Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1669–1675 | Cite as

Social Incentives and Gamification to Promote Weight Loss: The LOSE IT Randomized, Controlled Trial

  • Gregory W. Kurtzman
  • Susan C. Day
  • Dylan S. Small
  • Marta Lynch
  • Jingsan Zhu
  • Wenli Wang
  • Charles A. L. Rareshide
  • Mitesh S. PatelEmail author
Original Research



Social networks influence obesity patterns, but interventions to leverage social incentives to promote weight loss have not been well evaluated.


To test the effectiveness of gamification interventions designed using insights from behavioral economics to enhance social incentives to promote weight loss.


The Leveraging Our Social Experiences and Incentives Trial (LOSE IT) was a 36-week randomized, controlled trial with a 24-week intervention and 12-week follow-up.


One hundred and ninety-six obese adults (body mass index ≥ 30) comprising 98 two-person teams.


All participants received a wireless weight scale, used smartphones to track daily step counts, formed two-person teams with a family member or friend, and selected a weight loss goal. Teams were randomly assigned to control or one of two gamification interventions for 36 weeks that used points and levels to enhance collaborative social incentives. One of the gamification arms also had weight and step data shared regularly with each participant’s primary care physician (PCP).

Main outcome measures

The primary outcome was weight loss at 24 weeks. Secondary outcomes included weight loss at 36 weeks.

Key results

At 24 weeks, participants lost significant weight from baseline in the control arm (mean: − 3.9 lbs; 95% CI: − 6.1 to − 1.7; P < 0.001), the gamification arm (mean: − 6.6 lbs; 95% CI: − 9.4 to − 3.9; P < 0.001), and the gamification arm with PCP data sharing (mean: − 4.8 lbs; 95% CI: − 7.4 to − 2.3; P < 0.001). At 36 weeks, weight loss from baseline remained significant in the control arm (mean: − 3.5 lbs; 95% CI: − 6.1 to − 0.8; P = 0.01), the gamification arm (mean: − 6.3 lbs; 95% CI: − 9.2 to − 3.3; P < 0.001), and the gamification arm with PCP data sharing (mean: − 5.2 lbs; 95% CI: − 8.5 to − 2.0; P < 0.01). However, in the main adjusted model, there were no significant differences in weight loss between each of the intervention arms and control at either 12, 24, or 36 weeks.


Using digital health devices to track behavior with a partner led to significant weight loss through 36 weeks, but the gamification interventions were not effective at promoting weight loss when compared to control.

Trial registration Identifier: 02564445

Key Words

gamification behavioral economics social incentives weight loss physical activity clinical trial smartphones 


Funding Support

This study was funded by the grants from the University of Pennsylvania Center for Therapeutic Effectiveness Research (CTER) and the McCabe Fund. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Compliance with Ethical Standards

Conflict of Interest

Dr. Patel is supported by career development awards from the Department of Veterans Affairs HSR&D and the Doris Duke Charitable Foundation. Dr. Patel is also a principal at Catalyst Health, a technology and behavior change consulting firm. Dr. Patel also has received research funding from Deloitte, which is not related to the work described in this manuscript. All remaining authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4552_MOESM1_ESM.docx (52 kb)
ESM 1 (DOCX 51 kb)
11606_2018_4552_MOESM2_ESM.docx (22 kb)
ESM 2 (DOCX 22 kb)


