Context Identifying effective obesity treatment is both a clinical challenge and a public health priority due to the health consequences of obesity. Objective To determine whether common decision errors identified by behavioral economists such as prospect theory, loss aversion, and regret could be used to design an effective weight loss intervention. Design, Setting, and Participants Fifty-seven healthy participants aged 30-70 years with a body mass index of 30-40 were randomized to 3 weight loss plans: monthly weigh-ins, a lottery incentive program, or a deposit contract that allowed for participant matching, with a weight loss goal of 1 lb (0.45 kg) a week for 16 weeks. Participants were recruited May-August 2007 at the Philadelphia VA Medical Center in Pennsylvania and were followed up through June 2008. Main Outcome Measures Weight loss after 16 weeks. Results The incentive groups lost significantly more weight than the control group (mean, 3.9 lb). Compared with the control group, the lottery group lost a mean of 13.1 lb (95% confidence interval [CI] of the difference in means, 1.95-16.40; P=.02) and the deposit contract group lost a mean of 14.0 lb (95% CI of the difference in means, 3.69-16.43; P =.006). About half of those in both incentive groups met the 16-lb target weight loss: 47.4% (95% CI, 24.5%-71.1%) in the deposit contract group and 52.6% (95% CI, 28.9%-75.6%) in the lottery group, whereas 10.5% (95% CI, 1.3%- 33.1%; P = .01) in the control group met the 16-lb target. Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups (9.2 lb; t = 1.21; 95% CI, −3.20 to 12.66; P = .23, in the lottery group and 6.2 lb; t = 0.52; 95% CI, −5.17 to 8.75; P = .61 in the deposit contract group) than in the control group (4.4 lb), these differences were not statistically significant. However, incentive participants weighed significantly less at 7 months than at the study start (P = .01 for the lottery group; P = .03 for the deposit contract group) whereas controls did not. Conclusions The use of economic incentives produced significant weight loss during the 16 weeks of intervention that was not fully sustained. The longer-term use of incentives should be evaluated. Trial Registration clinicaltrials.gov Identifier: NCT00520611

https://jamanetwork.com/journals/jama/articlepdf/183047/jpc80011_2631_2637.pdf

Financial incentive-based approaches for weight loss: a randomized trial.

Background—Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. Methods and Results—For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change...

Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association

We present a generally applicable theory of focusing based on the hypothesis that a person focuses more on, and hence overweights, attributes in which her options dier more. Our model predicts that the decisionmaker is too prone to choose options with concentrated advantages relative to alternatives, but maximizes utility when the advantages and disadvantages of alternatives are equally concentrated. In intertemporal choice, because the relative concentrations of an option’s costs and benets can be dierent from the perspective of a single period and the perspective of the entire choice problem, the decisionmaker often exhibits a form of time inconsistency. She is present-biased when the costs of current misbehavior are distributed over many future dates (such as in harmful consumption), but \future-biased" when the benet of many

/pdf/a-model-of-focusing-in-economic-choice-1ivpuoegy0.pdf

A Model of Focusing in Economic Choice

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

An economy of scales: A selective review of obesity's economic causes, consequences, and solutions

Background Based on national estimates, the majority of working adults are overweight or obese. Overweight and obesity are associated with diminished health, productivity, and increased medical costs for employers. Worksite-based weight loss interventions are desirable from both employee and employer perspectives.Purpose To investigate organizational- and employee-level participation in a group-randomized controlled worksite-based weight loss trial.Methods Using a set of inclusion criteria and pre-established procedures, we recruited worksites (and overweight/obese employees from enrolled worksites) from the North Carolina Community College System to participate in a weight loss study. Recruitment results at the worksite (organization) and employee levels are described, along with an assessment of representativeness.Results Eighty-one percent (48/59) of community colleges indicated initial interest in participating in the weight loss study, and of those, 17 colleges were enrolled. Few characteristics dist...

Organizational- and employee-level recruitment into a worksite-based weight loss study.

Objective:To test the ability of two levels of modest financial incentives to encourage weight loss among overweight employeesMethods:This study used a randomized design with measurements at baseline, 3, and 6 months and two levels of financial incentives ($7 and $14 per percentage point of

A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees.

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Organizational- and employee-level recruitment into a worksite-based weight loss study.

A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees.