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Gross AC, Freese RL, Bensignor MO, Bomberg EM, Dengel DR, Fox CK, Rudser KD, Ryder JR, Bramante CT, Raatz S, Lim F, Hur C, Kelly AS. Financial Incentives and Treatment Outcomes in Adolescents With Severe Obesity: A Randomized Clinical Trial. JAMA Pediatr 2024:2819567. [PMID: 38884967 PMCID: PMC11184501 DOI: 10.1001/jamapediatrics.2024.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 06/18/2024]
Abstract
Importance Adolescent severe obesity is usually not effectively treated with traditional lifestyle modification therapy. Meal replacement therapy (MRT) shows short-term efficacy for body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) reduction in adolescents, and financial incentives (FIs) may be an appropriate adjunct intervention to enhance long-term efficacy. Objective To evaluate the effect of MRT plus FIs vs MRT alone on BMI, body fat, and cardiometabolic risk factors in adolescents with severe obesity. Design, Setting, and Participants This was a randomized clinical trial of MRT plus FIs vs MRT alone at a large academic health center in the Midwest conducted from 2018 to 2022. Participants were adolescents (ages 13-17 y) with severe obesity (≥120% of the 95th BMI percentile based on sex and age or ≥35 BMI, whichever was lower) who were unaware of the FI component of the trial until they were randomized to MRT plus FIs or until the end of the trial. Study staff members collecting clinical measures were blinded to treatment condition. Data were analyzed from March 2022 to February 2024. Interventions MRT included provision of preportioned, calorie-controlled meals (~1200 kcals/d). In the MRT plus FI group, incentives were provided based on reduction in body weight from baseline. Main Outcomes and Measures The primary end point was mean BMI percentage change from randomization to 52 weeks. Secondary end points included total body fat and cardiometabolic risk factors: blood pressure, triglyceride to high-density lipoprotein ratio, heart rate variability, and arterial stiffness. Cost-effectiveness was additionally evaluated. Safety was assessed through monthly adverse event monitoring and frequent assessment of unhealthy weight-control behaviors. Results Among 126 adolescents with severe obesity (73 female [57.9%]; mean [SD] age, 15.3 [1.2] years), 63 participants received MRT plus FIs and 63 participants received only MRT. At 52 weeks, the mean BMI reduction was greater by -5.9 percentage points (95% CI, -9.9 to -1.9 percentage points; P = .004) in the MRT plus FI compared with the MRT group. The MRT plus FI group had a greater reduction in mean total body fat mass by -4.8 kg (95% CI, -9.1 to -0.6 kg; P = .03) and was cost-effective (incremental cost-effectiveness ratio, $39 178 per quality-adjusted life year) compared with MRT alone. There were no significant differences in cardiometabolic risk factors or unhealthy weight-control behaviors between groups. Conclusions and Relevance In this study, adding FIs to MRT resulted in greater reductions in BMI and total body fat in adolescents with severe obesity without increased unhealthy weight-control behaviors. FIs were cost-effective and possibly promoted adherence to health behaviors. Trial Registration ClinicalTrials.gov Identifier: NCT03137433.
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Affiliation(s)
- Amy C Gross
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center, University of Minnesota Clinical and Translational Science Institute, Minneapolis
| | - Megan O Bensignor
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
| | - Eric M Bomberg
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
| | - Donald R Dengel
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- University of Minnesota School of Kinesiology, Minneapolis
| | - Claudia K Fox
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
| | - Kyle D Rudser
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis
| | - Justin R Ryder
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Carolyn T Bramante
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Medicine, University of Minnesota, Minneapolis
| | - Sarah Raatz
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
| | - Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Aaron S Kelly
- University of Minnesota Center for Pediatric Obesity Medicine, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
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Buis L, Lee U. Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study. JMIR Mhealth Uhealth 2023; 11:e41660. [PMID: 36705949 PMCID: PMC9919499 DOI: 10.2196/41660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A growing body of evidence shows that financial incentives can effectively reinforce individuals' positive behavior change and improve compliance with health intervention programs. A critical factor in the design of incentive-based interventions is to set a proper incentive magnitude. However, it is highly challenging to determine such magnitudes as the effects of incentive magnitude depend on personal attitudes and contexts. OBJECTIVE This study aimed to illustrate loss-framed adaptive microcontingency management (L-AMCM) and the lessons learned from a feasibility study. L-AMCM discourages an individual's adverse health behaviors by deducting particular expenses from a regularly assigned budget, where expenses are adaptively estimated based on the individual's previous responses to varying expenses and contexts. METHODS We developed a mobile health intervention app for preventing prolonged sedentary lifestyles. This app delivered a behavioral mission (ie, suggesting taking an active break for a while) with an incentive bid when 50 minutes of uninterrupted sedentary behavior happened. Participants were assigned to either the fixed (ie, deducting the monotonous expense for each mission failure) or adaptive (ie, deducting varying expenses estimated by the L-AMCM for each mission failure) incentive group. The intervention lasted 3 weeks. RESULTS We recruited 41 participants (n=15, 37% women; fixed incentive group: n=20, 49% of participants; adaptive incentive group: n=21, 51% of participants) whose mean age was 24.0 (SD 3.8; range 19-34) years. Mission success rates did not show statistically significant differences by group (P=.54; fixed incentive group mean 0.66, SD 0.24; adaptive incentive group mean 0.61, SD 0.22). The follow-up analysis of the adaptive incentive group revealed that the influence of incentive magnitudes on mission success was not statistically significant (P=.18; odds ratio 0.98, 95% CI 0.95-1.01). On the basis of the qualitative interviews, such results were possibly because the participants had sufficient intrinsic motivation and less sensitivity to incentive magnitudes. CONCLUSIONS Although our L-AMCM did not significantly affect users' mission success rate, this study configures a pioneering work toward adaptively estimating incentives by considering user behaviors and contexts through leveraging mobile sensing and machine learning. We hope that this study inspires researchers to develop incentive-based interventions.
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Affiliation(s)
| | - Uichin Lee
- School of Computing, Korea Advanced Institute of Science & Technology, Daejeon, Republic of Korea
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Abstract
OBJECTIVE To examine effects of a financial incentives program on follow-up and weight loss after bariatric surgery. SUMMARY BACKGROUND DATA Consistent follow-up may improve weight loss and other health outcomes after bariatric surgery. Yet, rates of follow-up after surgery are often low. METHODS Patients from 3 practices within a statewide collaborative were invited to participate in a 6-month financial incentives program. Participants received incentives for attending postoperative appointments at 1, 3, and 6 months which doubled when participants weighed less than their prior visit. Participants were matched with contemporary patients from control practices by demographics, starting body mass index and weight, surgery date, and procedure. Preintervention estimates used matched historic patients from the same program and control practices with the criteria listed above. Patients between the 2 historic groups were additionally matched on surgery date to ensure balance on matched variables. We conducted differ-ence-in-differences analyses to examine incentives program effects. Follow-up attendance and percent excess weight loss were measured postoperative months 1, 3, 6, and 12. RESULTS One hundred ten program participants from January 1, 2018 to July 31, 2019 were matched to 203 historic program practice patients (November 20 to December 27, 2017). The control group had 273 preinter-vention patients and 327 postintervention patients. In difference-in-differ-ences analyses, the intervention increased follow-up rates at 1 month (+14.8%, P <0.0001), 3months (+29.4%, P <0.0001), and 6 months (+16.4%, P <0.0001), but not at 12 months. There were no statistically significant differences in excess weight loss. CONCLUSIONS A financial incentives program significantly increased follow-up after bariatric surgery for up to 6 months, but did not increase weight loss. Our study supports use of incentivized approaches as one way to improve postoperative follow-up, but may not translate into greater weight loss without additional supports.
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John LK, Blunden H, Milkman KL, Foschini L, Tuckfield B. The limits of inconspicuous incentives. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2022. [DOI: 10.1016/j.obhdp.2022.104180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Krukowski RA, Harvey JR, Naud S, Finkelstein EA, West DS. Perspectives on the Form, Magnitude, Certainty, Target, and Frequency of Financial Incentives in a Weight Loss Program. Am J Health Promot 2022; 36:996-1004. [PMID: 35377246 PMCID: PMC10369452 DOI: 10.1177/08901171221078843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Financial incentives are a promising approach to enhance weight loss outcomes; however, little guidance exists on the optimal incentive structure. DESIGN Mixed methods. SETTING An online weight management trial, combining outcome (i.e., weight loss) and behavioral (i.e., self-weighing, dietary self-monitoring, and steps) incentives over 12 months (up to $665). SUBJECTS 116 participants who completed the incentive preference assessment at the 18-month follow-up visit. METHOD Response distributions on the form, magnitude, certainty, and target of the incentives and content analysis of the qualitative responses. RESULTS Nearly all (96.6%) participants indicated they liked receiving electronic Amazon gift cards, more so than the alternatives presented. Most participants (81.0%) thought they would have lost a similar amount of weight if the incentives were smaller. Few (18.1%) indicated they would have preferred a lottery structure, but 50.8% indicated the variable incentive schedule was beneficial during the maintenance period. Most (77.6%) felt incentives were most helpful when starting to lose weight. In both phases, most participants (85.3% and 72.4%, respectively) indicated appropriate behaviors were incentivized. Participants had mixed views on whether outcome or behavioral incentives were most motivating. CONCLUSION There was notable variation in preferences for the magnitude, duration, and timing of incentives; it will be important to examine in future research whether incentive design should be tailored to individual preferences.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, College of Medicine, 2358University of Virginia, Charlottesville, VA, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, 2092University of Vermont, Burlington, VT, USA
| | - Shelly Naud
- Biomedical Statistics, Larner College of Medicine, 2092University of Vermont, Burlington, VT, USA
| | - Eric A Finkelstein
- Duke-NUS Medical School and Duke University Global Health Institute, singapore
| | - Delia S West
- Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
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Crainich D. [Financial incentives to achieve health-related behavioral goals: State of play and unresolved questions]. Med Sci (Paris) 2022; 38:198-204. [PMID: 35179475 DOI: 10.1051/medsci/2022005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Programs providing monetary rewards to individuals who achieve a health-related goal (quitting smoking, losing weight, etc.) aim at promoting healthy behaviors. While these programs seem to achieve their objective in the short run, their ability to provoke lasting changes remains to be demonstrated. The identification of granting mechanisms likely to maximize the incentive effect of these rewards should be based on knowledge about individual attitudes evidenced by behavioral economics. As the latter has shown that preferences toward risk vary from one individual to another, these incentive mechanisms should be tailor-made according to individual preferences.
