The effect of financial incentives for patients on weight loss: a meta-analysis
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Context: Being overweight (BMI≥25kg/m<super>2</super>) and obesity (BMI≥30kg/m<super>2</super>) are common and costly. While reward systems can affect behaviors, it is uncertain whether financial incentives are beneficial in weight loss programs. Objective: To estimate the effectiveness of financial incentives in weight loss programs. Data sources: We searched the English-language literature in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, and the Cochrane Register of Controlled Clinical Trials) from 1966 to November 2011. Additional studies were identified by searching reference lists of all relevant articles. Search terms included financial, economic, monetary, reward, incentive or reimbursement, and diet, weight loss, obesity or overweight. Study selection: We included controlled trials evaluating the effect of financial incentives in weight loss programs for overweight individuals. We excluded studies that did not provide weight change over time. Data extraction: Data were extracted from articles by using predefined data fields, including study quality indicators. We performed subgroup analyses to examine the effect of study duration (at 4 months and 12 months) and a self-set goal versus program fixed goal on the effectiveness of financial incentives on weight loss. Results: Overall, the results of the meta-analysis show that using financial incentives was associated with higher weight loss (-0.32 SMD, 95%CI (-0.56, -0.08),, random effects model). The benefit of incentives was greater at 4 months (-0.56 SMD, 95%CI (-0.89, -0.23),random effects model) but there was no effect at 12 months. The effect of financial incentives in programs with predetermined, imposed weight loss goals was significant (-0.48 SMD, 95%CI (-0.67, -0.29)) but there was no benefit in studies with self-set weight loss goals. Conclusions: Our results suggest that financial incentives are beneficial on weight loss both overall, and at 4 months. This benefit appears greater in studies with an imposed weight loss goal compared to self-set goals. These results suggest that financial incentives should be used more widely in weight loss programs. Future studies are needed to determine the best way to administer these financial rewards (e.g., deposit contracting, competitions or lotteries).
- Health services