March 10, 2013

SAN FRANCISCO — A yearlong program in which some obese people were paid to attend weekly counseling sessions and meet weight-loss goals while others were not has shown that offering financial incentives long term appears to be a successful approach. Those who were paid lost 4 times as much weight as those who were not, Steven Driver, MD, from the Mayo Clinic, Rochester, Minnesota, told a press conference during the American College of Cardiology 2013 Scientific Sessions.

He will present his full findings during a poster session tomorrow.

And uniquely in this study, those in the financial-incentives group who failed to meet targets had to pay money out, which went into a "bonus pool" that could be won back later in the trial, explained Dr. Driver.

Dr. Steven Driver

"Usually there is something called an implementation gap, but here the reverse is happening," Dr. Driver told Medscape Medical News. Many employers are already offering some sort of workplace-wellness program with financial incentives to their employees for behavioral changes, and "that's part of the reason we wanted to do the study, because we wanted to find out what works." Prior studies have shown that people tend to lose weight in the short term with these programs, but once they stop them seem to regain the weight, he added.

"In our 1-year, randomized controlled trial we investigated the use of long-term continuous financial incentives for weight loss. Individuals who received incentives sustained much higher participation in weight-loss programs and lost significantly more weight compared with controls," he observed.

Dr. Claire Duvernoy

Asked to comment on the study, Claire Duvernoy, MD, from the University of Michigan Health System, Ann Arbor, who was not involved in the research, said: "This is happening. Smoking cessation, losing weight, achieving BP control, embarking on a regular exercise program — all those things are being tracked and rewarded or penalized, as the case may be. It's happening in my medical center and all these businesses, but we need more science to see whether this works, so this is a good first step. We'll see long term whether these sorts of programs really do make a difference. "

Those Paid Lost 4 Times the Weight of Those Who Were Not

In the study, 100 healthy adults or their dependents aged 18 to 63 years with a body mass index (BMI) of 30 to 39.9 were randomly assigned to 1 of 4 groups: education (Live It! with and without financial incentives) or education combined with a structured behavior modification plan (Lose It! with and without financial incentives). Participants were weighed monthly for a year.

It's happening in my medical center and all these businesses, but we need more science to see whether this works, so this is a good first step. Dr. Claire Duvernoy

All were given a weight loss goal of 4 lb per month (adjusted based on the previous month's weight). "Participants in the financial-incentive arms earned $10 for showing up to monthly weigh-ins, and they received $20 if they met their 4-lb weight-loss goal, but they stood to lose $20 of their own money if they failed to make their own weight-loss goal," Dr. Driver explained.

"Since we know that people not only respond to short-term financial incentives but also tend to keep playing when they know they are going to earn back more than they've lost, we diverted the losses from those who had failed to meet their weight-loss goals into an ever-growing bonus pool," he noted.

"Participants knew that they could earn half of the bonus pool via lottery if they stayed in until the end of the study. Lottery tickets were earned for 3 things: showing up to monthly weigh-ins, meeting monthly weight-loss goals, and participating via a Web site called weight tracker," he said.

About two thirds of patients (62%) in the financial-incentive groups stayed in the study for the full 52 weeks, as opposed to just 26% in the groups without incentives (p<0.001).

Those in the financial-incentive groups also "lost more weight, about 4 times more weight," Dr. Driver noted, a mean of 9.08 lb compared with 2.34 lb in the combined groups without incentives, "so we therefore concluded that financial incentives can increase participation and weight loss when sustained for up to a year."

Dr. Driver said that it is important that the intervention is "of appropriate magnitude, with proximity to the desired behavior change — we had the people pay out the $20 they owed while they were still standing on the scale for that reason.— and it has to be salient: they have to know what they are being incentivized to do."

He acknowledged to Medscape Medical News, however, that "there are still some unanswered questions. Can you develop a tolerance to financial incentives, for example? And how much is the right dose (amount of money)? I don't think we know, so it's an exciting area of research.

"There was a demand for some science behind this. The best place for incentives is to help people achieve things they already want to do instead of forcing them into things they don't want to do," he concluded.

Dr. Driver owns a small amount of a startup company called GymPact, which uses financial incentives to motivate exercise. GymPact was not involved in this study. Dr. Duvernoy has disclosed no relevant financial relationships.