Financial incentive strategies for maintenance of weight loss: results from an internet-based randomized controlled trial

• Published in: Nutrition & diabetes Vol. 8; no. 1; pp. 33 - 11
• Main Authors: Yancy Jr, William S., Shaw, Pamela A., Wesby, Lisa, Hilbert, Victoria, Yang, Lin, Zhu, Jingsan, Troxel, Andrea, Huffman, David, Foster, Gary D., Wojtanowski, Alexis C., Volpp, Kevin G.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 25.05.2018; Nature Publishing Group
• Subjects: 692/163/2743/393; 692/308/575; 692/499; 692/699/1702/393; Adult; Aged; Aged, 80 and over; Clinical Nutrition; Diabetes; Epidemiology; Exercise; Feeding Behavior; Female; Health Behavior; Humans; Incentives; Internal Medicine; Internet; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Monetary incentives; Motivation; Text messaging; Treatment Outcome; Weight control; Weight Loss; Weight Reduction Programs
• ISSN: 2044-4052; 2044-4052
• DOI: 10.1038/s41387-018-0036-y

Background/objective Financial incentives can improve initial weight loss; we examined whether financial incentives can improve weight loss maintenance. Subjects/methods 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. Results Of 191 participants randomized, the mean age was 49.0 (SD = 10.5) years and weight loss prior to randomization was 11.4 (4.7) kg; 92% were women and 89% were White. Mean weight changes during the next 6 months (Phase I) were: lottery −3.0 (5.8) kg; direct −2.8 (5.8) kg; and control −1.4 (5.8) kg (all pairwise comparisons p  > 0.1). Weight changes through the end of 12 months post-weight loss (Phase II) were: lottery −1.8 (10.5) kg; direct −0.7 (10.7) kg; and control −0.3 (9.4) kg (all pairwise comparisons p  > 0.1). The percentages of participants who maintained their weight loss (defined as gaining ≤1.36 kg) were: lottery 79%, direct 76%, and control 67% at 6 months and lottery 66%, direct 62%, and control 59% at 12 months (all pairwise comparisons p  > 0.1). At 6 and 12 months after initial weight loss, changes in self-reported physical activity or eating behaviors did not differ across arms. Conclusions Compared with the active control of daily texting based on daily home weighing, lottery-based and direct monetary incentives provided no additional benefit for weight loss maintenance.