Financial incentives for motivating changes in health behavior, for weight loss in obese individuals, areincreasingly being tested by health insurers, employers, and government agencies. However, a key unansweredquestion regarding weight loss is how to structure these incentive programs to maximize their (1) effectiveness,underscored by the fact that most programs have not resulted in significant long-term weight loss; and (2)economic sustainability, as defined by their return on investment?a major factor in public and privatedecision-making.Obese patients represent an important population to target for effective weight loss interventions because theysuffer from a high prevalence of serious obesity-related illnesses?including diabetes, hypertension,dyslipidemia, heart disease, stroke, sleep apnea, and cancer?disproportionately have a low socioeconomicstatus, and impose $147 billion in costs on the healthcare system annually. While prior studies testing financialincentives in this population have had variable short-term success and few have yielded long-term weight loss,a fundamental question remains unanswered and may partially explain variability in weight loss outcomes:specifically, it is unknown whether goal-directed incentives (incentives for achieving evidence-based,intermediate goals that increase weight loss but are underutilized, like dietary counseling, physical activity,behavioral self monitoring, and intensive weight management programs) or outcome-based incentives (likeincentives for successfully losing weight) are more effective for promoting weight loss. Prior studies of weightloss incentives have largely emphasized only the latter.We propose a three-arm randomized controlled trial that will address this important knowledge gap amongobese patients living in socioeconomically disadvantaged neighborhoods, with implications for other seriouschronic health conditions. Comparing goal-directed incentives to outcome-based incentives and usual care, wewill assess their impact on weight loss (?5% of baseline weight), use of evidenced-based therapy, and quality oflife, and evaluate their short-term and long-term return on investment.
Financial incentives for motivating changes in health behavior; particularly for weight loss in obese individuals;are increasingly being tested by health insurers; employers; and government agencies. However; a keyunanswered question regarding weight loss is how to structure these incentive programs to maximize theireffectiveness; acceptability to patients; and economic sustainability. Focusing on obese patients living inneighborhoods with a high concentration of low socioeconomic status households; we will compare the impactof financial incentives for weight loss on sustained weight loss; use of evidenced-based therapy; and quality oflife; and we will determine their short-term and long-term return on investment.
| Ladapo, Joseph A; Spritzer, Charles E; Nguyen, Xuan V et al. (2018) Economics of MRI Operations After Implementation of Interpersonal Skills Training. J Am Coll Radiol 15:1775-1783 |
