Effects on weight reduction of strong monetary contracts for calorie restriction or weight loss

doi:10.1016/0005-7967(78)90005-0

Behaviour Research and Therapy

Volume 16, Issue 5, 1978, Pages 363-369

https://doi.org/10.1016/0005-7967(78)90005-0 Get rights and content

Abstract

Thirty-one severely obese adults participated in behavioral weight control groups. In three groups utilizing powerful monetary contracts, subjects deposited substantial sums of money which were returned contingent on either attendance, calorie restriction, or weight loss. Subjects in a fourth no-contract control condition made no monetary deposits. Weight and calorie contract groups lost an average of nearly 20 lb in 10 weeks. They did not differ from each other, but both produced significantly more weight loss than the attendance contract group. High dropout rates in the no-contract condition precluded statistical evaluation of this group. Results are discussed in terms of the potential clinical value of contracting procedures.

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Cited by (84)

Promoting healthy behavior through repeated deposit contracts: An intervention study
2022, Journal of Economic Psychology
The current paper clarifies the conditions under which deposit contracts are sufficient to motivate people to perform daily breathing exercises using a smartphone app. Our analysis compares the impact of repeated deposit contracts with the impact of small bonus incentives. Accepting the daily contract provided the same monetary gain from exercising as the bonus, but led to a larger loss when the participants failed to exercise. Theoretical analysis shows that deposit contracts are expected to be more effective than bonus incentives when the probability of failing to practice due to an unexpected busy schedule is sufficiently low. These predictions are supported by a field experiment with more than 180 participants. While the bonus incentives failed to increase the exercise rate, repeated deposit contracts boosted it from 58% to 83%. Moreover, the use of the contracts eliminated much of the cost that the intervention designer has to bear.
Appealing to generosity to reduce food calorie intake: A natural field experiment
2022, Food Policy
Citation Excerpt :
Commitment devices have been previously used to increase motivations towards achieving a self-imposed goal such as weight loss when money is on the line. Failure to achieve the goal would result in forfeiting the monetary commitment and donating it to a charity of the participant’s choice (John et al., 2011; Volpp et al., 2008; Kane et al., 2004; Jeffery et al., 1978). However, the positive externality of the donation to a charity resulted in an ex-post self-serving bias that justified the failure to achieve the goal.
We conduct a natural field experiment where we exogenously manipulate a restaurant’s menu to include a third party charitable donation to a hunger-related charity when customers select a smaller food portion. We find that generosity is an effective instrument for motivating individuals to reduce their food portion size selection, particularly among Overweight/Obese individuals. Overweight/obese individuals are 35 percentage points more likely to choose the smaller portion when it carries a donation. When the donation is combined with a health information nudge, the proportion of smaller portion choices among overweight/obese individuals increases by 48.2 percentage points compared to the baseline.
Sustaining the reach of a scalable weight loss intervention through financial incentives- a pragmatic, feasibility, online randomized trial protocol
2020, Contemporary Clinical Trials
Citation Excerpt :
Glasgow et al. [6] similarly found that 50% of participants did not engage with an electronic weight loss intervention beyond an initial session. Providing incentives for weight loss has a long scientific history with early behavior-modification approaches finding some success with increasing the frequency of program attendance and weigh-in behavior (i.e. self-monitoring) [7–15]; while more recent approaches have a theoretical grounding in behavioral economics [16]. A behavioral economics approach is based on the use of external incentives as a way to compensate participants to forgo preferred lifestyle behaviors related to eating high calorie, flavorful foods and sedentary behaviors and to engage in less preferred but more healthful eating and activity behaviors [17].
High attrition following initial enrollment in evidence-based weight loss programs is a common, challenging, and under-studied issue. A behavioral economics approach consisting of modest monetary incentives may help to engage participants beyond enrollment to close the initial attrition gap.
To describe the methods and design of a pragmatic, online randomized controlled trial (RCT) of an incentivized, technology-facilitated weight loss program through an innovative research-practice partnership involving primary care, health promotion researchers, and a small business.