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Affiliation(s)
- David Crainich
- Univ. Lille, CNRS, IESEG School of management, UMR 9221 - LEM (Lille Économie Management), 3 rue de la Digue, F-59000 Lille, France
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Krukowski R, Johnson B, Kim H, Sen S, Homsi R. A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial. JMIR Form Res 2021; 5:e30578. [PMID: 34951594 PMCID: PMC8742213 DOI: 10.2196/30578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/29/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. OBJECTIVE The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. METHODS We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine's GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. RESULTS Participants were enrolled at, on average, 9.6 (SD 1.8) weeks' gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. CONCLUSIONS A financial incentive-based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive-based interventions for healthy GWG behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194.
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Affiliation(s)
- Rebecca Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.,Department of Public Health Science, University of Virginia, Charlottesville, VA, United States
| | - Brandi Johnson
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Hyeonju Kim
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Saunak Sen
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Riad Homsi
- Just For Women Obstetric Clinic, Memphis, TN, United States
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Achtziger A, Glas A, Kenning P, Rudolph T. Comparing the effects of financial incentives and implementation intentions on unhealthy snacking behavior in employees. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Glanz K, Shaw PA, Kwong PL, Choi JR, Chung A, Zhu J, Huang QE, Hoffer K, Volpp KG. Effect of Financial Incentives and Environmental Strategies on Weight Loss in the Healthy Weigh Study: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2124132. [PMID: 34491350 PMCID: PMC8424479 DOI: 10.1001/jamanetworkopen.2021.24132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Modest weight loss can lead to meaningful risk reduction in adults with obesity. Although both behavioral economic incentives and environmental change strategies have shown promise for initial weight loss, to date they have not been combined, or compared, in a randomized clinical trial. OBJECTIVE To test the relative effectiveness of financial incentives and environmental strategies, alone and in combination, on initial weight loss and maintenance of weight loss in adults with obesity. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from 2015 to 2019 at 3 large employers in Philadelphia, Pennsylvania. A 2-by-2 factorial design was used to compare the effects of lottery-based financial incentives, environmental strategies, and their combination vs usual care on weight loss and maintenance. Interventions were delivered via website, text messages, and social media. Participants included adult employees with a body mass index (BMI; weight in kilograms divided by height in meters squared) of 30 to 55 and at least 1 other cardiovascular risk factor. Data analysis was performed from June to July 2021. INTERVENTIONS Interventions included lottery-based financial incentives based on meeting weight loss goals, environmental change strategies tailored for individuals and delivered by text messages and social media, and combined incentives and environmental strategies. MAIN OUTCOME AND MEASURES The primary outcome was weight change from baseline to 18 months, measured in person. RESULTS A total of 344 participants were enrolled, with 86 participants each randomized to the financial incentives group, environmental strategies group, combined financial incentives and environmental strategies group, and usual care (control) group. Participants had a mean (SD) age of 45.6 (10.5) years and a mean (SD) BMI of 36.5 (7.1); 247 participants (71.8%) were women, 172 (50.0%) were Black, and 138 (40.1%) were White. At the primary end point of 18 months, participants in the incentives group lost a mean of 5.4 lb (95% CI, -11.3 to 0.5 lb [mean, 2.45 kg; 95% CI, -5.09 to 0.23 kg]), those in the environmental strategies group lost a mean of a 2.2 lb (95% CI, -7.7 to 3.3 lb [mean, 1.00 kg; 95% CI, -3.47 to 1.49 kg]), and the combination group lost a mean of 2.4 lb (95% CI, -8.2 to 3.3 lb [mean, 1.09 kg; 95% CI, -3.69 to 1.49 kg]) more than participants in the usual care group. Financial incentives, environmental change strategies, and their combination were not significantly more effective than usual care. At 24 months, after 6 months without an intervention, the difference in the change from baseline was similar to the 18-month results, with no significant differences among groups. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, across all study groups, participants lost a modest amount of weight but those who received financial incentives, environmental change, or the combined intervention did not lose significantly more weight than those in the usual care group. Employees with obesity may benefit from more intensive individualized weight loss strategies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02878343.
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Affiliation(s)
- Karen Glanz
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Pamela A. Shaw
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pui L. Kwong
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ji Rebekah Choi
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Annie Chung
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Qian Erin Huang
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Karen Hoffer
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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PASDAR YAHYA, NAJAFI FARID, DARBANDI MITRA, REZAEIAN SHAHAB, NIAZI PARISA, HAMZEH BEHROOZ. Financial incentive strategy for weight loss and maintenance of weight loss. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E206-E212. [PMID: 34322638 PMCID: PMC8283650 DOI: 10.15167/2421-4248/jpmh2021.62.1.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
Introduction The aim of this study was to investigate the effect of financial incentives on weight loss, maintain in obese women and biochemical factors. Methods This quasi-experimental study was conducted on 103 women with body mass index (BMI) ≥ 30 kg/m2. The participants were assessed over a 12-month follow-up in eight phases. Money payment for losing weight was incentive intervention in this study. The participants were given diet and physical activity. Results Mean of BMI was 34.78 ± 4.29 kg/m2 in baseline, that reduced to 32.41 ± 3.51 kg/m2 in the sixth phase, and 31.64 ± 3.71 kg/m2 in the final phase (P < 0.001). At baseline, mean of percentage of body fat (PBF) was 40.77 ± 2.81 that reduced to 37.34±4.02 at the end of the study (P < 0.001). Waist to hip ratio (WHR) and lean body mass (LBM) decreased significantly over the 12-month (P < 0.001). At the end of each phase, the mean of BMI reduction of 0.39 units was observed in the subjects, and 9 units of change were achieved by the end of the study compared to the baseline. The mean of triglyceride in the first, fourth and seventh phases were 128.57 ± 13.33, 101.43 ± 57.99 and 87.40 ± 57.59 mg/dl, respectively (P = 0.003). The mean of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate-pyruvate transaminase (SGPT) decreased significantly over the 12-month, P = 0.052 and P = 0.005, respectively. Conclusions Financial incentives can effectively help to weight loss and maintenance of weight, and improve lipid profiles; blood sugar and liver enzymes. The use of motivational factors with proper training (diet and physical activity) will have a better result.
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Affiliation(s)
- YAHYA PASDAR
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - FARID NAJAFI
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Cardiovascular Research center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MITRA DARBANDI
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Correspondence: Darbandi M, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Isar Square, School of Public Health, Department of Epidemiology, Kermanshah, Iran - Tel.: +98 83 37102015 - Fax: +98 83 38263048 - E.mail: ,
| | - SHAHAB REZAEIAN
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - PARISA NIAZI
- Department of Nutrition, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - BEHROOZ HAMZEH
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Michaud TL, Estabrooks PA, You W, McGuire TJ, Almeida F, Karls K, Love K, King K, Hill J, Reed J, Porter G, Su D. Sustaining the reach of a scalable weight loss intervention through financial incentives- a pragmatic, feasibility, online randomized trial protocol. Contemp Clin Trials 2020; 98:106142. [PMID: 32920241 DOI: 10.1016/j.cct.2020.106142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND High attrition following initial enrollment in evidence-based weight loss programs is a common, challenging, and under-studied issue. A behavioral economics approach consisting of modest monetary incentives may help to engage participants beyond enrollment to close the initial attrition gap. PURPOSE To describe the methods and design of a pragmatic, online randomized controlled trial (RCT) of an incentivized, technology-facilitated weight loss program through an innovative research-practice partnership involving primary care, health promotion researchers, and a small business. METHODS This study is a four-arm (1:1:1:1) RCT that compares the efficacy of outcome-based (weight loss), process-based (weighing in), a combination of outcome- and process-based, or choice-based incentives on sustaining program reach after initial enrollment for an evidence-based weight loss program. The multicomponent weight loss program includes a website, social cognitive theory-based daily health coaching, tailored messaging delivered via email and text messaging, access to online health coaches, and objective weight assessment through a community kiosk. The study will enroll 400 individuals aged 19 and older who have a body mass index ≥25 kg/m2, and have reliable access to the Internet or a smart phone. Participants will be followed for 3, 6, 9, and 12 months to assess program reach and representativeness, and continued participation after enrollment. The secondary outcomes include weight loss and program implementation costs. We will conduct participant focus groups to understand the barriers and facilitators of participation and key informant interviews focusing on clinic managers and care providers to explore the potential for future adoption and implementation of the evidence-based program. DISCUSSION This study possesses the potential to close the attrition gap after initial enrollment in a web-based digital weight loss intervention in the primary care and community settings. Clinicaltrials.gov registration: NCT04225234.
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Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Paul A Estabrooks
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - Fabio Almeida
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kelly Karls
- Fontenelle clinic, Nebraska Medicine, Omaha, Nebraska, NE, USA
| | - Kenya Love
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna King
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jennie Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jill Reed
- College of Nursing, Kearney Division, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gwenndolyn Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Adding Financial Incentives to Online Group-Based Behavioral Weight Control: An RCT. Am J Prev Med 2020; 59:237-246. [PMID: 32446752 PMCID: PMC8510645 DOI: 10.1016/j.amepre.2020.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Internet-delivered behavioral weight control is promising for expanding the reach and availability of weight management, but online programs produce lower weight losses than typically achieved in person. Financial incentives have been shown to increase weight losses. This study examined whether adding financial incentives for self-monitoring and achieving target weight losses increases weight losses attained in a fully online, group-based behavioral weight management program compared with the same program alone. STUDY DESIGN This study was an RCT. SETTING/PARTICIPANTS Adults with overweight and obesity (n=418; 91% female; 28% minority) were recruited from 2 clinical centers. INTERVENTION The intervention was a 24-session online group-based behavioral weight control program with weekly synchronous chat sessions (Internet-only) or the same program with weekly financial incentives for self-monitoring body weight and dietary intake daily and for achieving target weight losses at 2 and 6 months (Internet + incentives). MAIN OUTCOME MEASURES This study measured weight loss at 6 months and treatment engagement (attendance, self-monitoring of body weight, dietary intake, and physical activity). Data were collected between February 2016 and August 2018, and analyses were completed in 2019. RESULTS Participants randomized to the Internet + incentives group lost more weight (-6.4 [SD=5.5] kg) than those in the Internet-only group (-4.7 [SD=6.6] kg; p<0.01). Further, a higher proportion of the Internet + incentives group achieved ≥5% weight loss (55%) than those in the Internet-only group (40%; p<0.05). Treatment engagement was higher in the Internet + incentives condition, with greater self-monitoring of behaviors targeted by incentives, as well as higher rates of behaviors not targeted and higher self-reported physical activity. Study retention was higher among those in the Internet + incentives condition (91%) than those in the Internet-only condition (81%; p=0.003). CONCLUSIONS Adding financial incentives to a program delivered fully online increases weight losses compared with the program alone and can achieve weight losses comparable to in-person programs, offering potential for substantial geographic reach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02688621.
