Study: Financial incentives helped adolescents lose weight

Key takeaways:

• Adding financial incentives to meal replacement therapy resulted in reduced BMI.
• Such behavioral interventions could be combined with medication toward the same goal.

Financial incentives helped adolescents with severe obesity lose weight and body fat, according to research published in JAMA Pediatrics.

The aim of the investigation was to see if “adding financial incentives to meal replacement therapy, or MRT, would allow for a more significant and sustained effect,” one of the authors told Healio.

“At the time we developed this study, treatment options for adolescent severe obesity were limited to lifestyle interventions that often are ineffective in the long-term for this specific patient population, or bariatric surgery, which is often inaccessible to patients,” Amy C. Gross, PhD, associate director of clinical care at the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School, told Healio.

“MRT had shown short-term efficacy,” Gross said. “Given the biological contributors to obesity and counterregulatory mechanisms that promote weight regain after reduction, we were unsure if a combination of lifestyle and behavioral interventions would result in meaningful BMI reduction over 52 weeks.”

Gross and colleagues randomly assigned 126 adolescents aged 13 to 17 years with a history of severe obesity into two arms of treatment. Half of the cohort was assigned to an MRT-only plan, in which patients were delivered free, pre-prepared meals equaling 1,200 calories per day. The remaining half of patients also took part in the MRT program, but with the addition of a $20 gift card for every reduction of 0.5% from their original body weight.

One year after the intervention began, 89 adolescents completed a follow-up visit. Researchers found that the mean BMI reduction was greater by 5.9 percentage points (95% CI, 9.9 to 1.9 percentage points) in the MRT plus financial incentive group compared with the MRT-only group.

The group receiving financial incentives also had a larger reduction in mean total body fat mass, totaling 4.8 kg (95% CI, 9.1 to 0.6 kg). The researchers also found that this method was cost-effective, with an incremental cost-effectiveness ratio of $39,178 per quality-adjusted life year when compared with MRT alone, although they did not notice strong differences in cardiometabolic risk factors or unhealthy weight-control behaviors.

“We did end up seeing that this combination of MRT and financial incentives resulted in clinically meaningful BMI reduction beyond MRT alone at the end of a year,” Gross said. “While we cannot know for certain, we believe that financial incentives promoted greater adherence to MRT over time, which then resulted in greater BMI reduction.”

In an accompanying editorial, Aaron E. Carroll, MD, MS, chief health officer at Indiana University, doubted the sustainability of behavioral interventions in patients when medications such as the FDA-approved semaglutide could result in weight loss, improved cardiometabolic health and quality of life.

“One reason researchers have been trying to create successful interventions for weight loss is that obesity is so bad for health, especially in the long term,” Carroll wrote. “Behavioral interventions keep getting more and more complicated because they don’t work well, except in extreme circumstances, and often in ways that defy implementation. Maybe it’s time to stop focusing on them.”

Gross acknowledged the presence of such medications, but said that there is still “variability in treatment response.”

“Clinically, we also see that we often need to combine treatments to achieve meaningful and sustained results,” Gross said. “Therefore, we need to continue to study novel treatment options and combinations of treatments. We also need to identify ways we can match individual patients with the treatment that will work best for them.”

Gross said the study served as a “good proof of concept,” but cautioned providers from using financial incentives as a stand-alone strategy.

“Obesity is a complex, multifactorial disease and is best treated when intervention is matched to individual patient needs,” Gross said. “This often includes interventions that address the biological, psychosocial, and environmental contributors to obesity.”

References:

Carroll AE, et al. JAMA Pediatr. 2024;doi:10.1001/jamapediatrics.2024.1710.

Gross AC, et al. JAMA Pediatr. 2024;doi:10.1001/jamapediatrics.2024.1701.