Individual- Versus Group-Based Financial Incentives for Weight Loss

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. DESIGN Randomized, controlled trial. (ClinicalTrials.gov: NCT01208350) SETTING Children's Hospital of Philadelphia. PARTICIPANTS 105 employees with a body mass index between 30 and 40 kg/m2. INTERVENTION 24 weeks of monthly weigh-ins (control group; n = 35); individual incentive, designed as $100 per person per month for meeting or exceeding weight-loss goals (n = 35); and group incentive, designed as $500 per month split among participants within groups of 5 who met or exceeded weight-loss goals (n = 35). MEASUREMENTS Weight loss after 24 weeks (primary outcome) and 36 weeks and changes in behavioral mediators of weight loss (secondary outcomes). RESULTS Group-incentive participants lost more weight than control participants (mean between-group difference, 4.4 kg [95% CI, 2.0 to 6.7 kg]; P < 0.001) and individual-incentive participants (mean between-group difference, 3.2 kg [CI, 0.9 to 5.5 kg]; P = 0.008). Twelve weeks after incentives ended and after adjustment for 3-group comparisons, group-incentive participants maintained greater weight loss than control group participants (mean between-group difference, 2.9 kg [CI, 0.5 to 5.3 kg]; P = 0.016) but not greater than individual-incentive participants (mean between-group difference, 2.7 kg [CI, 0.4 to 5.0 kg]; P = 0.024). LIMITATION Single employer and short follow-up. CONCLUSION A group-based financial incentive was more effective than an individual incentive and monthly weigh-ins at promoting weight loss among obese employees at 24 weeks. PRIMARY FUNDING SOURCE National Institute on Aging.

[1]  Karen R Fitzgerald.  Review of article: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010 by Katherine M. Flegal, PhD; Margaret D. Carroll, MSPH; Brian K. Kit, MD; Cynthia L. Ogden, PhD (JAMA 2012;307:491-7). , 2013, Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing.

[2]  R. Jeffery.  Financial incentives and weight control. , 2012, Preventive medicine.

[3]  D. Asch,et al.  Automated hovering in health care--watching over the 5000 hours. , 2012, The New England journal of medicine.

[4]  J. Wardle,et al.  Dietary restraint and self-regulation in eating behavior , 2012, International Journal of Obesity.

[5]  P. Faghri,et al.  Cost-Effectiveness of a Workplace-Based Incentivized Weight Loss Program , 2012, Journal of occupational and environmental medicine.

[6]  Katherine M Flegal,et al.  Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. , 2012, JAMA.

[7]  Edoardo Cervoni.  The 'Pounds for Pounds' weight loss financial incentive scheme: an evaluation of a pilot in NHS Eastern and Coastal Kent. , 2011, Journal of public health.

[8]  Kevin G Volpp,et al.  Redesigning employee health incentives--lessons from behavioral economics. , 2011, The New England journal of medicine.

[9]  K. Volpp,et al.  The Law, Policy, and Ethics of Employers' Use of Financial Incentives to Improve Health , 2011, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.

[10]  R. Plotnikoff,et al.  Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial. , 2011, Preventive medicine.

[11]  Leslie K. John,et al.  Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial , 2011, Journal of General Internal Medicine.

[12]  K. Flegal,et al.  The Predicted Effects of Chronic Obesity in Middle Age on Medicare Costs and Mortality , 2010, Medical care.

[13]  E. Finkelstein,et al.  Individual and Aggregate Years‐of‐life‐lost Associated With Overweight and Obesity , 2010, Obesity.

[14]  Susan T. Stewart,et al.  Forecasting the effects of obesity and smoking on U.S. life expectancy. , 2009, The New England journal of medicine.

[15]  M. McHugh,et al.  Job-based health insurance: costs climb at a moderate pace. , 2009, Health affairs.

[16]  E. Finkelstein,et al.  Annual medical spending attributable to obesity: payer-and service-specific estimates. , 2009, Health affairs.

[17]  P. Lindfors,et al.  International Journal of Behavioral Nutrition and Physical Activity Three Factor Eating Questionnaire-r18 as a Measure of Cognitive Restraint, Uncontrolled Eating and Emotional Eating in a Sample of Young Finnish Females , 2022 .