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McInerney M, Meiselbach MK. Distributional Effects of Recent Health Insurance Expansions on Weight-Related Outcomes. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100870. [PMID: 32622182 DOI: 10.1016/j.ehb.2020.100870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
We provide new evidence that weight-related outcomes improved for the severely obese following three recent health insurance expansions. Using Behavioral Risk Factor Surveillance System (BRFSS) data from 2001 through 2016, we examine the effects of Massachusetts health care reform, the Affordable Care Act (ACA) dependent coverage mandate, and the ACA Medicaid expansion on Body Mass Index (BMI) and the likelihood of obesity or severe obesity. Estimates from unconditional quantile regression show that Body Mass Index (BMI) fell among the severely obese who are at the top of the distribution of BMI following all three of these insurance expansions. We also observe a robust reduction in the likelihood of severe obesity following the ACA dependent coverage mandate, and suggestive evidence of a reduction in severe obesity following Massachusetts health care reform. Together, these results identify an important benefit arising from recent health insurance expansions: improved weight-related outcomes for those with severe obesity.
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Affiliation(s)
- Melissa McInerney
- Department of Economics, Tufts University, Medford, MA, United States.
| | - Mark K Meiselbach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Rounds T, Crane M, Harvey J. The Impact of Incentives on Weight Control in Men: A Randomized Controlled Trial. Am J Mens Health 2020; 14:1557988319895147. [PMID: 32106757 PMCID: PMC7052474 DOI: 10.1177/1557988319895147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Overweight and obese men were recruited to a 6-month, randomized controlled
weight loss trial, which compared the Gutbusters weight loss program alone to
the Gutbusters program with incentives for successful weight loss. The
intervention was delivered primarily online, with weekly in-person weight
collections. Gutbusters was designed using a template from the REFIT
intervention and encouraged participants (N = 102, 47.0 ± 12.3
years, 32.5 kg/m2) to make six 100-calorie changes to their typical
daily diet for a total of 42 changes per week. Weight loss was significantly
greater in the Gutbusters+Incentive group compared to the Gutbusters alone group
at both 12 and 24 weeks (p’s = < .01). The
Gutbusters+Incentive group’s a mean weight loss was 9.9 pounds at 12 weeks (95%
CI: 6.9, 12.9) and 8.4 pounds at 24 weeks (95% CI: 3.9, 13.0). The Gutbusters
alone group mean weight loss was 3.7 pounds at 12 weeks (95% CI: –.06, 7.5) and
3.4 pounds at 24 weeks (95% CI: –2.2, 9.0). This study adds to the literature of
behavioral weight programs that are designed for men. Unlike the majority of
previous male weight loss interventions, which were designed with an
intervention comparison to a no treatment or waitlist control, Gutbusters was
implemented as a comparative effectiveness trial, which will help bolster the
evidence base for real-world application.
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Affiliation(s)
| | | | - Jean Harvey
- The University of Vermont, Burlington, VT, USA
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15
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Yancy WS, Shaw PA, Reale C, Hilbert V, Yan J, Zhu J, Troxel AB, Foster GD, Volpp KG. Effect of Escalating Financial Incentive Rewards on Maintenance of Weight Loss: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1914393. [PMID: 31675083 PMCID: PMC6826643 DOI: 10.1001/jamanetworkopen.2019.14393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Identifying effective strategies for treating obesity is a public health priority. OBJECTIVE To test an escalating lottery-based incentive tied to daily self-weighing for weight loss maintenance. DESIGN, SETTING, AND PARTICIPANTS This 2-phase, 2-arm randomized clinical trial enrolled participants aged 30 to 80 years with an initial body mass index (calculated as weight in kilograms divided by height in meters squared) of 30.0 to 45.0 who lost at least 5 kg during 4 to 6 months in a national online weight management program. Study investigators and outcomes assessors were blinded to participant groups. Data were collected and analyzed from May 23, 2016, through November 13, 2017, based on intention to treat. INTERVENTIONS All participants were advised to weigh themselves daily, with a goal of 6 or more days per week, and received text messaging feedback on their performance. Incentive group participants were eligible for a lottery-based incentive worth an expected value of $3.98 in week 1 that escalated by $0.43 each week they achieved their self-weighing goal during months 1 to 6 (phase 1), followed by no incentives during months 7 to 12 (phase 2). MAIN OUTCOMES AND MEASURES The primary outcome was weight change at the end of phase 1. Secondary outcomes included weight change at the end of phase 2 and changes in self-reported physical activity and eating behaviors. RESULTS A total of 258 participants (128 in the incentive group and 130 in the control group) had a mean (SD) age of 48.0 (10.5) years and mean (SD) body mass index of 32.1 (3.9); 225 (87.2%) were women; 235 (91.1%) were white; and 102 (39.5%) had an annual income of at least $100 000. Weight measurement was transmitted by 250 participants (96.9%) at 6 months and 227 (88.0%) at 12 months. The percentage of weeks that incentive and control participants achieved a mean self-weighing of at least 6 times was 85.3% vs 75.8%, respectively (P = .002) in phase 1 and 37.7% vs 50.2%, respectively (P = .009) in phase 2. Mean weight changes at the end of phase 1 were -1.1 (95% CI, -2.1 to -0.1) kg in the incentive group and -1.9 (95% CI, -2.9 to -0.8) kg in the control group, with a mean difference of 0.7 (95% CI, -0.7 to 2.2) kg (P = .30 for comparison). At the end of phase 2, mean weight changes were 0.2 (95% CI, -1.2 to 1.7) kg in the incentive group and -0.6 (95% CI, -2.0 to 0.8) kg in the control group, with a mean difference of 0.8 (95% CI, -1.2 to 2.8) kg (P = .41 for comparison). CONCLUSIONS AND RELEVANCE Compared with an active control condition of weekly messages, escalating lottery-based incentives transiently increased rates of self-weighing but did not significantly enhance weight loss maintenance. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01900392.
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Affiliation(s)
- William S Yancy
- Duke University Diet and Fitness Center, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Catherine Reale
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Victoria Hilbert
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jiali Yan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Andrea B Troxel
- Department of Population Health, New York University School of Medicine, New York
| | - Gary D Foster
- Department of Science, WW (formerly Weight Watchers), New York, New York
- Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G Volpp
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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16
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Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ, Carlin A, Patterson C, Longo A, Hutchinson G, Prior L, Tully MA, French DP, Adams J, McIntosh E, Xin Y, Kee F. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.
Objectives
To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.
Design
A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting
Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.
Participants
A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.
Intervention
The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main outcome measures
The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.
Results
The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).
Limitations
Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions
Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
Trial registration
Current Controlled Trials ISRCTN17975376.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jennifer M Murray
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jianjun Tang
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Sarah F Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | | | | | - Chris Patterson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Alberto Longo
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
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17
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Raymond LW, Roy DM, Mullinax SL, Yanni A, Pentek KC, Isaacs SE. Preventing Diabetes in the Workplace. J Occup Environ Med 2019; 61:e308-e311. [DOI: 10.1097/jom.0000000000001611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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18
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Gudzune KA, Alexander E, Tseng E, Durkin N, Jerome GJ, Dalcin A, Appel LJ, Clark JM. Influence of subsidies and promotional strategies on outcomes in a beneficiary-based commercial weight-loss programme. Clin Obes 2019; 9:e12307. [PMID: 30957415 DOI: 10.1111/cob.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.
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Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eleanore Alexander
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nowella Durkin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gerald J Jerome
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Arlene Dalcin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne M Clark
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
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19
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Nisa CF, Bélanger JJ, Schumpe BM. Parts greater than their sum: randomized controlled trial testing partitioned incentives to increase cancer screening. Ann N Y Acad Sci 2019; 1449:46-55. [PMID: 31111509 DOI: 10.1111/nyas.14115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/31/2019] [Accepted: 04/12/2019] [Indexed: 01/03/2023]
Abstract
Promoting healthy behavior is a challenge for public health officials, especially in the context of asking patients to participate in preventive cancer screenings. Small financial incentives are sometimes used, but there is a little scientific basis to support a compelling description of the best-practice implementation of such incentives. We present a simple behavioral strategy based on mental accounting from prospect theory that maximizes the impact of incentives with no additional cost. We show how the partition of one incentive into two smaller incentives of equivalent total amount produces substantial behavioral changes, demonstrated in the context of colorectal cancer screening. In a randomized controlled trial, eligible patients aged 50-74 (n = 1652 patients) were allocated to receive either one €10 incentive (upon completion of screening) or two €5 incentives (at the beginning and at the end of screening). We show that cancer screening rates were dramatically increased by partitioning the financial incentive (61.1%), compared with a single installment at the end (41.4%). These results support the hedonic editing hypothesis from prospect theory, and underline the importance of implementing theoretically grounded healthcare interventions. Our results suggest that, when patient incentives are feasible, healthcare procedures should be framed as multistage events with smaller incentives offered at multiple points in time.
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Affiliation(s)
- Claudia F Nisa
- Psychology Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jocelyn J Bélanger
- Psychology Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Birga M Schumpe
- Psychology Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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20
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Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review. Soc Sci Med 2019; 232:340-350. [PMID: 31129504 DOI: 10.1016/j.socscimed.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 01/27/2023]
Abstract
The rising epidemic of non-communicable diseases (NCDs) poses substantial health and economic challenges to both individuals and society. Application of incentive-based strategies based on traditional and behavioural economic theory has emerged as a potential strategy to address rising rates of NCDs. Yet, whether or not incentives truly represent a promising strategy for addressing NCDs has not been systematically addressed nor is it clear whether certain behavioural economic strategies outperform others or simply offering a cash-based incentive for meeting a goal. In this systematic review we aim to determine whether there is an evidence base for any of these strategies. Forty-eight published randomized controlled trials (70 contrasts) evaluating the effectiveness of incentive-based strategies for improvements in NCD risk-factors were reviewed. Our primary conclusion is that there is a lack of compelling evidence that incentives of any form represent a compelling NCD reduction strategy. More evidence for long-term effectiveness and cost-effectiveness is needed to justify third party funding of any incentive based strategy.
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21
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Murray JM, French DP, Patterson CC, Kee F, Gough A, Tang J, Hunter RF. Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial. J Med Internet Res 2019; 21:e11394. [PMID: 31002304 PMCID: PMC6498305 DOI: 10.2196/11394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/28/2018] [Accepted: 01/06/2019] [Indexed: 01/12/2023] Open
Abstract
Background Investigating participant engagement and nonusage attrition can help identify the likely active ingredients of electronic health interventions. Research on engagement can identify which intervention components predict health outcomes. Research on nonusage attrition is important to make recommendations for retaining participants in future studies. Objective This study aimed to investigate engagement and nonusage attrition in the Physical Activity Loyalty (PAL) scheme, a 6-month complex physical activity intervention in workplaces in Northern Ireland. The intervention included financial incentives with reward redemption and self-regulation techniques. Specific objectives were (1) to determine whether engagement in specific intervention components predicted physical activity at 6 months, (2) to determine whether engagement in specific intervention components predicted targeted mediators at 6 months, and (3) to investigate predictors of nonusage attrition for participants recording daily activity via the PAL scheme physical activity monitoring system and logging onto the website. Methods Physical activity was assessed at baseline and 6 months using pedometers (Yamax Digiwalker CW-701, Japan). Markers of engagement and website use, monitoring system use, and reward redemption were collected throughout the scheme. Random-effects generalized least-squares regressions determined whether engagement with specific intervention components predicted 6-month physical activity and mediators. Cox proportional hazards regressions were used to investigate predictors of nonusage attrition (days until first 2-week lapse). Results A multivariable generalized least-squares regression model (n=230) showed that the frequency of hits on the website’s monitoring and feedback component (regression coefficient [b]=50.2; SE=24.5; P=.04) and the percentage of earned points redeemed for financial incentives (b=9.1; SE=3.3; P=.005) were positively related to 6-month pedometer steps per day. The frequency of hits on the discussion forum (b=−69.3; SE=26.6; P=.009) was negatively related to 6-month pedometer steps per day. Reward redemption was not related to levels of more internal forms of motivation. Multivariable Cox proportional hazards regression models identified several baseline predictors associated with nonusage attrition. These included identified regulation (hazard ratio [HR] 0.88, 95% CI 0.81-0.97), recovery self-efficacy (HR 0.88, 95% CI 0.80-0.98), and perceived workplace environment safety (HR 1.07, 95% CI 1.02-1.11) for using the physical activity monitoring system. The EuroQoL health index (HR 0.33, 95% CI 0.12-0.91), financial motivation (HR 0.93, 95% CI 0.87-0.99), and perceived availability of physical activity opportunities in the workplace environment (HR 0.96, 95% CI 0.93-0.99) were associated with website nonusage attrition. Conclusions Our results provide evidence opposing one of the main hypotheses of self-determination theory by showing that financial rewards are not necessarily associated with decreases in more internal forms of motivation when offered as part of a complex multicomponent intervention. Identifying baseline predictors of nonusage attrition can help researchers to develop strategies to ensure maximum intervention adherence. Trial Registration ISRCTN Registry ISRCTN17975376; http://www.isrctn.com/ISRCTN17975376 (Archived by WebCite at http://www.webcitation.org/76VGZsZug)
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Affiliation(s)
- Jennifer M Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - David P French
- Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Christopher C Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Aisling Gough
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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22
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Jay M, Orstad SL, Wali S, Wylie-Rosett J, Tseng CH, Sweat V, Wittleder S, Shu SB, Goldstein NJ, Ladapo JA. Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial. BMJ Open 2019; 9:e025278. [PMID: 30962231 PMCID: PMC6500238 DOI: 10.1136/bmjopen-2018-025278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Obesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone. METHODS AND ANALYSIS We are recruiting 795 adults, aged 18-70 years with a body mass index ≥30 kg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5% to ≥5% reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months. ETHICS AND DISSEMINATION Human research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders. TRIAL REGISTRATION NUMBER NCT03157713.
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Affiliation(s)
- Melanie Jay
- Departments of Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Soma Wali
- Department of Medicine, Olive View-University of California Los Angeles (UCLA) Medical Center, Sylmar, California, USA
| | - Judith Wylie-Rosett
- Division of Health Promotion and Nutrition Research, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Victoria Sweat
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Sandra Wittleder
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Suzanne B Shu
- Anderson School of Management at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Noah J Goldstein
- Anderson School of Management at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Teixeira-Poit SM, Treiman KA, Li L, Hoerger TJ, Carmody D, Tardif-Douglin M. Perceived Impact of Incentives for Chronic Disease Prevention. Am J Prev Med 2019; 56:563-570. [PMID: 30898222 DOI: 10.1016/j.amepre.2018.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study evaluates the effect of program and incentive characteristics on satisfaction with incentives and perceived impact of incentives on behavior change among Medicaid beneficiaries who participated in the Centers for Medicare and Medicaid Services Medicaid Incentives for Prevention of Chronic Diseases program. METHODS In 2014-2015, an English- and Spanish-language survey was administered to Medicaid Incentives for Prevention of Chronic Diseases program participants about their satisfaction with incentives and perceived impact of incentives. Completed surveys were received from 2,276 eligible sample members (response rate=52.7%). In 2016-2017, multilevel, multivariable, ordinal logistic regression models were performed to examine program characteristics that predict outcomes, while controlling for respondent characteristics. RESULTS Medicaid Incentives for Prevention of Chronic Diseases participants were satisfied with program incentives. Most survey respondents strongly agreed that they liked getting incentives for taking care of their health (78%), they were happy with the incentives overall (75%), the incentives were fair (73%), and they liked how often they received incentives (67%). Participants in programs delivered by telephone reported higher satisfaction with incentives compared with those in programs delivered in person. However, participants in programs delivered both in person and by telephone were more likely to perceive a positive impact of incentives. Incentive form was a significant predictor of satisfaction with incentives but not of incentive impact. Dollar amount of incentives influenced satisfaction with incentives and impact of incentives. CONCLUSIONS Program delivery method, incentive form, and incentive magnitude are important characteristics to consider when designing incentive programs. Incentive programs can consider providing modest incentive amounts to achieve self-reported impact on behavior change.
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Affiliation(s)
- Stephanie M Teixeira-Poit
- Department of Social Work and Sociology, College of Health and Human Sciences, North Carolina A&T State University, Greensboro, North Carolina.
| | - Katherine A Treiman
- Center for Communication Science, Public Health Research Division, RTI International, Rockville, Maryland
| | - Lei Li
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
| | - Thomas J Hoerger
- Health Economics, Public Health Research Division, RTI International, Research Triangle Park, North Carolina
| | | | - Miriam Tardif-Douglin
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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The Association Between Incentive Designs and Health Assessment or Biometric Screening Completion. J Occup Environ Med 2019; 61:e146-e149. [DOI: 10.1097/jom.0000000000001556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Impact of Financial Incentives on Service Use, Spending, and Health in Medicaid. Am J Prev Med 2018; 55:875-886. [PMID: 30454639 DOI: 10.1016/j.amepre.2018.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/20/2018] [Accepted: 07/20/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Centers for Medicare and Medicaid Services provided grants to Medicaid programs through the Medicaid Incentives for Prevention of Chronic Diseases program to test whether financial incentives changed the use of healthcare services, Medicaid spending, and health outcomes. Six states implemented programs related to diabetes prevention, weight management, diabetes management, and hypertension management. The purpose of this study is to examine whether receipt of financial incentives increased use of services incentivized by the program; reduced expenditures, inpatient admissions, emergency department visits; and improved health outcomes. METHODS State data on program participation and incentives (between 2011 and 2015) and 2 years of Medicaid claims data pre-Medicaid Incentives for Prevention of Chronic Diseases enrollment and >2 years of claims data after enrollment were analyzed using covariate-adjusted regression analyses. Negative binomial, logistic, and linear regressions were used, depending on the outcome variable of interest (services, inpatient admissions and emergency department visits, and total expenditures). Analyses were conducted in 2015 and 2016. RESULTS Incentive recipients attended, on average, one to two more diabetes prevention classes than control participants, but incentives did not significantly improve uptake of other types of services, such as meetings with a health coach or doctor, gym visits, or attendance at Weight Watchers meetings. Modest improvements in health outcomes, such as weight loss, were observed, yet there were very few significant changes in inpatient admissions, emergency department visits, and Medicaid expenditures. CONCLUSIONS Financial incentives are useful for engaging Medicaid enrollees in disease prevention programs, but program engagement may not necessarily lead to changing patterns of healthcare utilization and expenditures in the short run.
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Glanz K, Shaw PA, Hoffer K, Chung A, Zhu J, Wu R, Huang QE, Choi JR, Volpp KG. The Healthy Weigh study of lottery-based incentives and environmental strategies for weight loss: Design and baseline characteristics. Contemp Clin Trials 2018; 76:24-30. [PMID: 30455160 DOI: 10.1016/j.cct.2018.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
Abstract
Identifying effective strategies for treating obesity is a clinical challenge and a public health priority. The present study is an innovative test of the relative effectiveness of lottery-based financial incentives and environmental strategies on weight loss and maintenance. The Healthy Weigh study is evaluating the comparative effectiveness of behavioral economic financial incentives and environmental strategies, separately and together, in achieving initial weight loss and maintenance of weight loss, in obese urban employee populations. Healthy Weigh is a multi-site, 4-arm randomized controlled trial (RCT) in which 344 employed participants were randomized to one of four arms. The study arms are: 1) standard employee wellness benefits and weigh-ins every 6 months (control arm/usual care); and the control/usual care plus either: 2) daily lottery incentives tied to achievement of weight loss goals (incentive arm); 3) individually tailored environmental strategies around food intake and physical activity (environmental arm); or 4) a combination of incentives and environmental strategies (combined arm). This trial used a web-based platform to enroll, communicate with, and track participant weight change. Wireless scales were used by participants in the three treatment group arms to digitally transmit daily/weekly weights. For females, the baseline median (interquartile range, IQR) for BMI and weight were 37.0 (33.5, 40.6) and 219.9 (198.1, 248.6), respectively; and for males, they were 36.0 (32.8, 39.8) and 247.9 (228.1, 279.5), respectively. The population was generally well-educated. This study demonstrated that multi-site employee-based recruitment for a weight-control intervention study is feasible but may need additional time for coordination between diverse environments.
