Effects of Loss and Gain Incentives on Adherence in Pediatric Weight Management: Preliminary Studies and Economic Evaluation of a Theoretical Trial (original) (raw)
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Journal of Obesity and Diabetes
Background: The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide. This study aimed to determine effectiveness of a structured goal setting incentive scheme, delivered within a community program, on health outcomes in overweight children at 6 and 18 months. Methods: Single-blind, cluster randomized controlled trial with 10 weeks, 6 month and 18 month follow-up. Community weight-loss programs for children were randomized to (i) standard program plus incentive scheme (intervention) or (ii) standard program alone (control). Primary outcome was mean BMIz score at 18 months. Secondary outcomes included anthropometric and behavioural measures. Results: A total of 37 sites (33 urban and 4 regional) and 512 children were recruited. Compared to baseline, at 18 month follow-up, the total cohort achieved significant reductions in the mean BMIz score (1.7 v 1.0, p<0.001), median screen time (16.5 v 15.8 hours/week p=0.0414), median number of fast food...
Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition
Childhood Obesity, 2017
Background: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/ guardian treatment expectations and attrition. Patients and Methods: A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months. Results: From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children <12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02). Conclusions: Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on familybased change and realistic goal setting. Clinical Trial Registration: Clinicaltrials.gov NCT01753063.
The effect of financial incentives for patients on weight loss: a meta-analysis
2012
Being overweight (BMI≥25kg/m 2) and obesity (BMI≥30kg/m 2) are common and costly. While reward systems can affect behaviors, it is uncertain whether financial incentives are beneficial in weight loss programs. Objective: To estimate the effectiveness of financial incentives in weight loss programs. Data sources: We searched the English-language literature in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, and the Cochrane Register of Controlled Clinical Trials) from 1966 to November 2011. Additional studies were identified by searching reference lists of all relevant articles. Search terms included financial, economic, monetary, reward, incentive or reimbursement, and diet, weight loss, obesity or overweight. Study selection: We included controlled trials evaluating the effect of financial incentives in weight loss programs for overweight individuals. We excluded studies that did not provide weight change over time. Data extraction: Data were extracted from articles by using predefined data fields, including study quality indicators. We performed subgroup analyses to examine the effect of study duration (at 4 months and 12 months) and a self-set goal versus program fixed goal on the effectiveness of financial incentives on weight loss. Results: Overall, the results of the meta-analysis show that using financial incentives was associated with higher weight loss (-0.32 SMD, 95%CI (-0.56,-0.08),, random effects model). The benefit of incentives was greater at 4 months (-0.56 SMD, 95%CI (-0.89,-0.23),random effects model) but there was no effect at 12 months. The effect of financial incentives in programs with predetermined, imposed weight loss goals was significant (-0.48 SMD, 95%CI (-0.67,-0.29)) but there was no benefit in studies with self-set weight loss goals. Conclusions: Our results suggest that financial incentives are beneficial on weight loss both overall, and at 4 months. This benefit appears greater in studies with an imposed weight loss goal compared to self-set goals. These results suggest that financial incentives should be used more widely in weight loss programs. Future studies are needed to determine the best way to administer these financial rewards (e.g., deposit contracting, competitions or lotteries).
Childhood overweight and obesity have health and economic impacts on individuals and the wider society. Families participating in weight management programmes may foresee or experience monetary and other costs which deter them from signing up to or completing programmes. This is recognised in the health economics literature, though within this sparse body of work, costs to families are often narrowly defined and not fully accounted for. A societal perspective incorporating a broader array of costs may provide a more accurate picture. This paper brings together a review of the health economics literature on the costs to families attending child weight management programmes with qualitative data from families participating in a programme to manage child overweight and obesity.
Obesity, 2020
Objectives:In traditional behavioral weight loss (BWL) programs, young adults (YA) fare worse than older adults (OA) with respect to engagement, retention and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. We evaluated YA performance in internet-based BWL offering financial incentives for self-monitoring and weight loss.Methods:Participants (N=180; BMI=33.2±6.0) were randomized to 12-week internet-based BWL (IBWL) or IBWL+incentives (IBWL+$). In this secondary data analysis, we compared YA (ages 18–35) in IBWL (n=16) to YA in IBWL+$ (n=12) on percent weight loss, engagement, and retention. YA (n=28) were also compared to OA (ages 36–70; n=152) on these outcomes.Results:YA weight loss was −2.8±5.2% in IBWL and −5.4±5.7% in IBWL+$ (p=.23, partial eta2 .06). A greater proportion of YA in IBWL+$ achieved a 10% weight loss compared to IBWL (42% vs. 6%, p=.02). Compared to OA, YA were less engaged, but there were no differences for retention or weight loss (p’s>.05).Conclusions:Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between YA and OA in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight losses for YA.
