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Preliminary Communication
December 10, 2008

Financial Incentive–Based Approaches for Weight Loss: A Randomized Trial

Author Affiliations

Author Affiliations: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia (Dr Volpp and Ms Norton); Center for Health Incentives, Leonard Davis Institute of Health Economics (Drs Volpp, Troxel, and Loewenstein and Ms Norton), Department of Medicine, University of Pennsylvania School of Medicine (Dr Volpp and Ms Norton), Department of Health Care Management, the Wharton School (Dr Volpp), and the Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (Drs Troxel and Fassbender); and the Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh (Dr Loewenstein and Ms John).

JAMA. 2008;300(22):2631-2637. doi:10.1001/jama.2008.804

Context Identifying effective obesity treatment 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, Setting, and Participants Fifty-seven healthy participants aged 30-70 years with a body mass index of 30-40 were randomized to 3 weight loss plans: monthly weigh-ins, a lottery incentive program, or a deposit contract that allowed for participant matching, with a weight loss goal of 1 lb (0.45 kg) a week for 16 weeks. Participants were recruited May-August 2007 at the Philadelphia VA Medical Center in Pennsylvania and were followed up through June 2008.

Main Outcome Measures Weight loss after 16 weeks.

Results The incentive groups lost significantly more weight than the control group (mean, 3.9 lb). Compared with the control group, the lottery group lost a mean of 13.1 lb (95% confidence interval [CI] of the difference in means, 1.95-16.40; P=.02) and the deposit contract group lost a mean of 14.0 lb (95% CI of the difference in means, 3.69-16.43; P =.006). About half of those in both incentive groups met the 16-lb target weight loss: 47.4% (95% CI, 24.5%-71.1%) in the deposit contract group and 52.6% (95% CI, 28.9%-75.6%) in the lottery group, whereas 10.5% (95% CI, 1.3%- 33.1%; P = .01) in the control group met the 16-lb target. Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups (9.2 lb; t = 1.21; 95% CI, −3.20 to 12.66; P = .23, in the lottery group and 6.2 lb; t = 0.52; 95% CI, −5.17 to 8.75; P = .61 in the deposit contract group) than in the control group (4.4 lb), these differences were not statistically significant. However, incentive participants weighed significantly less at 7 months than at the study start (P = .01 for the lottery group; P = .03 for the deposit contract group) whereas controls did not.

Conclusions The use of economic incentives produced significant weight loss during the 16 weeks of intervention that was not fully sustained. The longer-term use of incentives should be evaluated.

Trial Registration Identifier: NCT00520611