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Affiliation(s)
- Karen Glanz
- University of Pennsylvania, 423 Guardian Drive, 801 Blockley Hall, Philadelphia, PA 19104, United States.
| | - Pamela A Shaw
- University of Pennsylvania, 423 Guardian Drive, 6th Floor Blockley Hall, Philadelphia, PA 19104, United States.
| | - Karen Hoffer
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, 423 Guardian Drive, 11th Floor Blockley Hall, Philadelphia, PA 19104, United States.
| | - Annie Chung
- University of Pennsylvania, 423 Guardian Drive, 801 Blockley Hall, Philadelphia, PA 19104, United States.
| | - Jingsan Zhu
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, 423 Guardian Drive, 11th Floor Blockley Hall, Philadelphia, PA 19104, United States.
| | - Ruoming Wu
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, 423 Guardian Drive, 11th Floor Blockley Hall, Philadelphia, PA 19104, United States.
| | - Qian Erin Huang
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, 423 Guardian Drive, 11th Floor Blockley Hall, Philadelphia, PA 19104, United States.
| | - Ji Rebekah Choi
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, 423 Guardian Drive, 11th Floor Blockley Hall, Philadelphia, PA 19104, United States.
| | - Kevin G Volpp
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, 423 Guardian Drive, 11th Floor Blockley Hall, Philadelphia, PA 19104, United States.
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Vasquez K, Malhotra R, Østbye T, Low W, Chan MF, Chew L, Ling A. Lessons from Singapore's national weight management program, Lose To Win. Health Promot Int 2018; 33:834-845. [PMID: 28541435 DOI: 10.1093/heapro/dax021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The prevalence of overweight and obesity in Singapore is lower than in most countries, but it is increasing. There is evidence health complications may appear at lower weights among Asians. We describe the evolution of a national weight management program [Lose To Win (LTW)] organized by the Singapore Health Promotion Board from 2009 to 2013. LTW is a 12-week program comprising nutrition education, physical activity and mental wellbeing sessions and interim assessments. Individuals aged 18-69 years with a body mass index (BMI) between 23 and 37.4 kg/m2 were included. Primary outcomes were change in weight and BMI from baseline to end of 12-weeks. Effectiveness of the weight loss program was assessed using non-randomized control group (delayed intervention) during LTW 2010 and 2012. LTW 2009 enrolled 285 participants from 72 worksites. LTW 2010, expanded to the community, enrolling 952 participants (641 community-based and 311 workplace-based). In LTW 2012 and 2013, 959 and 1412 participants, respectively, were recruited from the community only. Completion rates of the 12-week program varied from 49 to 88%. Average weight loss ranged from 1.3 to 3.6 kg. For rounds including a control group, weight loss was higher in the intervention than in the control group. Competition and incentives were important motivators for participation. The LTW program was well-received and effective in producing short-term weight loss. Enhancements will be done to reinforce success factors in subsequent rounds to boost participation and follow-up rates and to ensure long-term sustainability.
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Affiliation(s)
- Kathryn Vasquez
- Obesity Prevention and Management, Health Promotion Board, Singapore
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Truls Østbye
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Wilson Low
- Research and Strategic Planning Division, Health Promotion Board, Singapore
| | - Mei Fen Chan
- Research and Strategic Planning Division, Health Promotion Board, Singapore
| | - Ling Chew
- Research and Strategic Planning Division, Health Promotion Board, Singapore
| | - Annie Ling
- Obesity Prevention and Management, Health Promotion Board, Singapore
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Leavy JM, Clifton PM, Keogh JB. The Role of Choice in Weight Loss Strategies: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:E1136. [PMID: 30134595 PMCID: PMC6164582 DOI: 10.3390/nu10091136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 12/02/2022] Open
Abstract
Effective strategies to achieve weight loss and long-term weight loss maintenance have proved to be elusive. This systematic review and meta-analysis aims to explore whether the choice of weight loss strategy is associated with greater weight loss. An electronic search was conducted using the MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO (Database of Abstracts of Literature in the Field of Psychology, produced by the American Psychological Association and distributed on the association's APA PsycNET) databases for clinical trials and randomized controlled trials, investigating the role of choice in weight loss strategies. A total of nine studies were identified as meeting the pre-specified criteria. All of the studies included a 'Choice' or preference arm and a 'No Choice' arm or group who did not receive their preference as a control. A total of 1804 subjects were enrolled in these studies, with weight loss observed in both experimental and control groups of all studies, irrespective of dietary intervention, study duration, or follow-up length. Twelve interventions in nine trials were used for the meta-analysis, with results indicating a greater weight loss in the control groups, 1.09 ± 0.28 (overall mean difference in weight loss between groups ± standard error; p = 0). There was no significant effect of duration or attrition. In this meta-analysis, the choice of weight loss strategy did not confer a weight loss benefit.
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Affiliation(s)
- Jill M Leavy
- Dublin Institute of Technology, Dublin 6, Ireland.
- Trinity College Dublin, Dublin 6, Ireland.
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5000, Australia.
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5000, Australia.
| | - Jennifer B Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5000, Australia.
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Treiman KA, Teixeira-Poit S, Li L, Tardif-Douglin M, Gaines J, Hoerger T. Participant Satisfaction and Perceptions About Program Impact in the Medicaid Incentives for Prevention of Chronic Disease Pilot Program. Am J Health Promot 2018; 33:381-390. [PMID: 30012014 DOI: 10.1177/0890117118785351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Evaluate the Centers for Medicare & Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program in terms of participant satisfaction and self-reported program impact. DESIGN Participant survey (mail/telephone follow-up), English and Spanish (N = 2274). SETTINGS Ten states in MIPCD program. PARTICIPANTS Medicaid beneficiaries. INTERVENTION Incentive-based health promotion programs targeting diabetes prevention and management, smoking cessation, and weight, hypertension, and cholesterol management. MEASURES Dependent measures are (1) overall program satisfaction and (2) self-reported program impact, operationalized as whether program helped with understanding health issues, learning ways to take care of health, and encouraging healthy lifestyle changes. ANALYSIS Multilevel multivariable ordinal logistic regression models to identify predictors of overall program satisfaction and program impact. RESULTS Sixty-seven percent were very satisfied with the program, and 76% strongly agreed the program encouraged healthy lifestyle changes. Age (59+ vs <45 years) and being female predicted overall program satisfaction. Satisfaction with specific aspects of the program including communication with staff, accessibility, and incentives predicted higher overall satisfaction. Age (45-52 vs <45 years) and being black or Hispanic predicted higher program impact. Points redeemable for rewards performed worse than money-valued incentives in terms of encouraging lifestyle changes (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.11-0.82). Participants receiving incentives valued at $25 to <$100 were more likely to report higher agreement that the program helped them learn ways to care for their health (OR, 1.72; 95% CI, 1.21-2.44) and encouraged lifestyle changes (OR, 1.46; 95% CI, 1.02-2.10), compared to participants receiving incentives valued at $0 to <$25. Incentives valued at $100 to <$400 predicted higher agreement that the program helped with understanding of health issues (OR, 1.62; 95% CI, 1.13-2.33), compared to incentives valued at $0 to <$25. CONCLUSION Effective chronic disease prevention programs are needed for Medicaid populations. Study findings highlight important considerations for incentive-based programs.
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Affiliation(s)
| | | | - Lei Li
- 2 RTI International, Research Triangle Park, NC, USA
| | | | - Jean Gaines
- 3 Centers for Medicare & Medicaid Services, Baltimore, MD, USA
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Discrete Choice Experiments on The Acceptability of Monetary-Based Health Treatments: A Replication and Extension to Deposit Contracts. PSYCHOLOGICAL RECORD 2018. [DOI: 10.1007/s40732-018-0296-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Witman A, Acquah J, Alva M, Hoerger T, Romaire M. Medicaid Incentives for Preventing Chronic Disease: Effects of Financial Incentives for Smoking Cessation. Health Serv Res 2018; 53:5016-5034. [PMID: 29896800 DOI: 10.1111/1475-6773.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To test the effectiveness of financial incentives for smoking cessation in the Medicaid population. DATA SOURCES Secondary data from the Medicaid Incentives for Prevention of Chronic Disease (MIPCD) program and Medicaid claims/encounter data from 2010 to 2015 for five states. STUDY DESIGN Beneficiaries were randomized into receipt or no receipt of financial incentives. We ran multivariate regression models testing the impact of financial incentives on the use of counseling services, smoking behavior, and Medicaid expenditures and utilization. DATA EXTRACTION Participating states provided Medicaid eligibility, claims and encounters, program enrollment, and incentivized service use data. PRINCIPAL FINDINGS Participants who received incentives were more likely to call the Quitline and complete counseling sessions. Incentive receipt was positively associated with self-reported quit attempts, self-reported quits, or passing cotinine tests of smoking cessation in most programs, although results were only statistically significant in a subset. There was no systematic evidence that incentives affected health care use or spending. CONCLUSIONS Financial incentives are a promising policy lever to motivate behavioral change in the Medicaid population, but more evidence is needed regarding optimal incentive size, effectiveness of process-versus outcome-based incentives, targeting of incentives, and long-run cost-effectiveness.
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Financial incentive strategies for maintenance of weight loss: results from an internet-based randomized controlled trial. Nutr Diabetes 2018; 8:33. [PMID: 29795365 PMCID: PMC5968035 DOI: 10.1038/s41387-018-0036-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/11/2018] [Accepted: 03/23/2018] [Indexed: 11/09/2022] Open
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.
