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Original Research |

Individual- Versus Group-Based Financial Incentives for Weight Loss: A Randomized, Controlled Trial

Jeffrey T. Kullgren, MD, MS, MPH; Andrea B. Troxel, ScD; George Loewenstein, PhD; David A. Asch, MD, MBA; Laurie A. Norton, MA; Lisa Wesby, MS; Yuanyuan Tao, MS; Jingsan Zhu, MS, MBA; and Kevin G. Volpp, MD, PhD
[+] Article and Author Information

From Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Penn-CMU Roybal Center on Behavioral Economics and Health, Perelman School of Medicine, and the Wharton School at the University of Pennsylvania, and the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania; and Carnegie Mellon University, Pittsburgh, Pennsylvania.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. government.

Acknowledgment: The authors thank Dana Gatto, BS, and Lin Yang, MS, of the Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Penn-CMU Roybal Center on Behavioral Economics and Health, and the Perelman School of Medicine at the University of Pennsylvania; and Robert Croner, MS, and Daniel Buckalew, MS, of the Children's Hospital of Philadelphia, for their assistance.

Grant Support: By grant RC2103282621 (National Institute on Aging). Support was also provided by the Department of Veterans Affairs and the Robert Wood Johnson Foundation.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1785.

Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Kullgren (e-mail, jkullgre@med.umich.edu). Data set: Not available.

Requests for Single Reprints: Jeffrey T. Kullgren, MD, MS, MPH, Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170; e-mail, jkullgre@med.umich.edu.

Current Author Addresses: Dr. Kullgren: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170.

Dr. Troxel: Perelman School of Medicine at the University of Pennsylvania, Department of Biostatistics and Epidemiology, 632 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Dr. Loewenstein: Carnegie Mellon University, College of Humanities and Social Sciences, 208 Porter Hall, 5000 Forbes Avenue, Pittsburgh, PA 15213.

Dr. Asch: The Wharton School, University of Pennsylvania, Health Care Management Department, 3641 Locust Walk, 210 Colonial Penn Center, Philadelphia, PA 19104.

Ms. Norton: Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, 1126 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Ms. Wesby: Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, 1121 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Ms. Tao: Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, 1132 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Mr. Zhu: Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, 1133 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Dr. Volpp: Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, 1120 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Author Contributions: Conception and design: J.T. Kullgren, G. Loewenstein, D.A. Asch, K.G. Volpp.

Analysis and interpretation of data: J.T. Kullgren, A.B. Troxel, D.A. Asch, Y. Tao, J. Zhu, K.G. Volpp.

Drafting of the article: J.T. Kullgren, A.B. Troxel, G. Loewenstein, K.G. Volpp.

Critical revision of the article for important intellectual content: J.T. Kullgren, A.B. Troxel, G. Loewenstein, D.A. Asch, L.A. Norton, L. Wesby, Y. Tao, J. Zhu, K.G. Volpp.

Final approval of the article: J.T. Kullgren, A.B. Troxel, G. Loewenstein, D.A. Asch, L. Wesby, J. Zhu, K.G. Volpp.

Statistical expertise: A.B. Troxel, Y. Tao, J. Zhu.

Obtaining of funding: D.A. Asch, K.G. Volpp.

Administrative, technical, or logistic support: J.T. Kullgren, L.A. Norton, L. Wesby, K.G. Volpp.

Collection and assembly of data: L.A. Norton, L. Wesby, J. Zhu.


Ann Intern Med. 2013;158(7):505-514. doi:10.7326/0003-4819-158-7-201304020-00002
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Chinese translation

Background: Data on the effectiveness of employer-sponsored financial incentives for employee weight loss are limited.

Objective: To test the effectiveness of 2 financial incentive designs for promoting weight loss among obese employees.

Design: Randomized, controlled trial. (ClinicalTrials.gov: NCT01208350)

Setting: Children's Hospital of Philadelphia.

Participants: 105 employees with a body mass index between 30 and 40 kg/m2.

Intervention: 24 weeks of monthly weigh-ins (control group; n = 35); individual incentive, designed as $100 per person per month for meeting or exceeding weight-loss goals (n = 35); and group incentive, designed as $500 per month split among participants within groups of 5 who met or exceeded weight-loss goals (n = 35).

Measurements: Weight loss after 24 weeks (primary outcome) and 36 weeks and changes in behavioral mediators of weight loss (secondary outcomes).

Results: Group-incentive participants lost more weight than control participants (mean between-group difference, 4.4 kg [95% CI, 2.0 to 6.7 kg]; P < 0.001) and individual-incentive participants (mean between-group difference, 3.2 kg [CI, 0.9 to 5.5 kg]; P = 0.008). Twelve weeks after incentives ended and after adjustment for 3-group comparisons, group-incentive participants maintained greater weight loss than control group participants (mean between-group difference, 2.9 kg [CI, 0.5 to 5.3 kg]; P = 0.016) but not greater than individual-incentive participants (mean between-group difference, 2.7 kg [CI, 0.4 to 5.0 kg]; P = 0.024).

Limitation: Single employer and short follow-up.

Conclusion: A group-based financial incentive was more effective than an individual incentive and monthly weigh-ins at promoting weight loss among obese employees at 24 weeks.

Primary Funding Source: National Institute on Aging.

Figures

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Figure 2.

Weight change through 24-wk intervention and 36-wk follow-up.

Error bars indicate 95% CIs. We imputed 8 missing 24-wk weights and 12 missing 36-wk weights. Plots of mean weight change, the respective CIs, and individual weight change include both observed and imputed data. To convert lb to kg, multiply by 0.45.

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Grahic Jump Location
Figure 3.

Mean cumulative weight change by month during 24-wk intervention.

Error bars indicate 95% CIs. Mean weight changes at each time point and the respective CIs include only observed data. To convert lb to kg, multiply by 0.45.

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Comments

Submit a Comment
Show me the money!!
Posted on April 2, 2013
Nida Hamiduzzaman, Daniel Arkfeld
Keck School of Medicine, University of Southern California
Conflict of Interest: None Declared
It is with fascination that we read Dr. Kullgren's insightful article on individual versus group weight loss. In our experience, we have found that when patients are financially motivated, we see more results with obesity reduction. Our experience though has to do with the opposite effect where patients pay into a lifestyle redesigned program $10 for a weekly visit for ten weeks. Perhaps this $100 amount is the key to getting patients invested into the programs regardless of any financial costs. Thus it appears that it may not be the actual financial amount but more the psychological grouping of patients that leads to weight loss.
Paying patients to lose weight in a doctor's office since 2002
Posted on April 6, 2013
Joseph Chemplavil, MD
Private practice, Hampton, Virginia
Conflict of Interest: Conflict of Interest: I am the creator of the Dollar for Pound weight loss program and the owner of the web site - www.DollarsForDieting.com
Prompted by his own patients’ struggle to lose weight and frustration of seeing the increasing obesity problem in his patients with diabetes, high blood pressure and high cholesterol, an endocrinologist in Virginia developed his Dollar for Pound weight loss program in 2002. Patients who agree to join his program sign a contract for one year to pay $1 for every pound of weight he or she gains. They get paid $1 in cash for every pound they lose on each office visit. The biggest losers get extra bonus payments. He continues to offer this unique and successful weight loss program for the last 11 years in his office. For more details, visit his web site - www.DollarsForDieting.com
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