More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. Existing regulatory approaches vary greatly.

Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation.

Gambling regulation is increasingly being informed by insights from public health. Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards.