of Nottingham; Emma Frew, PhD, and Kate Jolly, PhD, University of Birmingham; Graham Jameson (lay member and participant in the Football Fans in Training trial); David Gardner (lay member and Chairman of Scottish Men’s Sheds), the Scottish Men’s Sheds Association, Banchory, for their oversight and guidance; the trial protocol contributors who are no longer involved with the study: Andrew Elders, MSc, Glasgow Caledonian University, and Beatriz Goulao, PhD, Centre for Healthcare Randomised Trials, University of Aberdeen for statistics contributions; Mark Forrest, BSc, Connor Keegan, BSc(Hons), and the team at the Centre for Healthcare Randomised Trials Centre for Healthcare Randomised Trials, University of Aberdeen, for technical administrative support and database and website development; Fiona M. Harris, PhD, University of the West of Scotland, for process evaluation contributions; Claire Jones, PhD, Jack Gilmore, BSc, Ross Teviotdale, BSc(Hons), and Keith Milburn, BSc(Hons), Health Informatics Centre, University of Dundee, who developed the participant tracker software and delivered the text intervention. Finally, we acknowledge the earlier work of I. K. Crombie, MSc, University of Dundee. Mr Gardner and Mr Graham received compensation for their contributions.

PY - 2025/8

Y1 - 2025/8

N2 - Objective To explore whether socio-economic, health and behavioural characteristics moderate effectiveness of a text message intervention with or without financial incentives versus a control group, and to examine differences in exploratory outcomes. Methods Three-group randomized trial including 585 men with obesity comparing daily automated behavioural text messages for 12-months alongside financial incentives; text messages alone; or a waiting list control. Moderator analyses examined percent weight change after 12 months for 9 socio-economic and 11 health factors. Exploratory outcomes included: self-reported physical activity, sedentary behaviour, smoking and alcohol behaviours, 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 between groups for health behaviours. 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 to controls. Conclusion The Game of Stones interventions were equally effective across various sub-groups based on socio-economic, health or wellbeing status. Texts with financial incentive 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.

AB - Objective To explore whether socio-economic, health and behavioural characteristics moderate effectiveness of a text message intervention with or without financial incentives versus a control group, and to examine differences in exploratory outcomes. Methods Three-group randomized trial including 585 men with obesity comparing daily automated behavioural text messages for 12-months alongside financial incentives; text messages alone; or a waiting list control. Moderator analyses examined percent weight change after 12 months for 9 socio-economic and 11 health factors. Exploratory outcomes included: self-reported physical activity, sedentary behaviour, smoking and alcohol behaviours, 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 between groups for health behaviours. 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 to controls. Conclusion The Game of Stones interventions were equally effective across various sub-groups based on socio-economic, health or wellbeing status. Texts with financial incentive 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.

KW - obesity

KW - behaviour change

KW - financial incentives

KW - secondary analysis

U2 - 10.1002/oby.24316

DO - 10.1002/oby.24316

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SN - 1930-7381

VL - 33

SP - 1432

EP - 1446

JO - Obesity

JF - Obesity

IS - 8

ER -

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

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

Fingerprint

Cite this