Motivation for Participating in a Weight Loss Program and Financial Incentives: An Analysis from a Randomized Trial (original) (raw)
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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.
Journal of Occupational & Environmental Medicine, 2007
Learning Objectives • Recall whether economic theory and research on using financial incentives to alter health-related behaviors suggest that incentives should be linked to participating in a program or directly to outcomes. • Compare rates of any weight loss, clinically relevent loss of 5% or more, and attrition in overweight and obese employees who, for 3 months, were randomly assigned to receive one of two levels of financial incentive or no incentive. • State whether weight losses documented at 3 months persisted at 6 months when financial gains were equalized.
Individual- Versus Group-Based Financial Incentives for Weight Loss
Annals of Internal Medicine, 2013
Background: Data on the effectiveness of employer-sponsored financial incentives for employee weight loss are limited. Objective: To test the effectiveness of 2 financial incentive designs for promoting weight loss among obese employees.
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 ...
Financial incentives and weight control
Preventive Medicine, 2012
This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30 years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of incentives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit.
Identifying Financial Incentive Designs to Enhance Participation in Weight Loss Programs
Journal of Obesity & Weight Loss Therapy, 2015
Background: Financial incentives are routinely recommended to attract participants to weight loss programs; however there is a paucity of research that uses a systematic approach to determine incentive packages that may be most beneficial in increasing program reach or participation. Methods: The purpose of this study was to determine monetary incentive designs (in terms of magnitude, form, and timing of payment) that could increase the likelihood of participation in weight loss programs. Participants (n=863) completed surveys to collect stated preferences regarding to the magnitude, timing, and form of monetary incentives as well as willingness to participate in a weight loss program. Results: The results of our model show that, as expected, higher values of monetary incentive will increase the participation. Additionally, more flexible forms of payments (cash or grocery card as compared to gym pass or copay waiver) and more immediate payments (monthly as compared to quarterly payments) will enhance the participation in a weight loss program. Further, our second model, with respondent demographic interaction terms, shows significant differences between various groups of male participants (healthy, overweight, and obese males). This simply means that each group of male participants requires different incentive design to achieve a desired level of participation. The results do not show significant differences in incentive preference across women in different weight categories, which implies that the same monetary incentive design could be used for all women to achieve a given participation rate in a weight loss program. Conclusion: It is critical to carefully construct incentive packages offered in weight loss programs to enhance program reach. A one-size-fit-all weight loss program incentive design that ignores potential nuances in participation decisions are unlikely to be as successful in maximizing programs' reach as programs that provide customized designs to attract different cohorts of people.
Journal of occupational and environmental medicine, 2017
To evaluate if self-efficacy (SE) and financial incentives (FI) mediate the effect of health behavior on weight loss in a group of overweight and obese nursing-home employees participating in a 16-week weight-loss intervention with 12-week follow-up. Ninety nine overweight/obese (body mass index [BMI] > 25) employees from four nursing-homes participated, with a mean age of 46.98 years and BMI of 35.33. Nursing-homes were randomized to receiving an incentive-based intervention (n = 51) and no incentive (n = 48). Participants' health behaviors and eating and exercise self-efficacy (Ex-SE) were assessed at week 1, 16, and 28 using a self-reported questionnaire. Mediation and moderated mediation analysis assessed relationships among these variables. Eating self-efficacy (Eat-SE) and Ex-SE were significant mediators between health behaviors and weight loss (P < 0.05). Incentives significantly moderated the effects of self-efficacy (P = 0.00) on weight loss. Self-efficacy and FI...
Clinical trials (London, England), 2016
Obesity continues to be a serious public health challenge. Rates are increasing worldwide, with nearly 70% of the US adults overweight or obese, leading to increased clinical and economic burden. While successful approaches for achieving weight loss have been identified, techniques for long-term maintenance of initial weight loss have largely been unsuccessful. Financial incentive interventions have been shown in several settings to be successful in motivating participants to adopt healthy behaviors. Keep It Off is a three-arm randomized controlled trial that compares the efficacy of a lottery-based incentive, traditional direct payment incentive, and control of daily feedback without any incentive for weight-loss maintenance. This design allows comparison of a traditional direct payment incentive with one based on behavioral economic principles that consider the underlying psychology of decision-making. Participants were randomized in a 2:1 ratio for each active arm relative to con...
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).
BMJ Open, 2019
IntroductionObesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals’ utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual’s skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies ...