Methods to maximize retention in weight loss studies. A work-site weight control program using financial incentives collected through payroll deduction. Nationwide access to an internet‐based contingency management intervention to promote smoking cessation: a randomized controlled trial Effectiveness of Financial Incentives in a Worksite Diabetes Prevention Program Correspondence programs for smoking cessation and weight control: a comparison of two strategies in the Minnesota Heart Health Program. Promoting weight control at the worksite: a pilot program of self-motivation using payroll-based incentives. Behavioral treatment of obesity with monetary contracting: two-year follow-up. Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial. Does It Pay to Pay?: A Randomized Trial of Prepaid Financial Incentives and Lottery Incentives in Surveys of Nonphysician Healthcare Professionals
OBJECTIVE Dropouts from clinical trials  decrease quality and increase costs .  Free participation , paid participation , and contingency contracting are three study retention methods . Contingency contracting , or depositing a fee to be refunded contingent upon attendance in a clinical trial , has been reported to decrease dropouts without affecting weight loss . These three methods of retention were compared with a commercial weight loss clinic 's practice of charging nonrefundable fees . METHODS AND PROCEDURES  Dropouts  were compared in two studies testing mazindol , with one study using free care  and the other using contingency contracting ; two studies testing phenylpropanolamine , one using free care  and the other using  contingency contracting ;  and in studies with phenylpropanolamine on file with Thompson Medical Company using free care , paid participation , and contingency contracting . RESULTS The dropout rate was 50 % at 8 weeks in a trial of mazindol with free care vs. 7 % for contingency contracting ( p<0.001 ) . The two phenylpropanolamine studies gave the same weight losses , but the dropouts were 37 % at 8 weeks for free care vs. 11 % for contingency contracting ( p<0.001 ) . The studies of phenylpropanolamine on file at the Thompson Medical Company had 28 % dropouts at 8 weeks using free care vs. 19 % for paid participation ( p<0.001 ) , and 11 % for contingency contracting ( p<0.005 ) . Dropouts with contingency contracting ( 11 % ) were not different from the commercial weight loss program ( 13 % ) . DISCUSSION Contingency contracting can decrease dropouts , improve quality , and decrease costs without affecting weight loss in clinical trials for obesity In a work-site weight control program using a self-motivational program of financial incentives implemented through payroll deduction , 131 university employees chose weight loss goals ( 0 to 60 lb ) and incentives ( + 5 to + 30 ) to be deducted from each paycheck for six months . Return of incentive money was contingent on progress toward weight goals . Participants were assigned r and omly to one of four protocol s , involving group educational sessions v self-instruction only and required v optional attendance at weigh-ins and sessions . Overall , dropout rates ( 21.4 % ) and mean weight loss ( 12.2 lb ) were encouraging , especially compared with those of other work-site programs . Weight loss was positively associated with attendance at weigh-ins and educational sessions . However , requiring attendance did not increase program effectiveness and seemed also to discourage enrollment among men . The weight control program was equally effective when offered with professionally led educational sessions or when accompanied by self-instructional material s only Background and aims Contingency management ( CM ) is one of the most effective behavioral interventions to promote drug abstinence , but availability of this treatment is limited . We evaluated the efficacy and acceptability of internet‐based CM relative to an internet‐based monitoring and goal ‐ setting control group in a nationwide sample of cigarette smokers . Design R and omized controlled trial with 3‐ and 6‐month follow‐ups . Setting United States . Participants Smokers ( n = 94 ) from 26 states were enrolled ( mean age 36 , 56 % female ) . Intervention and comparator Participants were r and omized to earn financial incentives ( up to $ 480 over 7 weeks ) based on video‐verified abstinence using breath carbon monoxide ( CO ) output ( n = 48 ; abstinent contingent group , AC ) , or based on su bmi tting CO sample s ( n = 46 , su bmi ssion contingent , SC ) . Both groups also received the same CO‐based goals . A $ 50 deposit was required in both groups that could be recouped from initial earnings . Measures The primary outcome was point prevalence at week 4 . Secondary outcomes were point prevalence at the 3‐ and 6‐month follow‐ups , percentages of negative CO sample s , adherence to the CO sampling protocol , and treatment acceptability ratings on a 0–100‐mm visual analog scale . Findings Abstinence rates differed at 4 weeks between the AC ( 39.6 % ) and SC ( 13.0 % ) groups [ odds ratio ( OR ) = 4.4 , 95 % confidence interval ( CI ) = 1.6–12.3 ] , but not at the 3‐ ( 29.2 % AC and 19.6 % SC , OR = 1.7 , 95 % CI = 0.6–4.4 ) or 6‐ ( 22.9 % AC and 13.0 % SC , OR = 2.0 , 95 % CI = 0.7–5.9 ) month follow‐ups . During the two main treatment phases , there were significant differences in negative COs ( 53.9 % AC and 24.8 % SC , OR = 3.5 , 95 % CI = 3.1–4.0 ; 43.4 % AC and 24.6 % SC , OR = 2.3 , 95 % CI = 1.6–3.4 ) . Adherence to the CO su bmi ssion protocol was equivalent ( 78 % AC and 85 % SC , difference = 7.0 % , 95 % CI = −10.3 to 23.8 % , F < 1 , P = 0.39 ) . The lowest acceptability ratings were for the items assessing the deposit , whereas the highest ratings concerned the ease of the intervention , the graph of CO results , and earning money . Conclusions A contingency management/financial incentive program delivered via the internet improved short‐term abstinence rates compared with an internet program without the incentives Purpose To evaluate the effect of financial incentive in a diabetes prevention weight loss program at worksites . Design Group-level r and omized intervention study . Setting Four long-term care facilities , r and omly assigned to “ incentive-IG ” or “ non incentive-NIG ” groups . Participants Ninety-nine employees , all overweight or obese ( BMI = mean 34.8±7.4 kg/m2 ) and at risk for type 2 diabetes . Intervention A 16 week weight loss program ( diabetes prevention program ) with a 3 month follow up . IG could either choose a " st and ard incentive " to receive cash award when achieving the projected weight loss or to participate in a " st and ard plus deposit incentive " to get additional money matched with their deposit for projected weight loss . All of the participants received a one-hour consultation for a healthy weight loss at the beginning . Measures Weight-loss , diabetes risk score ( DRS ) , and cardiovascular risk outcomes . Analyses Linear and logistic regressions for completed cases with adjustments for clustering effect at group level . Results IG lost on average more pounds ( p=0.027 ) , reduced BMI ( p=0.04 ) , and reduced in DRS ( p=0.011 ) compared to NIG at week 16 . At the 12-week follow-up period , those in IG plus deposit subgroup had twice the odds ( OR=2.2 , p=0.042 ) and those in the st and ard IG had three times the odds of achieving weight loss goals than NIG ; those in the IG plus deposit group reduced DRS by 0.4 ( p=0.045 ) . Conclusion Monetary incentives appear to be effective in reducing weight and diabetes risk Mailed invitations to participate in weight loss and /or smoking cessation correspondence programs to 31,400 households in a suburban community . Two programs were offered to r and omized subsets of households , a 6-month correspondence program costing + 5 and the same program for free but requiring a + 60 deposit to be refunded based on success in weight loss or smoking cessation . Overall , sign-up included 1,304 people for weight loss and 142 for smoking cessation . The + 5 program was about 5 times as popular as the incentive program .  Vali date d weight change after 6 months averaged about 4 lb for the + 5 program and 8 lb for the incentive program . Corresponding rates of smoking cessation were about 9 % and 20 % , respectively . We conclude that correspondence programs for the promotion of weight control and smoking cessation are potentially cost-effective methods for reaching individuals in the community at large , many of whom would not be interested in clinic-based programs . Issues meriting further research include recruitment , especially of smokers , and evaluation of the relative trade-offs in recruitment success versus efficacy of differing treatment approaches Thirty-six individuals participated in a worksite weight-loss program  in which the central component was a self-motivation program of biweekly payroll deductions refunded contingent on meeting self-selected weight-loss goals . Half were assigned to early treatment and the remainder to a delayed treatment control group .  Nine additional individuals also enrolled at the time of  delayed treatment  and were included in descriptive analyses of factors associated with weight loss . Results showed low program attrition over 6 months ( 6 % ) and mean weight losses ( 12.3 lb ) that are competitive with those obtained in clinical setting s. Although not different at baseline , participants in the delayed treatment group lost more than twice as much weight as those in the early treatment condition . This difference was interpreted as either a strong seasonal effect or a critical mass effect related to the proportion of employees at the worksite participating in the program . We conclude that self-motivation programs for health behavior change using the payroll system as an organization framework offer a promising new methodology for promoting healthful behaviors in work setting Reported is a 2-year follow-up of a behavioral weight reduction program  for men using monetary contracts of varying size and group versus individual contingencies . Although initial weight losses were large , in the absence of an effective maintenance program weight losses at two years were modest , similar to those obtained with less effective initial weight loss procedures . Group contracts were significantly more effective in producing long term loss than individual contracts . Reported behaviors associated with weight loss at 2 years are presented ABSTRACT BACKGROUND Previous efforts to use incentives for weight loss have result ed in substantial weight regain after 16 weeks . OBJECTIVE To evaluate a longer term weight loss intervention using financial incentives . DESIGN A 32-week , three-arm r and omized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week , followed