A randomized controlled trial of financial incentives for weight loss

By K. Volpp, Leslie K. John, Andrea B. Troxel, L. Norton, Jennifer E. Fassbender, George Loewenstein. Journal of the American Medical Association (JAMA), 2008

941 citations recorded by the source corpus.

Context Identifying effective strategies for treating obesity is both a clinical challenge and a public health priority due to the health consequences of obesity. Objective To determine whether common decision errors identified by behavioral economists such as prospect theory, loss aversion, and regret could be used to design an effective weight loss intervention. Design 3-arm randomized controlled trial in which participants were randomized to either usual care (weigh ins once a month) or one of two financial incentives arms. One incentive arm used deposit contracts in which participants put their own money at risk (matched 1:1 by the study) which they would lose if they failed to lose weight. The second used lottery-based incentives in which participants who met the weight loss target had each day a 1 in 5 chance of winning a small reward ($10) and a 1 in 100 chance of winning a large reward ($100). All participants were given a weight loss goal of 1 pound per week for 16 weeks, and results were analyzed using intention-to-treat analysis of variance models. Setting Philadelphia Veterans Affairs Medical Center. Patients 57 patients with BMIs between 30-40 aged between 30 and 70, with no contraindications for study participation. Main Outcome Measures Weight loss after 16 weeks. Results Participants in both incentive groups lost significantly more weight than participants in the control group (3.9 pounds); (Lottery = 13.1 lbs; p-value for lottery vs. control .014; deposit contract = 14.0 lbs, p-value vs. control .003). 47.4% of deposit contract participants and 52.6% of lottery arm participants met the 16-pound weight loss goal compared to 10.5% in the control group (p-value 0.014.). By the end of 7 months, substantial amounts of weight were regained; however, incentive participants weighed significantly less than they did at the study start whereas controls did not. Low lost to follow-up rates (7.0%) during the weight loss phase of the study suggest that both incentive systems were successful in keeping participants engaged in the study. Conclusions Incentive approaches based on behavioral economic concepts could have a major impact in reducing the incidence of obesity-related illnesses.

Subfields: General Health Professions, Pharmacy, Surgery

View Paper: https://www.semanticscholar.org/paper/17f3629b7a623704f94f9daf942928ab10b62409

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Citations in the corpus

Nudge to Health: Harnessing Decision Research to Promote Health Behavior (2013, background): “Volpp and colleagues found effects of incentives on weight loss (Volpp et al., 2008) and smoking cessation (Volpp et al., 2009).”
Do The Effects of Social Nudges Persist? Theory and Evidence from 38 Natural Field Experiments (2017, positive): “, 2009), and weight loss (Volpp et al., 2008), two stark patterns emerge.”
Using Incentives to Encourage Healthy Eating in Children (2013, positive): “…behaviors including exercise, weight loss, smoking cessation, health screenings, and immunizations (Charness and Gneezy 2009; Cawley and Price 2011; Volpp et al. 2008; Volpp et al. 2006; Malotte, Rhodes, and Mais 1998; Moran et al. 1996).1 Research on other interventions designed to encourage…”
Workplace wellness programs can generate savings. (2010, background): “to raise participation among employees.[19, 20] In the 2004 National Worksite Health Promotion Survey, 26 percent of worksites used incentives to increase employee participation.”
Using Behavioral Economics to Design More Effective Food Policies to Address Obesity (2014, background): “In the weight-loss domain, monetary incentives can lead to significantly more weight loss (Volpp et al. 2008); however, this weight loss may not last if incentives are discontinued (Volpp et al. 2008).”
Behavioural economics and its implications for transport (2012, background): “In a study of incentives in health, participants were asked to deposit money into an account, which was returned to them (with a supplement) if they met weight loss targets (Volpp et al., 2008).”
Increasing Vaccination: Putting Psychological Science Into Action (2017, background): “However, a recent national television campaign in the United States played on anticipated regret to motivate parents to get the HPV vaccine for their adolescent children, and studies have used interventions theorized to harness anticipated regret to motivate other health behaviors, such as weight lo”
Maintenance of lost weight and long-term management of obesity (2018, background): “Whereas “white knuckling” and external, controlled motivations, such as directives from a spouse or health care provider, may lead to short-term weight loss, longer-term sustained motivation is more likely when patients take ownership of their behavioral changes and goals, and engage in them because”
Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions (2011, background): “Tangible rewards such as money may improve outcomes for tasks that are unpleasant, dull, or boring, particularly if the reinforcement is administered variably [47].”