Sweeten the Pot With Financial Incentives to Boost Weight Loss

Far more people with obesity living in a socioeconomically disadvantaged neighborhood lost weight when a financial incentive was added to the mix, according to a randomized clinical trial.

After 6 months, 49.1% of people lost at least 5% of their baseline weight when provided with resources such as commercial program memberships and self-monitoring tools plus outcome-based financial incentives linked to their percentage of weight loss, reported Melanie Jay, MD, of NYU Grossman School of Medicine in New York City, and colleagues.

Also effective were “goal-directed” incentives, which provided participants with the same weight loss resources, but paired them with financial incentives linked to engagement in weight-loss behaviors, with 39% of this group achieving at least a 5% weight loss, the group noted in JAMA Internal Medicine.

Participants in both the goal-directed and outcome-based financial incentive groups were eligible to earn up to $750. Mean earned incentives were $440.44 in the goal-directed group and $303.56 in the outcome-based group. The goal-directed group could also earn money by participating in weight management classes, using a food journal, and engaging in physical activity verified by a FitBit. Those in the outcome-based group were instead paid cash for losing specific amounts of weight.

Though a larger proportion of people lost weight with an outcome-based financial incentive, the total amount of weight lost on average was similar in both incentive arms.

Jay and team found that only providing participants with resources but no financial incentive was least effective, though still yielded a 5% or more weight loss in 22.1% of this group.

At month 6, this weight loss equated to a mean change of 2.21 kg (4.87 lb) lost for the resources-only group, 4.47 kg (9.85 lb) lost with goal-directed incentives, and 4.79 kg (10.56 lb) lost for the group receiving outcome-based incentives.

After a full year, 31.3% of participants in the resources-only group lost at least 5% of baseline weight, as did 41.9% of the goal-directed incentive group and 41.4% of the outcome-based incentive group, which equated to a 2.74 kg (6.04 lb), 5.43 kg (11.97 lb), and 4.61 kg (10.16 lb) loss, respectively.

Of note, no signal was seen for potentially dangerous weight loss behaviors in any of the arms, the authors said.

These findings weren’t totally surprising, Jay told MedPage Today, as her group expected to see more people lose weight when financial incentives were involved. That being said, she noted that they originally hypothesized that the goal-directed arm would do best because these participants in theory would be gaining more confidence over time to practice new behaviors.

“I am surprised that the patients in the outcome-based arm had similar amounts of weight loss as the goal-directed arm, even though they did not attend Weight Watchers or self-monitor as frequently,” she added. “It may be that the goal-directed arm gained more muscle, since they were exercising more and their waist circumference went down, but we did not measure body composition to know for certain.”

Jay said that they did see signals showing that those in the goal-directed arm engaged in more of the evidence-based strategies and also continued to lose weight after the incentives ended, though longer-term studies are needed to confirm this. At this time, it’s unclear whether one incentive strategy was better than another, she acknowledged.

“Clinicians should encourage their patients to use commercial programs, self- monitor their diet and weight, and meet physical activity recommendations as a part of a comprehensive strategy for treating obesity that also includes medications and surgery when indicated,” Jay noted.

She also suggested that people should be encouraged to participate in a program if their employer offers financial incentives for weight management. “Also, I would advocate to healthcare systems that offering financial incentives may be a way to overcome barriers that low-income patients face when trying to manage their weight.”

For this study, a total of 668 participants were randomized to the resources-only group (n=221), the goal-directed group (n=222), or the outcome-based group (n=225). The majority were women, 73% were Hispanic, 15% were Black, and mean age was 48. Mean BMI at baseline was 37.95 and mean weight was 98.96 kg (218.17 lb). Participants were recruited across three hospital systems in New York City and Los Angeles. Only those with a median annual household income under $40,000 were eligible to participate.

Resources provided to all three groups included a 1-year membership for WW Freestyle (formerly Weight Watchers), health education, monthly one-on-one check-ins, and self-monitoring tools like digital scales, food journals, and Fitbit trackers.

Jay and colleagues noted that study limitations included the inability to generalize the findings to populations living in higher-income areas, along with white and male populations.