Journal of Obesity, 2012
This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation.
Nutrition & diabetes, 2018
Financial incentives can improve initial weight loss; we examined whether financial incentives can improve weight loss maintenance. Participants aged 30-80 years who lost at least 5 kg during the first 4-6 months in a nationally available commercial weight loss program were recruited via the internet into a three-arm randomized trial of two types of financial incentives versus active control during months 1-6 (Phase I) followed by passive monitoring during months 7-12 (Phase II). Interventions were daily self-weighing and text messaging feedback alone (control) or combined with a lottery-based incentive or a direct incentive. The primary outcome was weight change 6 months after initial weight loss. Secondary outcomes included weight change 12 months after initial weight loss (6 months after cessation of maintenance intervention), and self-reported physical activity and eating behaviors. Of 191 participants randomized, the mean age was 49.0 (SD = 10.5) years and weight loss prior to ...
Implementation Science Communications
Background Understanding the cost and/or cost-effectiveness of implementation strategies is crucial for organizations to make informed decisions about the resources needed to implement and sustain evidence-based interventions (EBIs). This economic evaluation protocol describes the methods and processes that will be used to assess costs and cost-effectiveness across implementation strategies used to improve the reach, adoption, implementation, and organizational maintenance of an evidence-based pediatric weight management intervention- Building Health Families (BHF). Methods A within-trial cost and cost-effectiveness analysis (CEA) will be completed as part of a hybrid type III effectiveness-implementation trial (HEI) designed to examine the impact of an action Learning Collaborative (LC) strategy consisting of network weaving, consultee-centered training, goal-setting and feedback, and sustainability action planning to improve the adoption, implementation, organizational maintenance...
Health Psychology and Behavioral Medicine, 2017
The purpose of this study was to examine whether (a) an obesity treatment involving financial incentives yields higher levels of extrinsic motivation for weight management compared to an identical intervention without incentives, (b) extrinsic motivation for weight management mediates, or accounts for, the difference in weight loss outcomes between the two interventions, and (c) there is any evidence that financial incentives and associated extrinsic motivation "crowd out" intrinsic motivation for weight control. Participants (N = 153, 80.4% female; body mass index [BMI] = 33.2 ± 5.9) were randomly assigned to a 3-month Web-based behavioral weight loss program (WBWL) or the same program plus small financial incentives delivered consistent with behavioral economics and behavior change theories (WBWL + ).Weightwasobjectivelyassessedatbaseline,post−treatment(month3),andaftera9monthno−treatmentfollow−upphase(month12).Intrinsicandextrinsicmotivationforweightmanagementwereassessedatmonths3and12usingamodifiedversionoftheTreatmentSelf−RegulationQuestionnaire(TSRQ),withquestionsaddedtospecificallytargetextrinsicmotivationrelatedtoincentives.ComparedtoWBWLalone,WBWL+). Weight was objectively assessed at baseline, post-treatment (month 3), and after a 9month no-treatment follow-up phase (month 12). Intrinsic and extrinsic motivation for weight management were assessed at months 3 and 12 using a modified version of the Treatment Self-Regulation Questionnaire (TSRQ), with questions added to specifically target extrinsic motivation related to incentives. Compared to WBWL alone, WBWL + ).Weightwasobjectivelyassessedatbaseline,post−treatment(month3),andaftera9monthno−treatmentfollow−upphase(month12).Intrinsicandextrinsicmotivationforweightmanagementwereassessedatmonths3and12usingamodifiedversionoftheTreatmentSelf−RegulationQuestionnaire(TSRQ),withquestionsaddedtospecificallytargetextrinsicmotivationrelatedtoincentives.ComparedtoWBWLalone,WBWL+ had better weight loss and higher levels of both extrinsic and intrinsic motivation for weight management (p-values ≤ .02). Moreover, during the no-treatment follow-up phase, the trajectories of weight regain did not significantly differ between WBWL and WBWL + $ (p = .58). Extrinsic motivation was not a significant mediator of treatment outcomes. These results suggest that modest financial incentives delivered consistent with behavioral economics and behavior change theories do not undermine intrinsic motivation for weight management during obesity treatment; in fact, they yield higher levels of both extrinsic and intrinsic motivation. Additional research is needed to better understand the mechanisms by which incentives improve outcomes in health behavior change interventions. Clinicaltrials.gov number: NCT01560130.