Gamification for Health

How our addictive smartphones can help make being healthy addictive


Millions of people want to make healthier choices yet fail to. Turning life into a game might help.

Ant Forest is a Chinese smartphone app that aims to reduce carbon emissions, and it demonstrates how a simple game can create profound positive behaviour change at a huge scale. Remarkably, it has over 300 million users.

Ant Forest tracks how much people walk, bike, purchase transit tickets, and make other green choices, and then rewards them by growing a colourful digital tree on their smartphone. Success in the game, however, leads to real world outcomes. Once that tree reaches maturity, the company goes out and plants a real tree in the Ghobi Desert. The app is also highly motivating, in part, because users compete with their friends.

By 2017, the app helped people avoid 150,000 tons of carbon emissions. The project has planted 13.1 million real trees and will add 500 million more in the next five years if the current rate continues. In the process, it has also likely supported physical activity at a massive scale, but their progress report does not estimate this outcome.

Apps like Ant Forest help overcome a problem behavioural economists call “time inconsistent preferences.” What we want long term, and what we want right now, are often not the same — and what we want right now is often more powerful. While the benefits of exercising this morning can seem far off and abstract, the benefits of not bothering are clear and immediate. It is an unfair fight.

Ant Forest brings that long-term preference back into the present moment: while people may want to drive to work instead of walking, they also want to earn points in the game and beat their friends — not long term, but right now. It puts good choices on equal footing with temptations in the present moment.

It is the kind of nudge whole countries badly need to consistently make healthier choices. While 70% of smokers want to quit, only 6% successfully do. UK residents spends $2 billion on dieting, and yet only a tiny fraction, 1 in 210, of overweight men who try to reach a healthy weight succeed. That is a 0.5% chance. Few people need to be told that exercising and eating in moderation are good ideas, yet less than 3% of Americans follow these two guidelines. These problems of motivation are perhaps something addictive smartphones can help tackle.

The book Hooked teaches developers how to take advantage of human motivation to make people addicted to games and social media. Ant Forest is part of a new wave of apps that aims to take this insidious expertise in exploiting human psychology, and turn it around to help people achieve goals.

StickK invites users to put money on the line to stick with goals. In one option, if users don’t meet their own goals, money is sent to a advocacy organization they hate, on topics such as abortion, same-sex marriage, and gun control. It is as immediate a motivator as one can hope for: losing money while also supporting the enemy. It also takes advantage of another human quirk behavioural economists call “loss aversion.” Humans dislike losing things more than they like gaining things. As a result, StickK has incentivized a million workouts, according to the company’s stats, and has helped people butt out 24 million smokes.

Pact motivates people with both carrots and sticks. Users who fail to meet their goals have to pay. Users who meet their goals receive the money from those who paid.

Other apps help people meet goals by making progress itself a game. Habitica turns one’s to-do list into a Role Playing Game. As players complete their real-life to-do list, they receive, “battle armor, mysterious pets, magic skills, and even quests.”

Chains helps people compete with themselves to see how long they can keep up a good habit. It records how many days in a row they successfully do a certain thing, like avoiding snacks between meals, and provides stats on the longest “chains” they have achieved so far. Habitbull does something similar, but places goals on a schedule, acting both as a to-do list and a motivator. 

The scientific study of gamification for health is new, but promising. A randomised control trial of StickK finds participants are more likely to achieve their goals, and many who accomplish them sign up for new challenges. A study of a similar workplace intervention showed similar success at helping people lose weight. One group of Australian researchers set up their own gamified Facebook app, in which participants competed with each other to reach walking goals, and a high proportion of participants did. Other work finds that “leaderboards” — where people can see who is making the most progress — are highly motivating thanks to competition. Having people to compete with can increase exercise by 23%.

For most of human evolutionary history, we exercised because we needed to walk to collect food and run to catch animals. The reward for our effort was immediate: dinner. As Daniel Lieberman argues in The Story of the Human Body, we likely evolved to actually avoid getting exercise when there was no clear, salient need. Otherwise, we would waste the fuel necessary to survive. Games can help us tap back into the kind of goals we evolved for, the ones right in front of us.

In fact, in one highly-successful case, that goal was literally an animal people had to go outside and catch. Pokemon Go is an augmented reality game in which people look for small monsters outside, with their location identified on a smartphone app. A study finds people who played it walked 25% more than they did previously. Pokemon Go was more effective than other leading health apps, according to the study, and generated 144 billion steps in the United States in one month. Perhaps if someone created an augmented-reality hunter-gatherer simulator, we could solve the obesity epidemic completely.

I have written elsewhere that government has an ethical responsibility to create cities where it is easier for people to make healthy choices. And yet, individual willpower will always be a critical for improving population health. But telling people to be healthier choices has never been enough. Gamification may provide the kind of tool public health officials need to make widespread, systematic change. It allows people to take advantage of everything we know about human motivation and addictive behaviour, and aim it at things people actually want to do.


- By Tristan Cleveland