Introduction
Internet-delivered behavioral weight control is promising for expanding the reach
and availability of weight management, but online programs produce lower weight losses
than typically achieved in person. Financial incentives have been shown to increase
weight losses. This study examined whether adding financial incentives for self-monitoring
and achieving target weight losses increases weight losses attained in a fully online,
group-based behavioral weight management program compared with the same program alone.
Study design
This study was an RCT.
Setting/participants
Adults with overweight and obesity (n=418; 91% female; 28% minority) were recruited from 2 clinical centers.
Intervention
The intervention was a 24-session online group-based behavioral weight control program
with weekly synchronous chat sessions (Internet-only) or the same program with weekly
financial incentives for self-monitoring body weight and dietary intake daily and
for achieving target weight losses at 2 and 6 months (Internet + incentives).
Main outcome measures
This study measured weight loss at 6 months and treatment engagement (attendance,
self-monitoring of body weight, dietary intake, and physical activity). Data were
collected between February 2016 and August 2018, and analyses were completed in 2019.
Results
Participants randomized to the Internet + incentives group lost more weight (−6.4
[SD=5.5] kg) than those in the Internet-only group (−4.7 [SD=6.6] kg; p<0.01). Further, a higher proportion of the Internet + incentives group achieved ≥5%
weight loss (55%) than those in the Internet-only group (40%; p<0.05). Treatment engagement was higher in the Internet + incentives condition, with
greater self-monitoring of behaviors targeted by incentives, as well as higher rates
of behaviors not targeted and higher self-reported physical activity. Study retention
was higher among those in the Internet + incentives condition (91%) than those in
the Internet-only condition (81%; p=0.003).
Conclusions
Adding financial incentives to a program delivered fully online increases weight losses
compared with the program alone and can achieve weight losses comparable to in-person
programs, offering potential for substantial geographic reach.
Trial registration
This study is registered at www.clinicaltrials.gov NCT02688621.
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Article Info
Publication History
Published online: May 21, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
