Identifying effective strategies for treating obesity is both a clinical challenge and a public health priority.Over 70% of the U.S. population is overweight or obese, and obesity in nniddle age translates into higherrates of hospitalization. Medicare expenditures, disability, and mortality risk among older adults. While avariety of approaches are successful in achieving initial weight loss, techniques for maintenance of initialweight loss have largely been unsuccessful. This 3- arm randomized controlled trial will compare the relativeeffectiveness and cost-effectiveness of (1) lottery-based incentives, (2) traditional direct payments, and (3)daily feedback without incentives among patients who successfully lost at least 5 kg over 6 months duringparticipation in Weight Watchers (Pre Phase), incentives will be provided to some study participants for thefollowing 6 months (Phase I), and subjects will be followed for 6 more months to examine effects followingcessation of incentives (Phase II). A total of 188 participants will be randomized into the 3 arms.
SpecificAims will be to assess among participants who lose 5kg or more of baseline weight during Pre Phase: (1) theeffectiveness of a daily lottery-based financial incentive, relative to the usual care group, on maintenance ofweight loss over the ensuing 6 months; (2) the effectiveness of a direct payment incentive relative to theusual care group oh maintenance of weight loss; (3) the comparative effectiveness of lottery based anddirect payment financial incentives on maintenance of weight loss at the end of Phase I (month 12). Inaddition, we will assess the degree to which weight loss is maintained in the intervention groups compared tothe usual care group following cessation ofthe interventions, and we will assess the cost-effectiveness ofincentives for maintenance of weight loss. This study will build on our successful efforts using lottery-basedincentives for weight loss in partnership between experienced teams at the Center for Health Incentives andBehavioral Economics ofthe Leonard Davis Institute of Health Economics (LDI CHIBE) at the University ofPennsylvania and at Duke University.

Public Health Relevance

This study will contribute valuable knowledge about the effectiveness of innovative strategies to improvemaintenance of weight loss among middle aged and older Americans. This is central to reducing morbidityand mortality rates among older Americans and improving the health ofthe US population more broadlysince obesity is extremely common among Americans. '

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZAG1-ZIJ-1 (03))
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King, Jonathan W
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University of Pennsylvania
Internal Medicine/Medicine
Schools of Medicine
United States
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Yancy Jr, William S; Shaw, Pamela A; Wesby, Lisa et al. (2018) Financial incentive strategies for maintenance of weight loss: results from an internet-based randomized controlled trial. Nutr Diabetes 8:33
Shaw, Pamela A; Yancy Jr, William S; Wesby, Lisa et al. (2017) The design and conduct of Keep It Off: An online randomized trial of financial incentives for weight-loss maintenance. Clin Trials 14:29-36