This study is a four-arm (1:1:1:1) RCT that compares the efficacy of outcome-based (weight loss), process-based (weighing in), a combination of outcome- and process-based, or choice-based incentives on sustaining program reach after initial enrollment for an evidence-based weight loss program. The multicomponent weight loss program includes a website, social cognitive theory-based daily health coaching, tailored messaging delivered via email and text messaging, access to online health coaches, and objective weight assessment through a community kiosk. The study will enroll 400 individuals aged 19 and older who have a body mass index ≥25 kg/m², and have reliable access to the Internet or a smart phone. Participants will be followed for 3, 6, 9, and 12 months to assess program reach and representativeness, and continued participation after enrollment. The secondary outcomes include weight loss and program implementation costs. We will conduct participant focus groups to understand the barriers and facilitators of participation and key informant interviews focusing on clinic managers and care providers to explore the potential for future adoption and implementation of the evidence-based program.
This study possesses the potential to close the attrition gap after initial enrollment in a web-based digital weight loss intervention in the primary care and community settings. Clinicaltrials.gov registration: NCT04225234.
The use of financial incentives to prevent unhealthy behaviors: A review
2020, Social Science and Medicine
Citation Excerpt :
The use of positive financial incentives to discourage obesity has also gained in popularity, but the evidence regarding efficacy is more mixed. In particular, commitment devices have been tested to encourage weight loss in the U.S. On the one hand, Jeffery et al. (1978, 1984) established that commitment devices contingent on weight loss or calorie counts significantly increased the weight losses compared to the control group and a group with the condition linked to attendance to counseling sessions. On the other hand, Follick et al. (1984) studied the effects of a commitment device designed to decrease attrition in a worksite weight-loss intervention.
Behaviors that are putting people's health at risk are widespread and some of them are on the rise. Some of these behaviors can be prohibited or prevented by taxation. But financial incentives such as conditional cash transfers are also increasingly proposed and tested to discourage such behaviors, in domains as varied as HIV/AIDS, drugs, alcohol, smoking, and obesity. This paper presents the theoretical justification for using such incentives, distinguishing between the price, income effects, and the nudge effects. The growing literature about the effectiveness of financial incentives to prevent undesirable behaviors is reviewed in detail for each type of harmful behavior. Finally, the paper discusses the long-term sustainability of such incentives, a key issue if they are to be scaled up beyond pilot programs and research projects. The current evidence on whether such incentives have an impact after they are discontinued is mixed. Some design features, like lotteries or commitment devices, could induce savings as well as increase effectiveness, therefore improving sustainability.
Adding Financial Incentives to Online Group-Based Behavioral Weight Control: An RCT
2020, American Journal of Preventive Medicine
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.
This study was an RCT.
Adults with overweight and obesity (n=418; 91% female; 28% minority) were recruited from 2 clinical centers.
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).
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.
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).
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.
This study is registered at www.clinicaltrials.gov NCT02688621.
BWHealthy Weight Pilot Study: A randomized controlled trial to improve weight-loss maintenance using deposit contracts in the workplace
2020, Preventive Medicine Reports
Deposit contracts, where participants “bet” on achieving a goal and get their money back only if successful, have been shown to be effective for short-term weight-loss. This pilot study examined their effect on weight-loss maintenance.
From 2016 to 2018, we conducted a pilot, 50-week randomized controlled trial among 42 hospital employees (19 intervention and 23 control), in Boston, Massachusetts, who lost ≥10 lb (4.5 kg) in the two years prior to enrollment. Participants were recruited primarily in-person. Both control and intervention participants were asked to attend a weigh in weekly and received weekly email communication. Intervention participants also entered into a deposit contract to maintain baseline weight within ≤2 lb (0.9 kg). We examined weight change from baseline to 50 weeks (primary outcome) and maintenance of baseline weight at 50 weeks (secondary outcome; binary – yes v. no). Participants completed baseline and follow-up surveys and received incentives for completion.
At baseline, mean (SD) weight was 83.2 (15.5 kg) among intervention and 80.7 (14.5 kg) among control participants. After 50 weeks, intervention participants had slightly less but non-significant weight gain (adjusted β −1.12 kg; 95% CI −5.28, 3.05) than control participants; 73.7% of intervention v. 39.1% of control participants met their weight-loss maintenance goal by study end (adjusted OR 4.78; 95% CI 1.01, 22.71).
A deposit contract was not associated with differences in weight but led to more participants meeting their weight-loss maintenance goals; a deposit contract for weight-loss maintenance should be tested in a full-scale intervention. Most intervention participants viewed the deposit contract as acceptable.

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Effects on weight reduction of strong monetary contracts for calorie restriction or weight loss

Abstract

Behav. Res. Ther.

Behav. Ther.

Behav. Res. Ther.

Behav. Res. Ther.

Behav. Res. Ther.

Behav. Ther.

Behav. Ther.

Behav. Res. Ther.

Comparative effectiveness of situational programming, financial payoffs, and group pressure in weight reduction

Behav. Ther.