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Ananthapavan J, Peterson A, Sacks G. Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity - a systematic review. Obes Rev 2018; 19:605-613. [PMID: 29266677 DOI: 10.1111/obr.12657] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
Curbing the obesity epidemic is likely to require a suite of interventions targeting the obesogenic environment as well as individual behaviour. Evidence suggests that the effectiveness of behaviour modification programmes can be enhanced by financial incentives that immediately reward weight loss behaviour. This systematic review investigated the effectiveness of incentives with a focus on assessing the relative effectiveness of incentives that target different behaviours as well as factors of importance when implementing these programmes in real-world settings (health insurer settings). A narrative review of the academic and grey literature including a variety of study designs was undertaken. Twenty studies met inclusion criteria and were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results suggest that incentivizing weight loss is effective in the short term while the incentives are in place. There are various incentive designs, and although the relative effectiveness of each of these on weight loss is not clear, it appears that positive incentives increase the uptake into programmes and may reduce dropouts. As with other weight loss initiatives, there is a need to explore ways to maintain weight loss in the longer term - incentives for weight maintenance could play a role.
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Affiliation(s)
- J Ananthapavan
- Deakin University, Geelong, Australia, Deakin Health Economics, Centre for Population Health Research.,Deakin University, Geelong, Australia, Global Obesity Centre, Centre for Population Health Research
| | - A Peterson
- Deakin University, Geelong, Australia, Deakin Health Economics, Centre for Population Health Research
| | - G Sacks
- Deakin University, Geelong, Australia, Global Obesity Centre, Centre for Population Health Research
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Ward DS, Vaughn AE, Hales D, Viera AJ, Gizlice Z, Bateman LA, Grummon AH, Arandia G, Linnan LA. Workplace health and safety intervention for child care staff: Rationale, design, and baseline results from the CARE cluster randomized control trial. Contemp Clin Trials 2018; 68:116-126. [PMID: 29501740 PMCID: PMC5944351 DOI: 10.1016/j.cct.2018.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Low-wage workers suffer disproportionately high rates of chronic disease and are important targets for workplace health and safety interventions. Child care centers offer an ideal opportunity to reach some of the lowest paid workers, but these settings have been ignored in workplace intervention studies. METHODS Caring and Reaching for Health (CARE) is a cluster-randomized controlled trial evaluating efficacy of a multi-level, workplace-based intervention set in child care centers that promotes physical activity and other health behaviors among staff. Centers are randomized (1:1) into the Healthy Lifestyles (intervention) or the Healthy Finances (attention control) program. Healthy Lifestyles is delivered over six months including a kick-off event and three 8-week health campaigns (magazines, goal setting, behavior monitoring, tailored feedback, prompts, center displays, director coaching). The primary outcome is minutes of moderate and vigorous physical activity (MVPA); secondary outcomes are health behaviors (diet, smoking, sleep, stress), physical assessments (body mass index (BMI), waist circumference, blood pressure, fitness), and workplace supports for health and safety. RESULTS In total, 56 centers and 553 participants have been recruited and randomized. Participants are predominately female (96.7%) and either Non-Hispanic African American (51.6%) or Non-Hispanic White (36.7%). Most participants (63.4%) are obese. They accumulate 17.4 (±14.2) minutes/day of MVPA and consume 1.3 (±1.4) and 1.3 (±0.8) servings/day of fruits and vegetables, respectively. Also, 14.2% are smokers; they report 6.4 (±1.4) hours/night of sleep; and 34.9% are high risk for depression. CONCLUSIONS Baseline data demonstrate several serious health risks, confirming the importance of workplace interventions in child care.
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Affiliation(s)
- Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB 7461, Chapel Hill, NC 27599-7461, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., Chapel Hill, NC 27599-7426, USA.
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., Chapel Hill, NC 27599-7426, USA.
| | - Derek Hales
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB 7461, Chapel Hill, NC 27599-7461, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., Chapel Hill, NC 27599-7426, USA.
| | - Anthony J Viera
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., Chapel Hill, NC 27599-7426, USA.
| | - Lori A Bateman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., Chapel Hill, NC 27599-7426, USA.
| | - Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA.
| | - Gabriela Arandia
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA.
| | - Laura A Linnan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA.
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Marti J, Bachhuber M, Feingold J, Meads D, Richards M, Hennessy S. Financial incentives to discontinue long-term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate. BMJ Open 2017; 7:e016229. [PMID: 28988167 PMCID: PMC5640034 DOI: 10.1136/bmjopen-2017-016229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Investigate the acceptability of financial incentives for initiating a medically supervised benzodiazepine discontinuation programme among people with long-term benzodiazepine use and to identify programme features that influence willingness to participate. METHODS We conducted a discrete choice experiment in which we presented a variety of incentive-based programs to a sample of older adults with long-term benzodiazepine use identified using the outpatient electronic health record of a university-owned health system. We studied four programme variables: incentive amount for initiating the programme, incentive amount for successful benzodiazepine discontinuation, lottery versus certain payment and whether partial payment was given for dose reduction. Respondents reported their willingness to participate in the programmes and additional information was collected on demographics, history of use and anxiety symptoms. RESULTS The overall response rate was 28.4%. Among the 126 respondents, all four programme variables influenced stated preferences. Respondents strongly preferred guaranteed cash-based incentives as opposed to a lottery, and the dollar amount of both the starting and conditional incentives had a substantial impact on choice. Willingness to participate increased with the amount of conditional incentive. Programme participation also varied by gender, duration of use and income. CONCLUSIONS Participation in an incentive-based benzodiazepine discontinuation programme might be relatively low, but is modifiable by programme variables including incentive amounts. These results will be helpful to inform the design of future trials of benzodiazepine discontinuation programmes. Further research is needed to assess the financial viability and potential cost-effectiveness of such economic incentives.
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Affiliation(s)
- Joachim Marti
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Marcus Bachhuber
- Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael Richards
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
| | - Sean Hennessy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
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Kullgren JT, Hafez D, Fedewa A, Heisler M. A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus. Curr Diab Rep 2017; 17:73. [PMID: 28755061 PMCID: PMC5619648 DOI: 10.1007/s11892-017-0894-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper was to review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM. RECENT FINDINGS We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggested such approaches have the potential to improve patient behaviors and such approaches should be tested more broadly.
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Affiliation(s)
- Jeffrey T Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI, USA.
- Department of Internal Medicine, University of Michigan Medical School, 3101 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
- University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Dina Hafez
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, 3101 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, 2800 Plymouth Road, Building 10, Room G016, Ann Arbor, MI, 48109, USA
| | - Allison Fedewa
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, 2800 Plymouth Road, Building 10, Room G016, Ann Arbor, MI, 48109, USA
| | - Michele Heisler
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, 3101 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
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Finkelstein EA, Tham KW, Haaland BA, Sahasranaman A. Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) - A randomized controlled trial. Soc Sci Med 2017; 185:63-70. [PMID: 28554160 DOI: 10.1016/j.socscimed.2017.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 05/02/2017] [Accepted: 05/14/2017] [Indexed: 11/25/2022]
Abstract
The prevalence of overweight and obesity has more than doubled in the past three decades, leading to rising rates of non-communicable diseases. This study tests whether adding a payment/rewards (term reward) program to an existing evidence-based weight loss program can increase weight loss and weight loss maintenance. We conducted a parallel-group randomized controlled trial from October 2012 to October 2015 with 161 overweight or obese individuals randomized to either control or reward arm in a 1:2 ratio. Control and reward arm participants received a four month weight loss program at the LIFE (Lifestyle Improvement and Fitness Enhancement) Centre at Singapore General Hospital. Those in the reward arm paid a fee of S$165.00 (1US$ = 1.35S$) to access a program that provided rewards of up to S$660 for meeting weight loss and physical activity goals. Participants could choose to receive rewards as guaranteed cash payments or a lottery ticket with a 1 in 10 chance of winning but with the same expected value. The primary outcome was weight loss at months 4, 8, and 12. 161 participants were randomized to control (n = 54) or reward (n = 107) arms. Average weight loss was more than twice as great in the reward arm compared to the control arm at month 4 when the program concluded (3.4 kg vs 1.4 kg, p < 0.01), month 8 when rewards concluded (3.3 kg vs 1.8 kg, p < 0.05), and at month 12 (2.3 kg vs 0.8 kg, p < 0.05). These results reveal that a payment/rewards program can be used to improve weight loss and weight loss maintenance when combined with an evidence-based weight loss program. Future efforts should attempt to replicate this approach and identify how to cost effectively expand these programs to maximize their reach. This study is registered at www.clinicaltrials.gov (Identifier: NCT01533454).
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Affiliation(s)
- Eric A Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Level 4 169857, Singapore; Duke Global Health Institute, Duke University, 310 Trent Drive, Durham NC 27710, United States.
| | - Kwang-Wei Tham
- Department of Endocrinology, Obesity & Metabolic Unit, Singapore General Hospital, Outram Road 169608, Singapore
| | - Benjamin A Haaland
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, 765 Ferst Drive NW, Atlanta GA 30332-0205, United States; Centre for Quantitative Medicine, Duke-NUS Medical School, 20 College Road, Level 6 169856, Singapore
| | - Aarti Sahasranaman
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Level 4 169857, Singapore
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Faghri PD, Simon J, Huedo-Medina T, Gorin A. Perceived Self-Efficacy and Financial Incentives: Factors Affecting Health Behaviors and Weight Loss in a Workplace Weight Loss Intervention. J Occup Environ Med 2017; 59:453-460. [PMID: 28486342 PMCID: PMC5704946 DOI: 10.1097/jom.0000000000000987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate if self-efficacy (SE) and financial incentives (FI) mediate the effect of health behavior on weight loss in a group of overweight and obese nursing-home employees participating in a 16-week weight-loss intervention with 12-week follow-up. METHODS Ninety nine overweight/obese (body mass index [BMI] > 25) employees from four nursing-homes participated, with a mean age of 46.98 years and BMI of 35.33. Nursing-homes were randomized to receiving an incentive-based intervention (n = 51) and no incentive (n = 48). Participants' health behaviors and eating and exercise self-efficacy (Ex-SE) were assessed at week 1, 16, and 28 using a self-reported questionnaire. Mediation and moderated mediation analysis assessed relationships among these variables. RESULTS Eating self-efficacy (Eat-SE) and Ex-SE were significant mediators between health behaviors and weight loss (P < 0.05). Incentives significantly moderated the effects of self-efficacy (P = 0.00) on weight loss. CONCLUSIONS Self-efficacy and FI may affect weight loss and play a role in weight-loss interventions.
