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

Abstract

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.

Conflict of interest statement

Conflict of interest

K.G.V. is a principal in the behavioral economics consulting firm VAL Health and has received consulting income and research funding from CVS as well as research support from Weight Watchers, Humana, Hawaii Medical Services Association, and Merck. P.A.S., A.T., and K.G.V. have received research funding from the Vitality Institute. G.D.F. and A.C.W. are employees of Weight Watchers International. Access to Protocol and Statistical Analysis Programming Code may be made upon request to W.C.Y. and K.G.V.

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Figures

Fig. 1

Flow of study participants

Fig. 2

Average number of days per week self-weighing was performed by arm over time (randomization is time 0)

Fig. 3

Percent weight change by arm from entry into Weight Watchers program over time (randomization is time 0)