Obesity is a rapidly rising public health crisis, affecting over 100 million adults and children in the United States, and shows no signs of slowing down. Obesity contributes to severe chronic cardiometabolic diseases, including type 2 diabetes, hypertension, cancer, and cardiovascular disease, which have a significant impact on the economy. Medical professionals continuously seek effective strategies to aid patients in weight loss and management. Gamification is a novel approach to engaging individuals, especially men, in weight loss programs and may enhance efficacy through game-based elements. Gamification offers a promising approach to obesity treatment by making weight management engaging, enjoyable, and sustainable.
The Rise of Gamification in Weight Loss
Gamification involves applying game-design elements and game principles in non-game contexts. Think of it as turning everyday activities into a game to make them more engaging and enjoyable. It taps into our intrinsic motivation by leveraging the brain’s reward system. When patients achieve small goals, they receive immediate feedback and rewards, which release dopamine, the “feel-good” neurotransmitter. Weight management has become a massive global industry. The proliferation of diet trends, support groups, coaching methods, and targeted workout routines speaks to the need for diverse strategies.
How Gamification Motivates
Gamification can make weight management fun and engaging. Patients are more likely to stick to their treatment plans when they feel motivated and entertained. Changing long-standing habits is challenging. Gamification can help by breaking down complex behaviors into manageable tasks. Many gamified platforms include social features, allowing patients to connect with others on the same journey. Friendly competition and support from peers can boost motivation and accountability. Gamification can offer a personalized approach to weight management.
Gamification Strategies in Practice
Numerous mobile apps incorporate gamification to support weight loss. Apps like MyFitnessPal and Lose It! Wearable devices like Fitbit and Apple Watch use gamification to encourage physical activity. Users can set daily step goals, participate in challenges, and earn rewards for staying active. VR and AR can create immersive experiences that make exercise more enjoyable. For example, VR games that require physical movement can provide a fun and engaging way to burn calories. Online communities and social media platforms can foster a sense of camaraderie and support. Patients can join groups, share their progress, and participate in challenges.
Examples of Successful Gamification
- Zombies, Run! is a mobile app that turns running into an adventure game. Users complete missions by running and collecting supplies while being chased by zombies.
- Weight Watchers, now known as WW, has incorporated gamification into its program. Members earn “Wins” for tracking food, activity, and attending workshops.
- Noom is a weight loss app that uses psychology-based techniques and gamification to help users develop healthier habits.
The UCI Paul Merage School of Business Study
In their article “Gamified Challenges in Online Weight-Loss Communities,” published in Information Systems Research in 2022, Professor Behnaz Bojd of the UCI Paul Merage School of Business and her fellow researchers, Professor Xiaolong Song of Dongbei University of Finance and Economics, Professor Yong Tan of the Michael G. Foster School of Business at the University of Washington, and Professor Brad Greenwood of George Mason University, explored the effects of gamified challenges on weight loss. To collect data, Bojd and her team used an online platform. The researchers tracked individuals over several months, providing time-based or panel-level data. In the researchers’ study, the control group didn’t sign up for the competition, while the treatment group did. This allowed the team to measure the causal effects of the competition. “Would people be more engaged if their weight loss goals were gamified?” Bojd asks. “In the specific platform we studied, leaderboards were used to track results for people engaged in the competition. This is not necessarily a new thing.
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The Impact of Competition
Simply put, competition motivates people to take action. In diet competitions, the focus is often on what foods people avoid eating. “We couldn’t really run a field experiment to be accurate about the reason for this,” Bojd says, “but we could theorize that this was because exercise is about taking action, whereas with diet it’s about what you’re not eating or what you’re not doing. In each of the exercise groups, specific instructions included 100 push-ups a day or walking 1,000 steps, among others. Some of the participants had a specific additional target. “For example, some participants wanted to lose this much weight in this amount of time,” says Bojd. It is difficult to explain this result, but Bojd’s team has a theory: “We believe people were comparing themselves to the leaders in the competition. If people achieve their personal goals, they don’t care if they are in third or last place on the leaderboard because they already achieved their goals," says Bojd.
Group Size Matters
The research team also found that, in smaller group sizes, people benefit more from competition. “We think this is probably because of the social comparison factor,” Bojd says. “Elements of social comparison create more meaningful competition in smaller groups. In larger groups, the top 10% of people might feel very proud of themselves, but for the other 90%-the people who need more of a push or an incentive-their ranking doesn’t motivate them to keep going.
Implications for the Fitness Industry
“What we found about the differences between diet and exercise and how people need different incentives to commit to their goals is very interesting,” Bojd says. “We know we need both diet and exercise to become healthier. We can’t expect to exercise to remain healthy without changing our diets, nor can we diet without doing some exercise. However, Bojd and her fellow researchers found that we need specific incentives for each type if we want people to become more committed to certain methods of weight loss. “Diet and exercise are different animals. “The fitness industry should definitely use the gamification features to induce competition and leverage social comparison in a way that they can engage more users,” Bojd says.
University of Pennsylvania Study on Social Incentives
Led by Mitesh S. Patel, MD, MBA, MS, a team of researchers at the University of Pennsylvania investigated the most effective way of incorporating social incentives within behaviorally designed gamification interventions to encourage increased physical activity in overweight and obese adults. The trial evaluated 602 adults with body mass indexes of 25 and above over the course of the 36-week randomized study, which included a 24-week intervention and a 12-week follow-up period. Participants received a wearable device to track their daily steps, established a baseline, and selected a step count goal after which they were assigned to either the control group or one of three gamification interventions - support, collaboration, or competition.
Gamification Interventions
The three gamification groups entered a 24-week game - which was designed using insights from behavioral economics - with various points and levels awarded for their achieving step goals. These participants were awarded 70 points at the beginning of each week and lost 10 points for each day they did not meet their step goal. In the support-based intervention cohort, friends and family members of participants received weekly performance reports, while the collaboration-based group was divided into teams of three with a different member representing the team each day to increase accountability.
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Results of the Study
Compared with the control group, participants revealed greater step count increases in all three gamification interventions, with the highest change found in the competition cohort. Physical activity was significantly greater in the competitive group than within the control arm and remained so during follow up. The new research reveals the potential benefit of including behaviorally designed gamification strategies to increase the effectiveness of weight-loss interventions. Although, gamification as such may not be enough to promote sustainable lifestyle changes, as the study reveals. Further research is needed to assess the efficacy of competition-based gamification interventions on a larger scale to determine their impact on patients of different age, race, sex, and socio-economic backgrounds.
Engaging Men in Weight Loss through Gamification
Over 70% of men are overweight, and most desire weight loss; however, men are profoundly underrepresented in weight loss programs. Gamification represents a novel approach to engaging men and may enhance efficacy through two means: (1) game-based elements (e.g., streaks, badges, team-based competition) to motivate weight control behaviors and (2) arcade-style “neurotraining” to enhance neurocognitive capacities to resist the temptation of unhealthy foods and more automatically select healthy foods.
Study Design and Aims
This study will use a 2 x 2 factorial design to examine the independent and combinatory efficacy of gamification and inhibitory control training (ICT). Men with overweight/obesity (N = 228) will receive a 12-month mobile weight loss program that incorporates behavioral weight loss strategies (e.g., self-monitoring, goal setting, stimulus control). Men will be randomly assigned to a non-gamified or gamified version, and an active or sham ICT. A game design company will create the program, with input from a male advisory panel. Aims of the project are to test whether a gamified (versus non-gamified) weight loss program and/or ICT (versus sham) promotes greater improvements in weight, diet, and physical activity; whether these treatment factors have combinatory or synergistic effects; to test whether postulated mechanisms of action (increased engagement, for gamification, and inhibitory control, for ICT) mediate treatment effects; and whether baseline gameplay frequency and implicit preferences for ICT-targeted foods moderate effects.
The Role of Inhibitory Control Training (ICT)
One promising way to gamify eating behavior is through neurocognitive training games (“neurotraining”), such as inhibitory control training (ICT), which trains basic brain capacity to inhibit responses for high calorie food and/or changes food valuation, such that highly palatable foods seem less appealing (thus facilitating consumption of lower calorie alternatives). ICTs with specific attributes (e.g., trainings delivered repeatedly) can successfully reduce consumption, change palatability ratings of targeted foods/beverages, reduce calorie intake, and improve short-term weight loss. ICT could integrate into a gamified system, as it requires trainees to quickly follow rules on a specialized computer interface, adjusting difficulty levels with performance.
