Systematic review of the use of financial incentives in treatments for obesity and overweight

Nine studies met the criteria for inclusion in this systematic review of randomized controlled trials of treatments for obesity and overweight involving the use of financial incentives, with reported follow‐up of at least 1 year. All included trials were of behavioural obesity treatments. Justification of sample size and blinding procedure were not mentioned in any study. Attrition was well described in three studies and no study was analysed on an intention to treat basis. Participants were mostly women recruited through media advertisements. Mean age ranged from 35.7 to 52.8 years, and mean body mass index from 29.3 to 31.8 kg m−2. Results from meta‐analysis showed no significant effect of use of financial incentives on weight loss or maintenance at 12 months and 18 months. Further sub‐analysis by mode of delivery and amount of incentives although also non‐statistically significant were suggestive of very weak trends in favour of use of amounts greater than 1.2% personal disposable income, rewards for behaviour change rather than for weight, rewards based on group performance rather than for individual performance and rewards delivered by non‐psychologists rather than delivered by psychologists.

[1]  Tony Blakely,et al.  Effectiveness of monetary incentives in modifying dietary behavior:a review of randomized, controlled trials. , 2006, Nutrition reviews.

[2]  Andrea L Dunn,et al.  Identifying subgroups that succeed or fail with three levels of physical activity intervention: the Activity Counseling Trial. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[3]  Ming-Chin Yeh,et al.  Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. , 2005, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[4]  W. James Assessing obesity: are ethnic differences in body mass index and waist classification criteria justified? , 2005, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[5]  J. Donnelly,et al.  Reporting quality of randomized trials in the diet and exercise literature for weight loss , 2005, BMC medical research methodology.

[6]  Mary Butler,et al.  A structured review of the effect of economic incentives on consumers' preventive behavior. , 2004, American journal of preventive medicine.

[7]  G. Hunter,et al.  Comparison of self-reported with objectively assessed energy expenditure in black and white women before and after weight loss. , 2004, The American journal of clinical nutrition.

[8]  A. Gotto,et al.  Limitations of behavioral treatment of obesity: Review and analysis , 1981, Journal of Behavioral Medicine.

[9]  M K Campbell,et al.  Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. , 2004, Health technology assessment.

[10]  Deborah F Tate,et al.  Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? , 2003, The American journal of clinical nutrition.

[11]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[12]  G. Hunter,et al.  Physical activity in free-living, overweight white and black women: divergent responses by race to diet-induced weight loss. , 2002, The American journal of clinical nutrition.

[13]  D. Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. , 2001, Annals of internal medicine.

[14]  P. Sandercock,et al.  Framework for design and evaluation of complex interventions to improve health , 2000, BMJ : British Medical Journal.

[15]  J. Concato,et al.  Randomized, controlled trials, observational studies, and the hierarchy of research designs. , 2000, The New England journal of medicine.

[16]  R R Wing,et al.  Use of personal trainers and financial incentives to increase exercise in a behavioral weight-loss program. , 1998, Journal of consulting and clinical psychology.

[17]  D. Torgerson,et al.  Should we pay the patient? Review of financial incentives to enhance patient compliance , 1997, BMJ.

[18]  R. Wing,et al.  Long-term effects of interventions for weight loss using food provision and monetary incentives. , 1995, Journal of consulting and clinical psychology.

[19]  R R Wing,et al.  Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. , 1993, Journal of consulting and clinical psychology.

[20]  R. Cameron,et al.  Toward the development of self-help health behaviour change programs: weight loss by correspondence. , 1990, Canadian journal of public health = Revue canadienne de sante publique.

[21]  F. M. Kramer,et al.  Maintenance of successful weight loss over 1 year: Effects of financial contracts for weight maintenance or participation in skills training , 1986 .

[22]  R. Jeffery,et al.  Effectiveness of monetary contracts with two repayment schedules on weight reduction in men and women from self-referred and population samples , 1984 .

[23]  M. Becker,et al.  Contingency contracting to enhance patient compliance: a review. , 1984, Patient education and counseling.

[24]  R. Jeffery,et al.  Behavioral treatment of obesity with monetary contracting: two-year follow-up. , 1984, Addictive behaviors.

[25]  R A Lindquist,et al.  Monetary contracts in weight control: effectiveness of group and individual contracts of varying size. , 1983, Journal of consulting and clinical psychology.

[26]  L. Epstein,et al.  Strong monetary contingencies for weight loss during treatment and maintenance , 1981 .

[27]  A. C. Israel,et al.  Effects of experimenter versus significant other-controlled reinforcement and choice of target behavior on weight loss , 1978 .

[28]  M. Mahoney Self-reward and self-monitoring techniques for weight control , 1974 .

[29]  M. Harris,et al.  A comparison of a self-control and a contract procedure for weight control. , 1971, Behaviour research and therapy.