MATERIAL INCENTIVES FOR WEIGHT LOSS

Table 2

Incentive, treatment components and key findings for positive reinforcement, fixed ratio schedule studies.

Reference / Design / Nature of Incentive / Administration Schedule / Behavior/ Outcome Being Reinforced / Treatment Components in Incentive Condition(s) / Treatment Components in Non-incentive Condition(s) / Key Findings
Constant payment
Finkelstein et al., 2007 (12) / 3 conditions
Backloaded; Frontloaded; Steady payment / Backloaded condition: $14 cash/ % weight lost
Frontloaded condition: $14 cash/ % weight lost
Steady payment condition: $7 cash/ % weight lost / Backloaded condition: administered once at 6 mo.
Frontloaded condition: administered once at 3 mo.
Steady payment condition: administered at 3 mo. and 6 mo. / Each percentage point of weight lost since baseline / Information about healthy weight loss at baseline + incentive (level of specificity is unknown) / N/A / At 3 months, participants in the frontloaded condition lost more weight than those in the steady payment condition. Those in the steady payment lost more weight than those in backloaded condition
At 6 months, no difference between conditions in weight lost since baseline
French, Neumark-Sztainer, Story & Jeffery, 1998 (18) / 2 conditions
Incentive; No incentive / $10 coupon for fruit and vegetables / Weekly / Attendance / Weekly classes focusing on nutrition counseling, social support and physical activity
Self-monitoring
Weight and energy goal-setting
Free child care
Incentive / Same non-incentive components as incentive condition / Weight loss and attendance did not differ by condition
Hall, 1972 (13) / Within-subject design; counterbalanced
2 conditions
Self-control principles; Incentive / Participants instructed to identify a goal item that cost $20 or less that symbolized weight loss to them.
Given $5 to put item on lay away
Given remaining $15 if goal was met / $15 administered at 5 weeks / Reaching goal weight / Daily self-weighing for 12 weeks prior to intervention; kept food diary for 2 weeks prior to intervention
Self-weighing and food diaries during intervention
10 individual meetings with trained experimenter that involved setting a weight loss goal, monitoring the discrepancy between current and goal weight, reminder of time remaining to reach goal weight; reminder of goal item
Incentive / Daily self-weighing for 12 weeks prior to intervention; kept food diary for 2 weeks prior to intervention
Self-weighing and food diaries during intervention
10 individual meetings with trained experimenter that focused on manipulation of emotional responses, stimulus control, and development of prepotent responses / Weight loss was seen in both conditions.
Incentive condition produced greater weight loss than the self-control principles condition
Weight loss was maintained at 4-week follow-up
Jeffery et al., 1993 (15) / 5 conditions
Control; Incentive 1; Incentive 2; Comparison 1; Comparison 2 / $25 for reaching and/or maintaining ultimate weight-loss goal
$12.50 for 50% of ultimate weight loss goal
$2.50 if <50% of goal was achieved, but weight was not gained / Weekly / Percentage of ultimate weight loss goal achieved / Incentive 1: state-of – the-art standard behavior therapy that included individualized information and goal-setting (SBT) + incentive
Incentive 2: SBT + food provision + incentive / Control: No intervention
Comparison 1: Standard behavioral treatment (SBT)
Comparison 2: SBT+ food provision / Group with financial incentive + food provision showed the greatest decrease in BMI. This change was due to greater BMI changes in groups given food, rather than financial incentives.
Luley et al., 2010 (16) / 8 conditions
Factorial design
2 (Telemonitor Yes, No) x 2(Incentive: Yes, No) x 2 (Diet: Dual diet, calorie restriction) / 5 Euros / Unknown / Per kg lost / All participants received 1 education session
Telemonitor: scale, accelerometer, data sent directly to researchers via Homebox; weekly feedback; motivational comments
Incentive: parents and children received financial incentives
Dual diet: instructed to reduce intake by 500 kcal; dietary instruction; low glycemic index foods encouraged; food diaries
Calorie restriction: instructed to reduce intake by 500 kcal; dietary instruction; food diaries / All participants received 1 education session
Telemonitor and diet components / Parents offered the incentive lost more weight than parents who were not offered the incentive.
Escalating payment
Jeffery et al., 1998 (17) / 5 conditions
Incentive 1; Incentive 2; Control; Comparison 1; Comparison 2 / $1/walk for first 25 walks
$1.50/walk next 50 walks
$2/walk for next 50 walks
$3/walk thereafter / Each walk / Attendance at supervised walks / Incentive 1: SBT+ supervised walks+ incentive
Incentive 2: SBT+ personal trainer + incentive / Control: SBT only
Comparison 2: SBT+ supervised walks
Comparison 3: SBT+ personal trainer / All four treatment groups differed form control in walk attendance
Trainer + incentive had the greatest attendance of the four treatment groups
No significant differences in weight loss between treatment groups at 18 months
Deescalating payment
Hall, Hall, DeBoer & O’Kulitch, 1977 (14) / 5 conditions
Delayed treatment control; Insight psychotherapy; Self-management training (SM); Incentive only; SM + incentive / Incentive only: $1.00 /lb for the first 3 lbs lost that week; $.75/lb for the 4th lb; $.50/lb for the 5th lb; nothing thereafter
SM+ incentive:
$1.50 for quiz performance; $.75/lb for the first 3 lbs lost that week; $.50/lb for the 4th and 5th lbs; $.25/lb for the 6th lb; nothing thereafter / Earning tallied biweekly; paid at end of intervention / Incentive only: weight loss
SM + incentive: quiz performance and weight loss / All participants given dietary information from dietician; instructed to self-monitor intake and weight; biweekly group meetings with therapist
Incentive only:
Weight and food record check; biweekly tally of earnings; encouragement to spend earnings on an item that symbolized weight loss; non-directed discussion of weight and dieting issues + incentive
SM + incentive: focused on unlearning old eating behaviors and implementing new eating behaviors; quizzes about lessons and implementation + incentive / All participants given dietary information from dietician; instructed to self-monitor intake and weight; biweekly group meetings with therapist
Insight Psychotherapy: meetings with therapist; focus on improving emotional well-being and relationships
SM: focused on unlearning old eating behaviors and implementing new eating behaviors; quizzes about lessons and implementation / Weight loss since baseline did not differ between SM+ incentive, SM and incentive only. Weight loss in these three conditions was greater than in psychotherapy and control.
Weight loss since baseline did not differ across the four treatment conditions at 3- and 6-month follow-up.