Department of Medicine, University of Florida College of Medicine, Gainesville.
Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York.
JAMA Intern Med. 2023 Jan 1;183(1):61-69. doi: 10.1001/jamainternmed.2022.5618.
Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations.
To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources.
DESIGN, SETTING, AND PARTICIPANTS: Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled.
Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750.
Proportion of patients achieving 5% or greater weight loss at 6 months.
The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being.
In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes.
ClinicalTrials.gov Identifier: NCT03157713.
重要性：对于体重管理的财务激励可能会增加使用循证策略，同时解决低收入人群中与肥胖相关的经济差距。
目的：当添加体重管理资源时，使用行为经济学理论开发的两种财务激励策略的效果。
设计、设置和参与者：这是一项在纽约市和加利福尼亚州洛杉矶的 3 家医院诊所进行的三组随机临床试验，从 2017 年 11 月到 2021 年 5 月进行。邀请了居住在低收入社区的 1280 名肥胖成年人参加，其中 668 人参加了研究。
干预措施：参与者被随机分配到目标导向激励组、基于结果的激励组或仅提供资源组。仅提供资源组的参与者获得了为期 1 年的商业减肥计划会员资格、自我监测工具（电子秤、食物日记和体育活动监测器）、健康教育以及每月一次的一对一检查访问。目标导向组包括资源并将财务激励与基于证据的减肥行为联系起来。基于结果的手臂包括资源并将财务激励与体重减轻的百分比联系起来。激励组的参与者最多可以赚取 750 美元。
主要结果和措施：在 6 个月时体重减轻 5%或更多的患者比例。
结果：668 名入组患者的平均（SD）年龄为 47.7（12.4）岁；541 名（81.0%）为女性，485 名（72.6%）为西班牙裔，99 名（14.8%）为黑人。入组时的平均（SD）体重为 98.96（20.54）kg，平均身体质量指数（计算方法为体重以千克为单位除以身高以米为单位的平方）为 37.95（6.55）。在 6 个月时，资源仅组、目标导向组和基于结果的激励组中至少减轻基线体重 5%的患者比例分别为 22.1%、39.0%和 49.1%（基于结果的 vs 目标导向的差异为 10.08 个百分点[95%CI，1.31-18.85]；基于结果或目标导向的 vs 仅资源的差异分别为 27.03 个百分点[95%CI，18.20-35.86]和 16.95 个百分点[95%CI，8.18-25.72]）。然而，激励组的平均体重减轻百分比相似。目标导向组的平均赚取激励为 440.44 美元，基于结果的组为 303.56 美元，但激励措施并未改善财务状况。
结论和相关性：在这项随机临床试验中，基于结果和目标导向的财务激励同样有效，并且这两种策略在具有肥胖症的低收入人群中对于临床显著的体重减轻都比仅提供资源更有效。未来的研究应评估成本效益和长期结果。
试验注册：ClinicalTrials.gov 标识符：NCT03157713。
