Original Research

Journal of General Internal Medicine

, Volume 26, Issue 6, pp 621-626

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

  • Leslie K. JohnAffiliated withDepartment of Social and Decision Sciences, Carnegie Mellon University Email author 
  • , George LoewensteinAffiliated withDepartment of Social and Decision Sciences, Carnegie Mellon UniversityCenter for Health Incentives, Leonard Davis Institute of Health Economics, University of Pennsylvania
  • , Andrea B. TroxelAffiliated withCenter for Health Incentives, Leonard Davis Institute of Health Economics, University of PennsylvaniaCenter for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania
  • , Laurie NortonAffiliated withCenter for Health Incentives, Leonard Davis Institute of Health Economics, University of PennsylvaniaCenter for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical CenterDepartment of Medicine, University of Pennsylvania School of Medicine
  • , Jennifer E. FassbenderAffiliated withCenter for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania
  • , Kevin G. VolppAffiliated withCenter for Health Incentives, Leonard Davis Institute of Health Economics, University of PennsylvaniaCenter for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical CenterDepartment of Medicine, University of Pennsylvania School of MedicineDepartment of Health Care Management, The University of Pennsylvania Wharton School

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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.

KEY WORDS

behavioral medicine obesity psychology randomized trials behavioral economics