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Group-based financial incentives promote more weight loss
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Based on data from a study conducted at the Children’s Hospital of Philadelphia, group-based financial incentives were significantly more effective compared with individual incentives and monthly weigh-ins at promoting obese employee weight loss at 24 weeks.
“There is broad and growing enthusiasm for rewarding healthy behaviors in the workplace, but there is little evidence on the effects of these strategies,” health services researcher in the VA Center for Clinical Management Research and the division of general medicine in the U-M Medical School, Jeffrey T. Kullgren, MD, MS, MPH, said in a press release. “We anticipate more employers to offer these awards in an effort to help control health care costs while also improving the health of employees.”
Kullgren, also a researcher for the Institute for Healthcare Policy and Innovation at U-M Medical School, and colleagues tested the effectiveness of two financial incentive designs for promoting weight loss by randomly assigning 105 Children’s Hospital of Philadelphia employees with a BMI between 30 and 40 kg/m2 to 24 weeks of monthly weigh-ins.
Participants were assigned to a control group (n=35), an individual incentive group ($100 per person per month for meeting or exceeding weight loss goals; n=35) or a group incentive approach ($500 per month split among patients within groups of five who met or exceeded weight loss goals; n=35), the researchers wrote.
“We found that these incentives were substantially more powerful when delivered in groups, which has important implications for both policymakers and the employers who are considering offering them,” Kullgren said.
According to data, group incentive participants lost more weight compared with controls (mean between-group difference = 4.4 kg; 95% CI, 2 kg to 6.7 kg) and patients in the individual incentive group (mean between-group difference = 3.2 kg; 95% CI, 0.9 kg to 5.5 kg).
Data indicate 12 weeks after incentives ended and following adjustments for 3-group comparisons, participants in the group incentive maintained greater weight loss compared with controls (mean between-group difference = 2.9 kg; 95% CI, 0.5 kg to 5.3 kg). However, this weight loss was not greater than participants in the individual incentive group (mean between-group difference = 2.7 kg; 95% CI, 0.4 kg to 5 kg).
“Despite the health and economic consequences of obesity, the problem isn't getting any better, and there is great interest in identifying new approaches to combating this major health issue in our country,” Kullgren said.
In an accompanying editorial, Jason Riis, PhD, from Harvard Business School, wrote that the study demonstrates there is much more to learn from incentive approaches.
“Kullgren and colleagues have set the standard for the care and rigor with which such randomized, controlled trials of incentives should be conducted. Larger and longer trials would allow for more accurate measurement of incentive effectiveness and cost-effectiveness. Such trials could also measure possible positive side effects of employee incentive programs (such as community building) and negative side effects (such as weight stigmatization),” Riis wrote.
For more information:
Kullgren JT. Ann Intern Med. 2013; 158:505-514.
Riis J. Ann Intern Med. 2013; 2013; 158:560-561.
Disclosure: The study was supported by grant RC2103282621 from the National Institute on Aging. Kullgren reports institution administrative support and travel funds paid by the Department of Veterans Affairs and the Robert Wood Johnson Foundation. He also reports salary paid by the Department of Veterans Affairs.