Are Financial Incentives Good Patient Engagement Tools for Weight Loss?

Financial incentives may just be the most effective patient engagement tool for weight loss, outranking other strategies like wearables and diet books, according to researchers from the NYU Grossman School of Medicine.

After being offered cash for losing at least 5 percent of their original body weight, 49 percent of study participants were able to meet their weight loss goals, the team wrote in JAMA Internal Medicine.

Obesity is a common chronic illness affecting four in 10 Americans, figures from Trust for America’s Health show. Moreover, obesity is more salient among low-income populations; limited access to nutritious food and limited access to costly tools to overcome obesity may contribute to this trend.

Patient engagement is front and center in the work to address obesity as a chronic illness, as weight loss is primarily in the hands of the individual. But it’s not always clear which patient engagement strategies are both accessible and effective at addressing obesity.

“New tools are needed beyond encouragement and education to help some people struggling to cope with obesity,” senior investigator Melanie R. Jay, MD, an associate professor in the Departments of Medicine and Population Health at NYU Langone Health, said in a statement.

“There is no single solution to America’s worsening weight problem,” Jay added. “Our national approach has to include multiple approaches, including incentives tailored to the different needs of groups most profoundly impacted by illness and disease tied to obesity, such as type 2 diabetes, heart disease, and some cancers.”

The researchers zeroed in particularly on cash incentives, which have shown mixed results in motivating other health behaviors like medication adherence or even getting the COVID-19 vaccine. But considering the relationship between low income and obesity, the researchers posited that granting cash incentives for meeting a weight loss goal might outperform other types of patient engagement strategies, like access to Weight Watchers, free diet books, and free wearable technologies.

And that hypothesis was right, the researchers reported.

The team recruited 688 volunteers from New York and LA hospital-based clinics, most of whom were Hispanic men and women ages 18 to 70. The average weight at the start of the study was 218 pounds.

Participants were enrolled in one of three interventions: financial incentives tied to a weight loss goal, financial incentives tied to weight loss-oriented healthy behavior change, and free access to weight loss resources (digital scale, food journal, and fitness monitors). All participants received free access to Weight Watchers.

The resources were the least successful in motivating patient engagement and yielding weight loss. At six months, 22 percent of this group lost 5 percent of their original body weight, and by 12 months post-intervention, a third had lost the weight.

Those in either of the two financial incentive models were more likely to lose 5 percent of their body weight, the researchers reported.

At six months, 49 percent of those receiving cash for hitting a weight loss goal had hit their goal; this number dropped to 41 percent at 12 months post-intervention.

That trend was reversed for those who received cash incentives for fulfilling certain weight loss behaviors, like attending weight loss counseling classes, weighing themselves, and exercising for 75 minutes each week. At six months, 39 percent of those receiving financial incentives for completing such activities achieved their weight loss goal. At 12 months, that figure increased to 42 percent.

The researchers emphasized that none of the weight loss patient engagement strategies was a failure; helping one in five people achieve their weight loss goals is a clear success, even if another strategy was somewhat more effective, they indicated.

“Our study provides firm evidence that offering incentives, especially cash rewards, even if only for six months, helps people of limited means struggling with obesity to lose weight,” said Jay, who is also director of NYU Langone’s Comprehensive Program on Obesity. “However, any kind of incentive to lose weight can work, even if it is just offering the tools to help do so.”

Future research should broaden and diversify the participant pool, the research team said. Additionally, a more longitudinal look at weight loss outcomes for this current study’s participants could help uncover whether the initial incentives were enough to support goal weight loss or if “booster” incentives will be necessary in the future.