Testing Strategies for Weight Loss, II
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 30 - 70 |
| Updated: | 12/7/2016 |
| Start Date: | June 2008 |
| End Date: | January 2010 |
In the pilot study, Testing Strategies for Weight Loss, we tested two different approaches
using financial incentives to encourage weight loss. In the first, we built on previous work
showing the effectiveness of 'deposit contracts', in which subjects are given the
opportunity to put their own money at risk if they do not lose weight. In this incentive
condition, subjects received a direct payment conditional on daily weight loss, and an
optional additional payment based on their own contributions to the deposit contract. We
matched their contribution 1:1 to make the option of depositing their own money attractive
to this predominantly low SES population. In the second approach we built on our own prior
work using lotteries to promote drug adherence. In this incentive condition, participants
are entered into a daily lottery, and receive any payoffs they earn from the lottery only if
they stay on track with their weight-loss goal. Given their popularity in the general
population, lotteries hold the promise of providing a cost-effective means of motivating
weight loss and making efforts to lose weight more salient to obese patients. Results from
this trial indicate significantly higher weight loss in the incentive arms of the trial than
in the control group. The low lost to follow-up rates suggest that this approach to
providing daily feedback to keep weight loss salient among participants is feasible.
Incentive participants who completed the study called in their daily weights an average
95.8% of the time. 17/19 (89.4%) of subjects deposited money in their deposit contracts and
14/17 participants who made initial deposits either held constant or increased their
contributions each month. Subjects in both incentive groups lost significantly more weight
on average than subjects in the control group (4.0 lbs) (lottery 13.1 lbs, p = 0.015;
deposit contract 14.0 lbs, p = 0.003). Of the subjects not lost to follow-up in the two
incentive arms (32 out of 38), all of them lost weight.
Based on this promising preliminary evidence and supplemental funding from the Hewlett
Foundation, we propose an 8-month study with 2 intervention arms to further examine the
effect of incentives on long term weight loss success. This study will build on the work to
date to examine which intervention is most successful in promoting sustained weight loss.
The proposed 3-arm extension will enroll 66 participants from Philadelphia VA with BMIs
between 30 and 40, starting with those potential participants who were placed on a waiting
list for our previous study after an overwhelming response to the initial mailing.
using financial incentives to encourage weight loss. In the first, we built on previous work
showing the effectiveness of 'deposit contracts', in which subjects are given the
opportunity to put their own money at risk if they do not lose weight. In this incentive
condition, subjects received a direct payment conditional on daily weight loss, and an
optional additional payment based on their own contributions to the deposit contract. We
matched their contribution 1:1 to make the option of depositing their own money attractive
to this predominantly low SES population. In the second approach we built on our own prior
work using lotteries to promote drug adherence. In this incentive condition, participants
are entered into a daily lottery, and receive any payoffs they earn from the lottery only if
they stay on track with their weight-loss goal. Given their popularity in the general
population, lotteries hold the promise of providing a cost-effective means of motivating
weight loss and making efforts to lose weight more salient to obese patients. Results from
this trial indicate significantly higher weight loss in the incentive arms of the trial than
in the control group. The low lost to follow-up rates suggest that this approach to
providing daily feedback to keep weight loss salient among participants is feasible.
Incentive participants who completed the study called in their daily weights an average
95.8% of the time. 17/19 (89.4%) of subjects deposited money in their deposit contracts and
14/17 participants who made initial deposits either held constant or increased their
contributions each month. Subjects in both incentive groups lost significantly more weight
on average than subjects in the control group (4.0 lbs) (lottery 13.1 lbs, p = 0.015;
deposit contract 14.0 lbs, p = 0.003). Of the subjects not lost to follow-up in the two
incentive arms (32 out of 38), all of them lost weight.
Based on this promising preliminary evidence and supplemental funding from the Hewlett
Foundation, we propose an 8-month study with 2 intervention arms to further examine the
effect of incentives on long term weight loss success. This study will build on the work to
date to examine which intervention is most successful in promoting sustained weight loss.