by an 8-week maintenance phase . PARTICIPANTS Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMI s of 30–40.INTERVENTION Participants were r and omly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins ( control condition ) , or the same program with one of two financial incentive plans . Both incentive arms used deposit contracts ( DC ) in which participants put their own money at risk ( matched 1:1 ) , which they lost if they failed to lose weight . In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance ; in the other , no such distinction was made . MAIN MEASUREWeight loss after 32 weeks . KEY RESULTS Results were analyzed using intention-to-treat . There was no difference in weight loss between the incentive arms ( P = 0.80 ) . Incentive participants lost more weight than control participants [ mean DC = 8.70 pounds , mean control = 1.17 , P = 0.04 , 95 % CI of the difference in means ( 0.56 , 14.50 ) ] . Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain ; the net weight loss between the incentive and control groups was no longer significant ( mean DC = 1.2 pounds , 95 % CI , -2.58–5.00 ; mean control = 0.27 , 95 % CI , -3.77–4.30 , P = 0.76 ) . CONCLUSIONS Financial incentives produced significant weight loss over an 8-month intervention ; however , participants regained weight post-intervention There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss .  Between March 2010 and January 2012 , in a r and omized controlled trial , we assigned 700 obese persons to three experimental arms . We test whether particular subgroups react differently to financial incentives for weight loss . Two treatment groups obtained a cash reward ( € 150 and € 300 with 237 and 229 participants , respectively ) for achieving an individually-assigned target weight within four months ; the control group ( 234 participants ) was not incentivized . Participants and administrators were not blinded to the intervention . We find that monetary rewards effectively induced  obese individuals to reduce weight across all subgroups . However , there is no evidence for treatment-effect heterogeneity for those groups that were incentivized . Among those who were in the € 300 group , statistically significant and large weight losses were observed for women , singles , and those who are not working ( all above 4 kg in four months ) . In addition , the magnitude of the reward matters only for women and migrants . The effectiveness of financial incentives to reduce weight nevertheless raises sensitive ethical issues that should be taken into consideration by policymakers Background Monetary incentives in survey research may provide important gains from a method ological perspective in the control and reduction of survey error associated with potential nonresponse of participants . However , few studies have systematic ally investigated the use of monetary incentives or other methods to improve the response rates in the nonphysician clinician population . Objective To investigate differences in response rates to a mailed self-administered survey of nonphysician clinicians who were r and omized to receive a prepaid monetary incentive , a postsurvey prize drawing , or no incentive . Methods A r and omized controlled trial of financial incentives was conducted from November 2002 to February 2003 . Nonphysician clinicians ( nurse practitioners [ NPs ] and physician assistants [ PAs ] ; N = 3,900 ) r and omly selected to participate in a national ethics-related study were assigned r and omly in equal allocations ( n = 1,300 [ 650 NPs , 650 PAs ] ) to three incentive groups : ( a ) no incentive ; ( b ) a $ 5 prepaid token incentive in the initial mailing ; or ( c ) a chance to win one of ten $ 100 prize drawings upon completion and return of a self-administered survey . Results A $ 5 cash incentive increased survey response rates to an adjusted 64.2 % : a 19.5 percentage point increase over the lottery group ( 44.7 % response rate ) , and a 22 percentage point increase over the control group ( 42.2 % response rate ) . Discussion A nominal cash incentive of $ 5 yields a significantly higher response rate from nonphysician providers than receiving either a lottery option or no incentive
Group refunds , deposit not paid as lump sum , participants setting their own deposit size and additional behaviour change techniques were associated with greater weight loss during treatment .
Post-treatment , there was no significant effect of MCCs on weight loss .
There was a significant small-to-medium effect of MCCs on participant retention during treatment .
Research er-set deposits paid as one lump sum , refunds delivered on an all-or-nothing basis and refunds contingent on attendance at classes were associated with greater retention during treatment .
Post-treatment , there was no significant effect of MCCs on participant retention .
The results support the use of MCCs to promote weight loss and participant retention up to the point that the incentive is removed and identifies the conditions under which MCCs work best
Financial incentives to improve health have received increasing attention , but are subject to ethical concerns .
Monetary Contingency Contracts ( MCCs ) , which require individuals to deposit money that is refunded contingent on reaching a goal , are a potential alternative strategy .
This review evaluates systematic ally the evidence for weight loss – related MCCs .