[18]  L. Heinen,et al.  Addressing obesity in the workplace: the role of employers. , 2009, The Milbank quarterly.

[19]  Kevin G Volpp,et al.  Financial incentive-based approaches for weight loss: a randomized trial. , 2008, JAMA.

[20]  E. Finkelstein,et al.  The Lifetime Medical Cost Burden of Overweight and Obesity: Implications for Obesity Prevention , 2008, Obesity.

[21]  E. Cohen,et al.  We Can Do Better — Improving the Health of the American People , 2008 .

[22]  J. Ard,et al.  Effects of a Reimbursement Incentive on Enrollment in a Weight Control Program , 2007, Obesity.

[23]  William Caplan,et al.  Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. , 2007, Journal of the American Dietetic Association.

[24]  S. Schroeder.  Shattuck Lecture. We can do better--improving the health of the American people. , 2007, The New England journal of medicine.

[25]  E. Finkelstein,et al.  A Pilot Study Testing the Effect of Different Levels of Financial Incentives on Weight Loss Among Overweight Employees , 2007, Journal of occupational and environmental medicine.

[26]  A. Tversky,et al.  Prospect theory: an analysis of decision under risk — Source link , 2007 .

[27]  Terence Connolly,et al.  Regret in economic and psychological theories of choice , 2006 .

[28]  E. Finkelstein,et al.  The Costs of Obesity among Full-Time Employees , 2005, American journal of health promotion : AJHP.

[29]  George Loewenstein,et al.  Wearing out your shoes to prevent someone else from stepping into them : Anticipated regret and social takeover in sequential decisions , 2005 .

[30]  Jan Karlsson,et al.  The Three-Factor Eating Questionnaire-R18 is able to distinguish among different eating patterns in a general population. , 2004, The Journal of nutrition.

[31]  L. Houtkooper,et al.  Pretreatment predictors of attrition and successful weight management in women , 2004, International Journal of Obesity.

[32]  J. Gerberding,et al.  Actual causes of death in the United States, 2000. , 2004, JAMA.

[33]  Marcel Zeelenberg,et al.  Consequences of regret aversion in real life : The case of the Dutch postcode lottery , 2004 .

[34]  Russell V. Lenth,et al.  Statistical Analysis With Missing Data (2nd ed.) (Book) , 2004 .

[35]  E. Finkelstein,et al.  State-level estimates of annual medical expenditures attributable to obesity. , 2004, Obesity research.

[36]  Nicole A. Lazar,et al.  Statistical Analysis With Missing Data , 2003, Technometrics.

[37]  D. Allison,et al.  Effects of outcome-driven insurance reimbursement on short-term weight control , 2003, International Journal of Obesity.

[38]  Karen C Johnson,et al.  Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. , 2003, Controlled clinical trials.

[39]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[40]  J. Honas,et al.  Predictors of attrition in a large clinic-based weight-loss program. , 2003, Obesity research.

[41]  C. Lenfant.  National Heart, Lung, and Blood Institute cardiothoracic surgery program: drawing from our past, building for our future. , 2000, Circulation.

[42]  M. Addis,et al.  Predictors of attrition from behavioral medicine treatments , 1999, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[43]  Treatment of Obesity in Adults.  Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. , 1998, Obesity research.

[44]  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.

[45]  Summary: weighing the options--criteria for evaluating weight-management programs. Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. , 1995, Journal of the American Dietetic Association.

[46]  P. Blackman.  Actual causes of death in the United States. , 1994, JAMA.

[47]  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.

[48]  McGinnis Jm,et al.  Actual causes of death in the United States. , 1993 .

[49]  D. Rubin.  Multiple imputation for nonresponse in surveys , 1989 .

[50]  R. Jeffery,et al.  A work-site weight control program using financial incentives collected through payroll deduction. , 1985, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[51]  L. Seidman,et al.  A cost-effective weight loss program at the worksite. , 1984, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[52]  O. Svenson.  ARE WE ALL LESS RISKY AND MORE SKILLFUL THAN OUR FELLOW DRIVERS , 1981 .

[53]  D. Rubin,et al.  Maximum likelihood from incomplete data via the EM - algorithm plus discussions on the paper , 1977 .

[54]  G. O. Lignac.  [Actual causes of death]. , 1951, Nederlands tijdschrift voor geneeskunde.