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Affiliation(s)
- Pouran D Faghri
- Department of Allied Health Sciences (Dr Faghri, Ms Simon, Dr Huedo-Medina); and Department of Psychology (Dr Gorin), University of Connecticut, Storrs, Connecticut
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Barte JCM, Wendel-Vos GCW. A Systematic Review of Financial Incentives for Physical Activity: The Effects on Physical Activity and Related Outcomes. Behav Med 2017; 43:79-90. [PMID: 26431076 DOI: 10.1080/08964289.2015.1074880] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this review is to give an overview of the available evidence on the effects of financial incentives to stimulate physical activity. Therefore, a systematic literature search was performed for randomized trials that investigate the effects of physical-activity-related financial incentives for individuals. Twelve studies with unconditional incentives (eg, free membership sport facility) and conditional incentives (ie, rewards for reaching physical-activity goals) related to physical activity were selected. Selected outcomes were physical activity, sedentary behavior, fitness, and weight. Results show that unconditional incentives do not affect physical activity or the other selected outcomes. For rewards, some positive effects were found and especially for rewards provided for physical-activity behavior instead of attendance. In conclusion, rewards seem to have positive effects on physical activity, while unconditional incentives seem to have no effect. However, it should be kept in mind that the long-term effects of financial incentives are still unclear.
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Affiliation(s)
- Jeroen C M Barte
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment , Bilthoven , the Netherlands.,b Behavioural Science Institute , Radboud University , Nijmegen , the Netherlands
| | - G C Wanda Wendel-Vos
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment , Bilthoven , the Netherlands
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Adams MA, Hurley JC, Todd M, Bhuiyan N, Jarrett CL, Tucker WJ, Hollingshead KE, Angadi SS. Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to increase adults' physical activity. BMC Public Health 2017; 17:286. [PMID: 28356097 PMCID: PMC5372290 DOI: 10.1186/s12889-017-4197-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background Emerging interventions that rely on and harness variability in behavior to adapt to individual performance over time may outperform interventions that prescribe static goals (e.g., 10,000 steps/day). The purpose of this factorial trial was to compare adaptive vs. static goal setting and immediate vs. delayed, non-contingent financial rewards for increasing free-living physical activity (PA). Methods A 4-month 2 × 2 factorial randomized controlled trial tested main effects for goal setting (adaptive vs. static goals) and rewards (immediate vs. delayed) and interactions between factors to increase steps/day as measured by a Fitbit Zip. Moderate-to-vigorous PA (MVPA) minutes/day was examined as a secondary outcome. Results Participants (N = 96) were mainly female (77%), aged 41 ± 9.5 years, and all were insufficiently active and overweight/obese (mean BMI = 34.1 ± 6.2). Participants across all groups increased by 2389 steps/day on average from baseline to intervention phase (p < .001). Participants receiving static goals showed a stronger increase in steps per day from baseline phase to intervention phase (2630 steps/day) than those receiving adaptive goals (2149 steps/day; difference = 482 steps/day, p = .095). Participants receiving immediate rewards showed stronger improvement (2762 step/day increase) from baseline to intervention phase than those receiving delayed rewards (2016 steps/day increase; difference = 746 steps/day, p = .009). However, the adaptive goals group showed a slower decrease in steps/day from the beginning of the intervention phase to the end of the intervention phase (i.e. less than half the rate) compared to the static goals group (−7.7 steps vs. -18.3 steps each day; difference = 10.7 steps/day, p < .001) resulting in better improvements for the adaptive goals group by study end. Rate of change over the intervention phase did not differ between reward groups. Significant goal phase x goal setting x reward interactions were observed. Conclusions Adaptive goals outperformed static goals (i.e., 10,000 steps) over a 4-month period. Small immediate rewards outperformed larger, delayed rewards. Adaptive goals with either immediate or delayed rewards should be preferred for promoting PA. Trial Registration ClinicalTrials.gov ID: NCT02053259 registered prospectively on January 31, 2014.
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Affiliation(s)
- Marc A Adams
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA. .,Global Institute of Sustainability (GIOS), Arizona State University, Tempe, AZ, 85287, USA.
| | - Jane C Hurley
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Michael Todd
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA.,College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004, USA
| | - Nishat Bhuiyan
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Catherine L Jarrett
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Wesley J Tucker
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Kevin E Hollingshead
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Siddhartha S Angadi
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
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Patel MS, Asch DA, Troxel AB, Fletcher M, Osman-Koss R, Brady J, Wesby L, Hilbert V, Zhu J, Wang W, Volpp KG. Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study. Health Aff (Millwood) 2017; 35:71-9. [PMID: 26733703 DOI: 10.1377/hlthaff.2015.0945] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior, but the effectiveness of those adjustments is controversial. We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight. They were randomly assigned to a control arm, with no financial incentive for achieving the goal, or to one of three intervention arms offering an incentive valued at $550. Two intervention arms used health insurance premium adjustments, beginning the following year (delayed) or in the first pay period after achieving the goal (immediate). A third arm used a daily lottery incentive separate from premiums. At twelve months there were no statistically significant differences in mean weight change either between the control group (whose members had a mean gain of 0.1 pound) and any of the incentive groups (delayed premium adjustment, -1.2 pound; immediate premium adjustment, -1.4 pound; daily lottery incentive, -1.0 pound) or among the intervention groups. The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.
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Affiliation(s)
- Mitesh S Patel
- Mitesh S. Patel is an assistant professor of medicine at the Perelman School of Medicine and of health care management at the Wharton School, and a faculty member at the Leonard Davis Institute Center for Health Incentives and Behavioral Economics (CHIBE), all at the University of Pennsylvania; and a staff physician at the Crescenz Veterans Affairs (VA) Medical Center, all in Philadelphia
| | - David A Asch
- David A. Asch is a professor of medicine, medical ethics and health policy, and anesthesiology and critical care medicine at the Perelman School of Medicine and of health care management and operations, information, and decision at the Wharton School, and a member of the faculty at CHIBE, all at the University of Pennsylvania; executive director of the Penn Medicine Center for Health Care Innovation; and a staff physician at the Crescenz VA Medical Center, all in Philadelphia
| | - Andrea B Troxel
- Andrea B. Troxel is a professor of biostatistics and associate director of the Division of Biostatistics in the Department of Biostatistics at the Perelman School of Medicine; and director of Biostatistics at CHIBE, all at the University of Pennsylvania
| | - Michele Fletcher
- Michele Fletcher is associate vice president of human resources at the University of Pennsylvania Health System, in Philadelphia
| | - Rosemary Osman-Koss
- Rosemary Osman-Koss is director of employee benefits at the University of Pennsylvania Health System
| | - Jennifer Brady
- Jennifer Brady is a manager of employee health and well-being at the University of Pennsylvania Health System
| | - Lisa Wesby
- Lisa Wesby is Way to Health research operations manager at CHIBE
| | | | - Jingsan Zhu
- Jingsan Zhu is assistant director of data operations at CHIBE
| | | | - Kevin G Volpp
- Kevin G. Volpp is a professor of medicine at the Perelman School of Medicine and of health care management at the Wharton School; vice chairman for health policy in the Department of Medical Ethics and Health Policy; and director of CHIBE, all at the University of Pennsylvania; and a staff physician at the Crescenz VA Medical Center
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Wilson ER, Kyle TK, Nadglowski JF, Stanford FC. Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI. Obesity (Silver Spring) 2017; 25:370-377. [PMID: 28063213 PMCID: PMC6100791 DOI: 10.1002/oby.21746] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/18/2016] [Accepted: 11/21/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Evidence-based obesity treatments, such as bariatric surgery, are not considered essential health benefits under the Affordable Care Act. Employer-sponsored wellness programs with incentives based on biometric outcomes are allowed and often used despite mixed evidence regarding their effectiveness. This study examines consumers' perceptions of their coverage for obesity treatments and exposure to workplace wellness programs. METHODS A total of 7,378 participants completed an online survey during 2015-2016. Respondents answered questions regarding their health coverage for seven medical services and exposure to employer wellness programs that target weight or body mass index (BMI). Using χ2 tests, associations between perceptions of exposure to employer wellness programs and coverage for medical services were examined. Differences between survey years were also assessed. RESULTS Most respondents reported they did not have health coverage for obesity treatments, but more of the respondents with employer wellness programs reported having coverage. Neither the perception of coverage for obesity treatments nor exposure to wellness programs increased between 2015 and 2016. CONCLUSIONS Even when consumers have exposure to employer wellness programs that target BMI, their health insurance often excludes obesity treatments. Given the clinical and cost-effectiveness of such treatments, reducing that coverage gap may mitigate obesity's individual- and population-level effects.
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Affiliation(s)
| | - Theodore K. Kyle
- ConscienHealth, Pittsburgh, Pennsylvania, USA
- Obesity Action Coalition, Tampa, Florida, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital-Department of Medicine-Gastroenterology, MGH Weight Center, Harvard Medical School, Boston, Massachusetts, USA. Correspondence: Fatima Cody Stanford ()
- Department of Pediatrics-Endocrinology, MGH Weight Center, Harvard Medical School, Boston, Massachusetts, USA
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Ouayogodé MH. Effectiveness of weight loss intervention in highly-motivated people. ECONOMICS AND HUMAN BIOLOGY 2016; 23:263-282. [PMID: 27816867 DOI: 10.1016/j.ehb.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/26/2016] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
Abstract
A variety of approaches have been implemented to address the rising obesity epidemic, with limited success. I consider the success of weight loss efforts among a group of highly motivated people: those required to lose weight in order to qualify for a life-saving kidney transplantation. Out of 246 transplantation centers, I identified 156 (63%) with explicit body mass index (BMI) requirements for transplantation, ranging from 30 to 50kg/m2. Using the United States national registry of transplant candidates, I examine outcomes for 29,608 obese deceased-donor transplant recipients between 1990 and 2010. I use value-added models to deal with potential endogeneity of center choice, in addition to correcting for sample selection bias arising from focusing on transplant recipients. Outcome variables measure BMI level and weight change (in BMI) between initial listing and transplantation. I hypothesize that those requiring weight loss to qualify for kidney transplantation will be most likely to lose weight. I find that the probability of severe and morbid obesity (BMI≥35kg/m2) decreases by 4 percentage points and the probability of patients achieving any weight loss increases by 22 percentage points at centers with explicit BMI eligibility criteria. Patients are also 13 percentage points more likely to accomplish clinically relevant weight loss of at least 5% of baseline BMI by transplantation at these centers. Nonetheless, I estimate an average decrease in BMI of only 1.7kg/m2 for those registered at centers with BMI requirements. Further analyses suggest stronger intervention effects for patients whose BMI at listing exceeds thresholds as the distance from their BMI to the thresholds increases. Even under circumstances with great potential returns for weight loss, transplant candidates exhibit modest weight-loss. This suggests that, even in high-stakes environments, weight loss remains a challenge for the obese, and altering individual incentives may not be sufficient.
