Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
School of Nursing, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2021 Sep 1;4(9):e2124132. doi: 10.1001/jamanetworkopen.2021.24132.
Modest weight loss can lead to meaningful risk reduction in adults with obesity. Although both behavioral economic incentives and environmental change strategies have shown promise for initial weight loss, to date they have not been combined, or compared, in a randomized clinical trial.
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.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from 2015 to 2019 at 3 large employers in Philadelphia, Pennsylvania. 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; weight in kilograms divided by height in meters squared) of 30 to 55 and at least 1 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.
A total of 344 participants were enrolled, with 86 participants each randomized 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) BMI of 36.5 (7.1); 247 participants (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 5.4 lb (95% CI, -11.3 to 0.5 lb [mean, 2.45 kg; 95% CI, -5.09 to 0.23 kg]), those in the environmental strategies group lost a mean of a 2.2 lb (95% CI, -7.7 to 3.3 lb [mean, 1.00 kg; 95% CI, -3.47 to 1.49 kg]), and the combination group lost a mean of 2.4 lb (95% CI, -8.2 to 3.3 lb [mean, 1.09 kg; 95% CI, -3.69 to 1.49 kg]) 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 6 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 this randomized clinical trial, across all study groups, participants lost a modest amount of weight but those who received financial incentives, environmental change, or the combined intervention did not lose significantly more weight than those in the usual care group. Employees with obesity may benefit from more intensive individualized weight loss strategies.
ClinicalTrials.gov Identifier: NCT02878343.
重要性：适度的体重减轻可以显著降低肥胖成年人的风险。虽然行为经济学激励和环境改变策略都显示出对初始体重减轻的有效性，但迄今为止，它们尚未在随机临床试验中结合或比较。
目的：测试财务激励和环境策略单独和联合使用对肥胖成年人初始体重减轻和体重维持的相对有效性。
设计、设置和参与者：这项随机临床试验于 2015 年至 2019 年在宾夕法尼亚州费城的 3 家大雇主进行。采用 2×2 析因设计，比较基于彩票的财务激励、环境策略及其组合与常规护理对体重减轻和维持的影响。干预措施通过网站、短信和社交媒体提供。参与者包括体重指数（BMI；体重以千克为单位除以身高以米为单位）在 30 到 55 之间且至少有 1 个其他心血管风险因素的成年员工。数据分析于 2021 年 6 月至 7 月进行。
干预措施：干预措施包括基于达到体重减轻目标的基于彩票的财务激励、针对个人的环境改变策略以及通过短信和社交媒体提供的环境改变策略，以及联合激励和环境策略。
主要结果和测量：主要结果是从基线到 18 个月的体重变化，通过亲自测量。
结果：共有 344 名参与者被纳入，其中 86 名参与者被随机分配到财务激励组、环境策略组、联合财务激励和环境策略组和常规护理（对照组）。参与者的平均（标准差）年龄为 45.6（10.5）岁，平均（标准差）BMI 为 36.5（7.1）；247 名参与者（71.8%）为女性，172 名（50.0%）为黑人，138 名（40.1%）为白人。在 18 个月的主要终点，激励组的参与者平均减轻了 5.4 磅（95%CI，-11.3 至 0.5 磅[平均，2.45 千克；95%CI，-5.09 至 0.23 千克]），环境策略组的参与者平均减轻了 2.2 磅（95%CI，-7.7 至 3.3 磅[平均，1.00 千克；95%CI，-3.47 至 1.49 千克]），联合组比常规护理组平均多减轻了 2.4 磅（95%CI，-8.2 至 3.3 磅[平均，1.09 千克；95%CI，-3.69 至 1.49 千克]）。财务激励、环境变化策略及其组合并不比常规护理更有效。在 24 个月时，在没有干预的 6 个月后，与 18 个月的结果相似，各组之间没有显著差异。
结论和相关性：在这项随机临床试验中，在所有研究组中，参与者的体重都有所减轻，但接受财务激励、环境改变或联合干预的参与者的体重减轻并不明显多于常规护理组。肥胖的员工可能会从更强化的个体化体重减轻策略中受益。
试验注册：ClinicalTrials.gov 标识符：NCT02878343。