The proposed 3-arm extension will enroll 66 participants from Philadelphia VA with BMIs
between 30 and 40, starting with those potential participants who were placed on a waiting
list for our previous study after an overwhelming response to the initial mailing.
The proposed study, a 3-arm randomized control trial (RCT), would be tested with 66 patients
at Philadelphia VA with BMIs between 30 and 40. Participants in the control group would
receive usual care from their providers and monthly weigh ins. Participants in the incentive
conditions will receive daily monitoring of their weights for 32 weeks, plus a package of
financial incentives if they lose weight. Incentive group subjects will be given a weight
loss target of 24 lbs in the first 24 weeks and will be able to choose a weight loss goal of
0, 0.5, or 1 lb per week for the final two months of the study. Financial incentives in the
first deposit contract condition will consist of a potential payment for every day they are
under their target weight which consists of the prorated daily amount of their deposit
contract plus an equal 1:1 match provided by the study team for the first 6 months framed as
'weight loss period' and then for 2 months framed as 'maintenance of weight loss'. In the
second deposit condition, the incentive consists of 8 months of the prorated daily amount of
their deposit contract plus a 1:1 match (without the framing of 'weight loss' vs
'maintenance of weight loss'). We will have 80% power to find a 5 kg difference in weight
loss between the intervention and control groups. Subjects who lose more than 20 pounds in
either of the intervention groups will be eligible for an additional incentive.
The proposed interventions will serve as the basis for a larger-scale intervention study of
incentives for weight loss and maintenance that has the potential to substantially reduce
the health burden of obesity among veterans.
at Philadelphia VA with BMIs between 30 and 40. Participants in the control group would
receive usual care from their providers and monthly weigh ins. Participants in the incentive
conditions will receive daily monitoring of their weights for 32 weeks, plus a package of
financial incentives if they lose weight. Incentive group subjects will be given a weight
loss target of 24 lbs in the first 24 weeks and will be able to choose a weight loss goal of
0, 0.5, or 1 lb per week for the final two months of the study. Financial incentives in the
first deposit contract condition will consist of a potential payment for every day they are
under their target weight which consists of the prorated daily amount of their deposit
contract plus an equal 1:1 match provided by the study team for the first 6 months framed as
'weight loss period' and then for 2 months framed as 'maintenance of weight loss'. In the
second deposit condition, the incentive consists of 8 months of the prorated daily amount of
their deposit contract plus a 1:1 match (without the framing of 'weight loss' vs
'maintenance of weight loss'). We will have 80% power to find a 5 kg difference in weight
loss between the intervention and control groups. Subjects who lose more than 20 pounds in
either of the intervention groups will be eligible for an additional incentive.
The proposed interventions will serve as the basis for a larger-scale intervention study of
incentives for weight loss and maintenance that has the potential to substantially reduce
the health burden of obesity among veterans.
Inclusion Criteria:
- BMI between 30-40;
- Age between 30-70;
- At least moderately interested in losing weight (Self-reported 3,4, or 5 on 5 point
scale)
Exclusion Criteria:
- Unstable medical conditions that would likely prevent the subject from completing the
study;
- Myocardial infarction within 6 months;
- Uncontrolled hypertension, defined as BP>170 mm Hg systolic or BP>110 mm Hg
diastolic;
- Diabetic using any medicine besides metformin to control blood sugars
- Metastatic cancer;
- Self-report of 6 or more alcoholic beverages per day;
- Severe depression;
- Active substance abuse;
- Schizophrenia
- Inability to read or severe cognitive deficits that would preclude ability to read
consent form or fill out surveys).
- Participation in another research study unless copy of consent form obtained and
screened for possible confounding of results.
- Those currently enrolled in a weight loss program elsewhere.
- Pregnant women
We found this trial at
1
site
3900 Woodland Avenue
Philadelphia, Pennsylvania 19104
Philadelphia, Pennsylvania 19104
Click here to add this to my saved trials
