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

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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.

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Contributors

Daniel McDonald

Funders

USDA, Economic Research Service (grant no. 58-4000-7-0058) and the Hewlett Foundation.

Prior Presentations

Annual Meeting of the Society for General Internal Medicine, Minneapolis, May, 2010.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Social and Decision Sciences, Carnegie Mellon University, 208 Porter Hall, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA

    Leslie K. John MS & George Loewenstein PhD

  2. Center for Health Incentives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    George Loewenstein PhD, Andrea B. Troxel ScD, Laurie Norton MA & Kevin G. Volpp MD, PhD

  3. Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Andrea B. Troxel ScD & Jennifer E. Fassbender MS

  4. Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA

    Laurie Norton MA & Kevin G. Volpp MD, PhD

  5. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Laurie Norton MA & Kevin G. Volpp MD, PhD

  6. Department of Health Care Management, The University of Pennsylvania Wharton School, Philadelphia, PA, USA

    Kevin G. Volpp MD, PhD

Authors
  1. Leslie K. John MS
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  2. George Loewenstein PhD
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  3. Andrea B. Troxel ScD
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  4. Laurie Norton MA
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  5. Jennifer E. Fassbender MS
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  6. Kevin G. Volpp MD, PhD
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Corresponding author

Correspondence to Leslie K. John MS.

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John, L.K., Loewenstein, G., Troxel, A.B. et al. Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial. J GEN INTERN MED 26, 621–626 (2011). https://doi.org/10.1007/s11606-010-1628-y

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  • DOI: https://doi.org/10.1007/s11606-010-1628-y

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