Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial

Abstract

BACKGROUND: Previous efforts to use incentives for weight loss have resulted in substantial weight regain after 16 weeks. OBJECTIVE: To evaluate a longer term weight loss intervention using financial incentives. DESIGN: A 32-week, three-arm randomized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week, followed by an 8-week maintenance phase. PARTICIPANTS: Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMIs of 30-40. INTERVENTION: Participants were randomly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins (control condition), or the same program with one of two financial incentive plans. Both incentive arms used deposit contracts (DC) in which participants put their own money at risk (matched 1:1), which they lost if they failed to lose weight. In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance; in the other, no such distinction was made. MAIN MEASURE: Weight loss after 32 weeks. KEY RESULTS: Results were analyzed using intention-to-treat. There was no difference in weight loss between the incentive arms (P=0.80). Incentive participants lost more weight than control participants [mean DC = 8.70 pounds, mean control = 1.17, P= 0.04, 95% CI of the difference in means (0.56, 14.50)]. Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain; the net weight loss between the incentive and control groups was no longer significant (mean DC = 1.2 pounds, 95% CI, -2.58-5.00; mean control = 0.27, 95% CI, -3.77-4.30, P=0.76). CONCLUSIONS: Financial incentives produced significant weight loss over an 8-month intervention; however, participants regained weight post-intervention.

Implementation of a financially incentivized weight loss competition into an already established employee wellness program

“…Patients in this study lost an average of 10 lbs over 8 weeks compared to the similar studies which averaged 14 pounds over 16 weeks, 9 pounds over 32 weeks and 10 pounds over 36 weeks. [25][26][27] Other studies concluding similar weight loss did not discuss patient participation in a EWP or adjunct tool or support system to achieve and maintain weight loss in addition to the financial incentive, nor did they assess cholesterol and blood pressure values. The Kullgren, et al study focused on group versus individual outcomes in weight loss while the John, et al study explored self-funded financial contract for weight loss.…”

“…The Kullgren, et al study focused on group versus individual outcomes in weight loss while the John, et al study explored self-funded financial contract for weight loss. 26,27 No study to date has developed a successful method to motivate and facilitate weight loss for a period greater than 36 weeks or has looked at the effect of a financially incentivized competition adjunct to a pharmacist-directed EWP on weight loss.…”

“…Other studies evaluating success of financially incentivized weight loss programs do not address this model nor attempt to evaluate success and failure through multiple rounds of the same weight loss program. [25][26][27] …”

“…No study to date has assessed a successful strategy to facilitate weight loss for a period greater than 36 weeks. [23][24][25][26][27] Inspired by the short-term success of financial incentives and ongoing support of the EWP, this study attempts to combine methods with desires of improving long-term clinical outcomes in the DiDonato et al study population, which previously showed no significant improvement in weight loss. This is the first pilot study to look at the effect of a financially incentivized competition facilitated by a pharmacist-directed EWP on the short-term success on weight loss.…”

Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial

“…Incentive programs are not unusual for health insurers, who would like their customers to engage in healthy behavior [Stock et al 2010]. However, the use of financial incentives in the treatment of obesity and overweight still raises ethical concerns [Halpern, Madison, and Volpp 2009], and its effectiveness is not well-established with respect to the issue of weight maintenance [Jeffery 2012;John et al 2011;Augurzky et al 2015].…”