Hypotheses and Exploratory Aims
The current project tests hypotheses that (1) a gamified weight loss program and ICT will independently promote greater improvements in weight, diet, and physical activity among men with overweight/obesity, and (2) increased engagement, inhibitory control and valuation of healthy foods, and decreased valuation of unhealthy foods, will mediate these effects. As an exploratory aim, we will examine the interaction of gamification and ICT to determine whether they have combinatory or synergistic effects. Because those with stronger implicit preferences for targeted foods may benefit most from improvements in inhibitory control, we also aim to test whether baseline implicit preferences moderate neurotraining effects.
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Program Components
In both conditions, the program will include digital self-monitoring, neurotraining, self-selected dietary targets (to use as neurotraining stimuli), and physical activity and calorie goals. Both programs will also include gold-standard behavioral weight loss strategies from previous successful in-person, remote, and mHealth interventions. Methods of customizing for men, including intervention modules tailored for men, and autonomy with dietary choices will be adapted from prior behavioral weight loss programs for men. The game-based version will feature additional gamification features (e.g., teams, badges, leveling, challenges), all within a themed game wrapper (e.g., science fiction; spaceships).
Gamified Incentives
For the gamification conditions, the app will include not only the base features described above, but also gamification elements to incentivize desired behaviors and outcomes, e.g., self-monitoring (of weight, calories, and physical activity), weight loss, ICT/sham completion, physical activity, and reductions or increases in consumption of targeted red- and green-zone foods. Behaviors and outcomes are operationalized both in terms of increasing levels (e.g., 4% to 5% weight loss) and streaks (e.g., meeting 10 moderate-to-vigorous physical activity goals in a row, weighing 14 days in a row). Gamified incentives include badges rewarding important program benchmarks (e.g., 10% weight loss), team campaigns challenging users to complete a challenge within a 2-week period (e.g., accumulate a total of 300 minutes of moderate to vigorous physical activity), and in-game currency or “gems” earned by completing program tasks (e.g., weighing in, completing team campaigns). Participants will also be able to compete and cooperate with one another in pre-assigned teams, accumulating points for all app activities.
ICT Training
Participants will be assigned to receive either an active or inert (sham) ICT. Training (ICT and sham) length and schedule will be the same (7 minutes or approximately 220 trials; daily for 4 weeks, then weekly for 11 months) across conditions. In brief, we randomized 181 men with overweight to one of three ICT variations or a sham. Thus, in the active ICT conditions, a 50 millisecond pause will separate the presentation of the stimuli and the Go or No Go signal. The stimuli will be made up of each participant’s personalized red and green targets, and those targets will be both direct food matches and randomly selected foods from these target categories (to promote greater generalization to more foods). As per our pilot study36, sham ICT conditions are designed to be an attention control without training inhibition. In this condition, 50% of the stimuli will be personalized red/green food targets (as per above) and 50% will be non-food items. In the gamified condition, the ICT training will occur within the context of a narrative goal (e.g., delivering goods to planets or fighting aliens and enemy ships), with occasional side tasks (e.g., wiping asteroid debris from windshield). Participant responses to stimuli will be used to determine their progress toward that goal (e.g., faster and more accurate responses mean that their ship will fly faster).
Systematic Review of Gamification Interventions
A systematic search of PubMed, ScienceDirect, Wiley, and Cochrane databases was conducted in August 2024 to identify randomized controlled trials assessing gamification interventions. Outcomes included nutritional knowledge, physical activity, and nutritional status. Risk of bias was evaluated using RoB 2.0 and certainty of evidence using GRADE.
Results of the Review
Gamification interventions showed positive trends in improving nutritional knowledge (SMD = 2.71), moderate-to-vigorous physical activity (SMD = 0.37), and step counts (SMD = 0.13), although not statistically significant. Significant reductions were found in BMI (SMD = -0.24) and body fat percentage (SMD = -0.16). Gamification strategies, particularly those incorporating active physical components, are associated with significant reductions in BMI and body fat percentage.
Considerations for Implementing Gamification
- Not all patients may be receptive to gamification.
- Select gamified tools and platforms that align with your patients’ preferences and needs.
- Work with your patients to set clear, achievable goals.
- Regularly monitor your patients’ progress and provide feedback.
- Promote social interaction and support through online communities or group challenges.
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