  1. 1.
    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA 2016;315(21):2284–2291.CrossRefPubMedGoogle Scholar
  2. 2.
    Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med 2017;377(1):13–27.CrossRefGoogle Scholar
  3. 3.
    Snook KR, Hansen AR, Duke CH, Finch KC, Hackney AA, Zhang J. Change in Percentages of Adults With Overweight or Obesity Trying to Lose Weight, 1988-2014. JAMA 2017;317(9):971–973.CrossRefPubMedGoogle Scholar
  4. 4.
    Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014;129(25 Suppl 2):S102–138.CrossRefPubMedGoogle Scholar
  5. 5.
    Kushner RF, Ryan DH. Assessment and lifestyle management of patients with obesity: clinical recommendations from systematic reviews. JAMA 2014;312(9):943–952.CrossRefPubMedGoogle Scholar
  6. 6.
    Soleymani T, Daniel S, Garvey WT. Weight maintenance: challenges, tools and strategies for primary care physicians. Obes Rev 2016;17(1):81–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Edwards EA, Lumsden J, Rivas C, et al. Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps. BMJ Open 2016;6(10):e012447.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kawachi I. It’s All in the Game-The Uses of Gamification to Motivate Behavior Change. JAMA Intern Med 2017;177(11):1593–1594.CrossRefPubMedGoogle Scholar
  9. 9.
    Miller AS, Cafazzo JA, Seto E. A game plan: Gamification design principles in mHealth applications for chronic disease management. Health Informatics J 2016;22(2):184–193.CrossRefPubMedGoogle Scholar
  10. 10.
    Patel MS, Foschini L, Kurtzman GW, et al. Using wearable devices and smartphones to track physical activity: Initial activation, sustained use, and step counts across sociodemographic characteristics in a national sample. Ann Intern Med 2017;Published Online, Sept 26.Google Scholar
  11. 11.
    Patel MS, Benjamin EJ, Volpp KG, et al. Effect of a Game-Based Intervention Designed to Enhance Social Incentives to Increase Physical Activity Among Families: The BE FIT Randomized Clinical Trial. JAMA Intern Med 2017;177(11):1586–1593.CrossRefPubMedGoogle Scholar
  12. 12.
    Patel MS, Asch DA, Rosin R, et al. Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial. Ann Intern Med 2016;164(6):385–394.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Patel MS, Asch DA, Troxel AB, et al. Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study. Health Aff (Millwood) 2016;35(1):71–79.CrossRefGoogle Scholar
  14. 14.
    Patel MS, Asch DA, Rosin R, et al. Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial. J Gen Intern Med 2016;31(7):746–754.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Patel MS, Volpp KG, Rosin R, et al. A Randomized Trial of Social Comparison Feedback and Financial Incentives to Increase Physical Activity. Am J Health Promot 2016;30(6):416–424.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Case MA, Burwick HA, Volpp KG, Patel MS. Accuracy of smartphone applications and wearable devices for tracking physical activity data. JAMA 2015;313(6):625–626.CrossRefPubMedGoogle Scholar
  17. 17.
    Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32(6):705–714.CrossRefGoogle Scholar
  18. 18.
    Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997;12(1):38–48.CrossRefPubMedGoogle Scholar
  19. 19.
    Ariely D, Wertenbroch K. Procrastination, deadlines, and performance: self-control by precommitment. Psychol Sci. 2002;13(3):219–224.CrossRefPubMedGoogle Scholar
  20. 20.
    Rogers T, Milkman KL, Volpp KG. Commitment devices: using initiatives to change behavior. JAMA. 2014;311(20):2065–2066.CrossRefPubMedGoogle Scholar
  21. 21.
    Skinner BF. The behavior of organisms: an experimental analysis. New York, London,: D. Appleton-Century Company; 1938.Google Scholar
  22. 22.
    Dai H, Milkman KL, Riis J. The Fresh Start Effect: Temporal Landmarks Motivate Aspirational Behavior. Manag Sci 2014;60(10):2563–2582.CrossRefGoogle Scholar
  23. 23.
    Bassett DR Jr., Wyatt HR, Thompson H, Peters JC, Hill JO. Pedometer-measured physical activity and health behaviors in U.S. adults. Med Sci Sports Exerc 2010;42(10):1819–1825.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kang M, Rowe DA, Barreira TV, Robinson TS, Mahar MT. Individual information-centered approach for handling physical activity missing data. Res Q Exerc Sport 2009;80(2):131–137.CrossRefPubMedGoogle Scholar
  25. 25.
    Rubin DB. Multiple imputation for nonresponse in surveys. New York, NY: Wiley; 1987.CrossRefGoogle Scholar
  26. 26.
    Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med 2007;357(4):370–379.CrossRefPubMedGoogle Scholar
  27. 27.
    Jackson SE, Steptoe A, Wardle J. The influence of partner’s behavior on health behavior change: the English Longitudinal Study of Ageing. JAMA Intern Med 2015;175(3):385–392.CrossRefPubMedGoogle Scholar
  28. 28.
    Roess A. The Promise, Growth, and Reality of Mobile Health—Another Data-free Zone. N Engl J Med 2017;377(21):2010–2011.CrossRefPubMedGoogle Scholar
  29. 29.
    Asch DA, Muller RW, Volpp KG. Automated hovering in health care—watching over the 5000 hours. N Engl J Med 2012;367(1):1–3.CrossRefPubMedGoogle Scholar
  30. 30.
  31. 31.
    Asch DA, Volpp KG. On the Way to Health. LDI Issue Brief 2012;17(9):1–4.PubMedGoogle Scholar

Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2018

Authors and Affiliations

  • Gregory W. Kurtzman
    • 1
    • 2
  • Susan C. Day
    • 1
  • Dylan S. Small
    • 3
  • Marta Lynch
    • 2
  • Jingsan Zhu
    • 1
  • Wenli Wang
    • 1
  • Charles A. L. Rareshide
    • 2
  • Mitesh S. Patel
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUSA
  2. 2.Penn Medicine Nudge UnitPhiladelphiaUSA
  3. 3.The Wharton School, University of PennsylvaniaPhiladelphiaUSA
  4. 4.Crescenz Veterans Affairs Medical CenterPhiladelphiaUSA

Personalised recommendations