Video game

A new public body is necessary to effectively regulate the UK video game industry – The BMJ – The BMJ

This week the NHS has opened the country’s first specialist clinic to treat children and young adults who are addicted to playing computer games after concerns that heavy use of computers games is causing health harms for young people. The UK should lead the world in ensuring that individuals, families, and communities are not exposed to adverse consequences of video gaming. We believe that our current regulatory environment does not offer this protection.

In our view, concerns over video games are not being adequately addressed by the self-regulatory approach that the games industry is currently allowed to operate under.  A new video game regulator is urgently needed to protect the interests of the public. 

Separating gambling activities from video games has become increasingly challenging in recent years. Some games allow players to wager real world money on simulated games of chance. Players of some games now commonly use items that they have won in-game as stakes on gambling websites. [1] Real-money video games allow players to place cash wagers on their success or failure in-game. [2] The gambling-like monetisation schemes in video games known as “loot boxes” may have generated as much as $30 billion for the video game industry in 2018 alone. [3]

All of these practices have been linked to problem gambling. [4] In particular, there are serious concerns that spending on loot boxes may form a gateway to problem gambling. [5–7] These concerns are particularly keen when it comes to children: a recent report commissioned by the UK Gambling Commission found that as many as 31% of children aged 11-15 had opened a loot box. [7,8]

There are also serious concerns about excessive video game play. Disordered engagement with video games has been repeatedly linked to mental health issues like anxiety and depression. [9,10] Concerns over excessive video game play have been severe enough to prompt the World Health Organisation to include “‘gaming disorder”’ in the ICD-11. [13]. The prevalence of situations in which excessive play directly causes psychopathological symptoms is unclear, and this inclusion is therefore controversial. However, there is consensus among scholars that some individuals can experience substantial problems as a consequence of spending too much time playing video games. [11,12].

In many countries, including the UK, the video game industry is largely self-regulatory. However, it is far from clear whether this is the best approach to deal with the challenges that lie ahead, nor is it clear whether the industry is currently willing to face up to these challenges. 

Moving forward, we believe in the need for statutory mechanisms to be put in place to address the potential for adverse consequences present in industry practices. An effective way to do this may be the creation of an entirely new regulator. This regulator must have expertise, powers, and funding that enable it to minimise the potential for gaming to lead to exploitation or harm.

While the specific form of such a regulator would be the topic for extensive debate, we believe that it should necessarily incorporate several key features. 

A video games regulator must have the ability to generate and update an evolving code of practice for industry bodies that is able to cope with the similarly evolving nature of video games. This evolving code of practice would ideally be the responsibility of a dedicated research board whose remit incorporates the ability to rapidly commission targeted video game research that adheres to best practices and open science principles. 

In order to ensure that such a code of practice is adhered to, an effective regulator must be able to take meaningful enforcement action. This would include the ability to impose substantial fines. 

It is important that the regulator outlined above is cost neutral to the public sector. The activities outlined above may be funded through the imposition of a levy on the gaming industry. In order to maintain the impartiality of the regulator, it is vital that this levy is mandatory, not voluntary.

Recent decades have brought substantial new concerns regarding the effects of video games. It is key that governments take a unified approach to regulation that reflects such concerns. We hope that this opinion piece begins a discussion about what such an approach might resemble among academics, regulators, policymakers, and consumers.

David Zendle is a Lecturer, University of York.

Heather Wardle, assistant professor, London School of Hygiene and Tropical Medicine. 

Gerda Reith, Professor of Social Sciences, University of Glasgow.

Henrietta Bowden-Jones, Psychiatrist at National Problem Gambling Clinic and Honorary Lecturer at Imperial College London, and director of the NHS’s new Centre for Internet and Gaming Disorder. 

Competing interests:

DZ and HBJ none to declare.

GR is employed by the University of Glasgow. She has received research funds from the National Institute of Health Research, the Economic and Social Research Council, the Medical Research Council, the Danish Research Council, the Scottish government, and. the Responsibility in Gambling Trust (RiGT). Funding from RiGT was match-funded and administered by the ESRC. She was previously a member of RGSB. She has received honorarium from the Gambling Research Exchange Ontario, Alberta Gambling Research Institute (AGRI) and the Gambling Commission.   

HW is supported by a fellowship from Wellcome (grant number 200306/Z/15/Z). Remuneration for her ABSG role is provided by the Gambling Commission. In previous employment, HW worked on contracts funded by GambleAware in a previous role and currently on a project looking at gambling and suicide. GambleAware are a national charity designated by government to fund research into gambling. Funds are provided by industry but decisions about what research is commissioned and the research questions are made by the Gambling Commission, advised by ABSG 



1 Wardle H. The Same or Different? Convergence of Skin Gambling and Other Gambling Among Children. Journal of gambling studies 2019;:1–17.

2 Zendle D. Is real-money mobile gaming a form of gambling or video gaming? PsyArXiv 2019. doi:10.31234/

3 Juniper Research. In-Game Gambling ~ The Next Cash Cow for Publishers. 2018. (accessed 15 Jul 2018).

4 Zendle D. Gambling-like video game practices: Links with problem gambling and disordered gaming in a nationally representative sample. PsyArXiv 2019. doi:10.31234/

5 Drummond A, Sauer JD. Video game loot boxes are psychologically akin to gambling. Nature Human Behaviour 2018;:530–2. doi:10.1038/s41562-018-0360-1

6 Zendle D, Cairns P. Video game loot boxes are linked to problem gambling: Results of a large-scale survey. PLoS One Published Online First: 10 October 2018. doi:10.1371/journal.pone.0204664

7 Zendle D, Meyer R, Over H. Adolescents and loot boxes: links with problem gambling and motivations for purchase. Royal Society Open Science 2019;6:190049. doi:10.1098/rsos.190049

8 UK Gambling Commission. Young People and Gambling: 2018 Report. 2018. (accessed 2 Jan 2019).

9 González-Bueso V, Santamaría J, Fernández D, et al. Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: a comprehensive review. International journal of environmental research and public health 2018;15:668.

10 Wu AM, Chen JH, Tong K-K, et al. Prevalence and associated factors of Internet gaming disorder among community dwelling adults in Macao, China. Journal of behavioral addictions 2018;7:62–69.

11 Saunders JB, Hao W, Long J, et al. Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention. Journal of Behavioral Addictions 2017;6:271–279.

12 Aarseth E, Bean AM, Boonen H, et al. Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. Journal of Behavioral Addictions 2017;6:267–270.

13 Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019;18:3–19.


Leave a Reply

This website uses cookies. By continuing to use this site, you accept our use of cookies.