The investigators from the Health Weight randomised clinical trial have concluded that whilst participants across all study groups lost a modest amount of weight, study participants felt they would have benefited more from intensive guidance such as on-going counselling and coaching.
"In our Healthy Weight trial, incentives and environmental strategies led to modest but nonsignificant improvements in weight loss," explains Dr Karen Glanz, the George A Weiss University Professor and Professor of Nursing at the University of Pennsylvania School of Nursing (Penn Nursing), and the lead author of the article. "From a translational standpoint, benefits designs could consider incorporating ongoing financial incentives for weight loss among employees with obesity, while linking online support to more intensive personalised approaches."
The trial was designed 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. The study’s findings, ‘Effect of Financial Incentives and Environmental Strategies on Weight Loss in the Healthy Weigh Study’, were published in the Journal of the American Medical Association.
The trial was conducted from 2015 to 2019 at three large employers in Philadelphia, PA. 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) 30-55 and at least one other cardiovascular risk factor. Data analysis was performed from June to July 2021.
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. The primary outcome was weight change from baseline to 18 months, measured in person.
Outcomes
The study recruited 344 participants, with 86 participants each randomised 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) BMI36.5 (7.1); the majority of participants (n=247, 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 5.4lb, those in the environmental strategies group lost a mean of a 2.2lb, and the combination group lost a mean of 2.4lb 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 six months without an intervention, the difference in the change from baseline was similar to the 18-month results, with no significant differences among groups.
“In the Healthy Weigh trial, incentives and environmental strategies led to modest but nonsignificant improvements in weight loss,” the authors concluded. “From a translational standpoint, benefits designs could consider incorporating ongoing financial incentives for weight loss among employees with obesity, while linking online support to more intensive personalized interactive approaches.”
Further information
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