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Affiliation(s)
- Mariétou H Ouayogodé
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Level 5, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, United States.
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Caperchione CM, Sabiston CM, Clark MI, Bottorff JL, Toxopeus R, Campbell KL, Eves ND, Ellard SL, Gotay C. Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study. BMJ Open 2016; 6:e012533. [PMID: 27531738 PMCID: PMC5013483 DOI: 10.1136/bmjopen-2016-012533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Physical activity is a cost-effective and non-pharmaceutical strategy that can help mitigate the physical and psychological health challenges associated with breast cancer survivorship. However, up to 70% of women breast cancer survivors are not meeting minimum recommended physical activity guidelines. Project MOVE is an innovative approach to increase physical activity among breast cancer survivors through the use of Action Grants, a combination of microgrants (small amounts of money awarded to groups of individuals to support a physical activity initiative) and financial incentives. The purpose of this paper is to describe the rationale and protocol of Project MOVE. METHOD AND ANALYSIS A quasi-experimental pre-post design will be used. Twelve groups of 8-12 adult women who are breast cancer survivors (N=132) were recruited for the study via face-to-face meetings with breast cancer-related stakeholders, local print and radio media, social media, and pamphlets and posters at community organisations and medical clinics. Each group submitted a microgrant application outlining their proposed physical activity initiative. Successful applicants were determined by a grant review panel and informed of a financial incentive on meeting their physical activity goals. An evaluation of feasibility will be guided by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and assessed through focus groups, interviews and project-related reports. Physical activity will be assessed through accelerometry and by self-report. Quality of life, motivation to exercise and social connection will also be assessed through self-report. Assessments will occur at baseline, 6 months and 1 year. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board (#H14-02502) and has been funded by the Canadian Cancer Society Research Institute (project number #702913). Study findings will be disseminated widely through peer-reviewed publications, academic conferences, local community-based presentations, as well as partner organisations, including the Canadian Cancer Society.
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Affiliation(s)
- Cristina M Caperchione
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Marianne I Clark
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Renee Toxopeus
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil D Eves
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | - Susan L Ellard
- Cancer Centre of the Southern Interior, British Columbia Cancer Agency, Kelowna, British Columbia, Canada
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Terry PE, Pshock J, O'Donnell MP, Cawley J, Karen H, Whitsel L, Calitz C, Fonarow GC, Terry P. The Art of Health Promotion ideas for improving health outcomes. Am J Health Promot 2016; 30:475. [PMID: 27445328 DOI: 10.1177/0890117116658726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paul E Terry
- HERO: The Health Enhancement Research OrganizationEditor, The Art of Health Promotion
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Weerasekara YK, Roberts SB, Kahn MA, LaVertu AE, Hoffman B, Das SK. Effectiveness of Workplace Weight Management Interventions: a Systematic Review. Curr Obes Rep 2016; 5:298-306. [PMID: 27023071 DOI: 10.1007/s13679-016-0205-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A systematic review was conducted of randomized trials of workplace weight management interventions, including trials with dietary, physical activity, environmental, behavioral, and incentive-based components. Main outcomes were defined as change in weight-related measures. Keywords related to weight management and workplace interventions were used to search relevant databases, and 23 eligible studies were reviewed in detail using a data extraction form and quality assessment checklist. The trials were conducted mainly in the USA and Europe, with four additional countries represented. Interventions were mostly multicomponent and were implemented in both sexes and in a range of employment categories. Intervention effectiveness appeared unrelated to region of the world and was highest in 6-12-month trials. The results ranged widely from clinically significant 8.8-kg weight loss in one trial to less effective than the control treatment in others. Some workplace interventions achieve clinically significant benefits, and further studies are needed to replicate those results in wider sociocultural and geographical contexts.
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Affiliation(s)
- Yasoma Kumari Weerasekara
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Susan B Roberts
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Mira A Kahn
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA
| | - Amy E LaVertu
- Hirsh Health Sciences Library, Tufts University, Boston, MA, USA
| | - Ben Hoffman
- General Electric Medical Services, GE, Chicago, IL, USA
- University of Texas School of Public Health, San Antonio, TX, USA
| | - Sai Krupa Das
- Obesity and Energetics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, USA.
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Kullgren JT, Williams GC, Resnicow K, An LC, Rothberg A, Volpp KG, Heisler M. The Promise of Tailoring Incentives for Healthy Behaviors. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2016; 9:2-16. [PMID: 29242715 PMCID: PMC5726567 DOI: 10.1108/ijwhm-12-2014-0060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe how tailoring financial incentives for healthy behaviors to employees' goals, values, and aspirations might improve the efficacy of incentives. DESIGN/METHODOLOGY/APPROACH We integrate insights from self-determination theory (SDT) with principles from behavioral economics in the design of financial incentives by linking how incentives could help meet an employee's life goals, values, or aspirations. FINDINGS Tailored financial incentives could be more effective than standard incentives in promoting autonomous motivation necessary to initiate healthy behaviors and sustain them after incentives are removed. RESEARCH IMPLICATIONS Previous efforts to improve the design of financial incentives have tested different incentive designs that vary the size, schedule, timing, and target of incentives. Our strategy for tailoring incentives builds on strong evidence that difficult behavior changes are more successful when integrated with important life goals and values. We outline necessary research to examine the effectiveness of this approach among at-risk employees. PRACTICAL IMPLICATIONS Instead of offering simple financial rewards for engaging in healthy behaviors, existing programs could leverage incentives to promote employees' autonomous motivation for sustained health improvements. SOCIAL IMPLICATIONS Effective application of these concepts could lead to programs more effective at improving health, potentially at lower cost. ORIGINALITY/VALUE Our approach for the first time integrates key insights from SDT, behavioral economics, and tailoring to turn an extrinsic reward for behavior change into an internalized, self-sustaining motivator for long-term engagement in risk-reducing behaviors.
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Affiliation(s)
- Jeffrey T Kullgren
- VA Center for Clinical Management Research and Department of Internal Medicine, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey C Williams
- Departments of Medicine and Clinical Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence C An
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy Rothberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kevin G Volpp
- Departments of Medicine and Health Care Management, Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA, USA
| | - Michele Heisler
- VA Center for Clinical Management Research and Departments of Internal Medicine and Health Behavior and Health Education, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI, USA
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Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial. Soc Sci Med 2015; 145:44-52. [PMID: 26448164 DOI: 10.1016/j.socscimed.2015.09.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/16/2015] [Accepted: 09/25/2015] [Indexed: 11/22/2022]
Abstract
There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss. Between March 2010 and January 2012, in a randomized controlled trial, we assigned 700 obese persons to three experimental arms. We test whether particular subgroups react differently to financial incentives for weight loss. Two treatment groups obtained a cash reward (€150 and €300 with 237 and 229 participants, respectively) for achieving an individually-assigned target weight within four months; the control group (234 participants) was not incentivized. Participants and administrators were not blinded to the intervention. We find that monetary rewards effectively induced obese individuals to reduce weight across all subgroups. However, there is no evidence for treatment-effect heterogeneity for those groups that were incentivized. Among those who were in the €300 group, statistically significant and large weight losses were observed for women, singles, and those who are not working (all above 4 kg in four months). In addition, the magnitude of the reward matters only for women and migrants. The effectiveness of financial incentives to reduce weight nevertheless raises sensitive ethical issues that should be taken into consideration by policymakers.
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Cawley J. An economy of scales: A selective review of obesity's economic causes, consequences, and solutions. JOURNAL OF HEALTH ECONOMICS 2015; 43:244-68. [PMID: 26279519 DOI: 10.1016/j.jhealeco.2015.03.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This paper reviews the economic research on obesity, covering topics such as the measurement of, and trends in, obesity, the economic causes of obesity (e.g. the monetary price and time cost of food, food assistance programs, income, education, macroeconomic conditions, and peer effects), and the economic consequences of obesity (e.g. lower wages, a lower probability of employment, and higher medical care costs). It also examines the extent to which obesity imposes negative externalities, and economic interventions that could potentially internalize such externalities, such as food taxes, subsidies for school-based physical activity programs, and financial rewards for weight loss. It discusses other economic rationales for government intervention with respect to obesity, such as imperfect information, time inconsistent preferences, and irrational behavior. It concludes by proposing a research agenda for the field. Overall, the evidence suggests that there is no single dominant economic cause of obesity; a wide variety of factors may contribute a modest amount to the risk. There is consistent evidence regarding the economic consequences of obesity, which are lower wages and higher medical care costs that impose negative externalities through health insurance. Studies of economic approaches to preventing obesity, such as menu labeling, taxes on energy-dense foods, and financial rewards for weight loss find only modest effects on weight and thus a range of policies may be necessary to have a substantial effect on the prevalence of obesity.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management, Cornell University, United States; Department of Economics, Cornell University, United States; School of Economics, University of Sydney, Australia.
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Breaux-Shropshire TL, Whitt L, Oster RA, Lewis D, Shropshire TS, Calhoun DA. Results of an Academic, Health Care Worksite Weight Loss Contest for Southeastern Americans: Scale Back Alabama 2011-2013. Workplace Health Saf 2015; 63:165-9. [PMID: 26081473 DOI: 10.1177/2165079915580738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few studies have assessed the effectiveness of competitive incentivized worksite weight loss programs. Scale Back Alabama (SBA) is a free, state-supported program designed to promote weight loss among overweight and obese citizens. The purpose of this manuscript is to describe the design and preliminary findings of SBA as a worksite intervention among employees at a collegiate institution and university hospital. In teams of 4 employees, SBA participants volunteered to engage in a 10-week competitive weight loss contest; both teams and individuals who lost significant weight were eligible for randomly drawn cash incentives. Trained staff objectively measured participants' weight before and at the conclusion of the contest. Preliminary analyses suggest that SBA as a worksite program can promote weight loss among employees, but future analyses are warranted to understand the context of these findings and determine if current results are confounded by unmeasured factors.
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Affiliation(s)
| | | | | | | | - Toneyell S Shropshire
- Louisiana State University, Baton Rouge Louisiana State Health Sciences Center, New Orleans
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