• Leslie K John, George Loewenstein, Andrea B Troxel, Laurie Norton, Jennifer E Fassbender, and Kevin G Volpp.
• Department of Social and Decision Sciences, Carnegie Mellon University, 208 Porter Hall, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA. lkjohn@andrew.cmu.edu
• J Gen Intern Med. 2011 Jun 1; 26 (6): 621-6.

BackgroundPrevious efforts to use incentives for weight loss have resulted in substantial weight regain after 16 weeks.ObjectiveTo evaluate a longer term weight loss intervention using financial incentives.DesignA 32-week, three-arm randomized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week, followed by an 8-week maintenance phase.ParticipantsVeterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMIs of 30-40.InterventionParticipants were randomly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins (control condition), or the same program with one of two financial incentive plans. Both incentive arms used deposit contracts (DC) in which participants put their own money at risk (matched 1:1), which they lost if they failed to lose weight. In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance; in the other, no such distinction was made.Main MeasureWeight loss after 32 weeks.Key ResultsResults were analyzed using intention-to-treat. There was no difference in weight loss between the incentive arms (P = 0.80). Incentive participants lost more weight than control participants [mean DC = 8.70 pounds, mean control = 1.17, P = 0.04, 95% CI of the difference in means (0.56, 14.50)]. Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain; the net weight loss between the incentive and control groups was no longer significant (mean DC = 1.2 pounds, 95% CI, -2.58-5.00; mean control = 0.27, 95% CI, -3.77-4.30, P = 0.76).ConclusionsFinancial incentives produced significant weight loss over an 8-month intervention; however, participants regained weight post-intervention.

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