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Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) – A randomized controlled trial

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  • Finkelstein, Eric A.
  • Tham, Kwang-Wei
  • Haaland, Benjamin A.
  • Sahasranaman, Aarti

Abstract

The prevalence of overweight and obesity has more than doubled in the past three decades, leading to rising rates of non-communicable diseases. This study tests whether adding a payment/rewards (term reward) program to an existing evidence-based weight loss program can increase weight loss and weight loss maintenance. We conducted a parallel-group randomized controlled trial from October 2012 to October 2015 with 161 overweight or obese individuals randomized to either control or reward arm in a 1:2 ratio. Control and reward arm participants received a four month weight loss program at the LIFE (Lifestyle Improvement and Fitness Enhancement) Centre at Singapore General Hospital. Those in the reward arm paid a fee of S$165.00 (1US$ = 1.35S$) to access a program that provided rewards of up to S$660 for meeting weight loss and physical activity goals. Participants could choose to receive rewards as guaranteed cash payments or a lottery ticket with a 1 in 10 chance of winning but with the same expected value. The primary outcome was weight loss at months 4, 8, and 12. 161 participants were randomized to control (n = 54) or reward (n = 107) arms. Average weight loss was more than twice as great in the reward arm compared to the control arm at month 4 when the program concluded (3.4 kg vs 1.4 kg, p < 0.01), month 8 when rewards concluded (3.3 kg vs 1.8 kg, p < 0.05), and at month 12 (2.3 kg vs 0.8 kg, p < 0.05). These results reveal that a payment/rewards program can be used to improve weight loss and weight loss maintenance when combined with an evidence-based weight loss program. Future efforts should attempt to replicate this approach and identify how to cost effectively expand these programs to maximize their reach. This study is registered at www.clinicaltrials.gov (Identifier: NCT01533454).

Suggested Citation

  • Finkelstein, Eric A. & Tham, Kwang-Wei & Haaland, Benjamin A. & Sahasranaman, Aarti, 2017. "Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) – A randomized controlled trial," Social Science & Medicine, Elsevier, vol. 185(C), pages 63-70.
    • Handle: RePEc:eee:socmed:v:185:y:2017:i:c:p:63-70
    DOI: 10.1016/j.socscimed.2017.05.030
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    References listed on IDEAS

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    1. Petracca, Francesco & Ardito, Vittoria & Sala, Francesca & Bertolaso, Guido & Menichelli, Lorenzo & Vecchio, Riccardo & Tarricone, Rosanna, 2025. "Harnessing financial incentives for health promotion: A scoping review of prevention programs implemented in upper-middle and high-income countries," Social Science & Medicine, Elsevier, vol. 383(C).
    2. Augurzky, Boris & Bauer, Thomas K. & Reichert, Arndt R. & Schmidt, Christoph M. & Tauchmann, Harald, 2025. "Obesity And Cash Rewards," Economics & Human Biology, Elsevier, vol. 57(C).
    3. Rojas Mendez,Ana Maria & Munoz Boudet,Ana Maria & Moscoe,Ellen Elizabeth & Jamison,Julian C & Herl,Carlos Rumiallo, 2023. "Behavioral Aspects of Healthy Longevity," Policy Research Working Paper Series 10347, The World Bank.
    4. Augurzky, Boris & Bauer, Thomas K. & Reichert, Arndt R. & Schmidt, Christoph M. & Tauchmann, Harald, 2018. "Habit formation, obesity, and cash rewards," Ruhr Economic Papers 750, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    5. Tony Beatton & Carly J. Moores & Dipanwita Sarkar & Jayanta Sarkar & Juliana Silva Goncalves & Helen A. Vidgen, 2021. "Do parental preferences predict engagement in child health programs?," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2686-2700, November.
    6. Finkelstein, Eric A. & Bilger, Marcel & Baid, Drishti, 2019. "Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review," Social Science & Medicine, Elsevier, vol. 232(C), pages 340-350.
    7. Yusi Gong & Taylor P Trentadue & Swastina Shrestha & Elena Losina & Jamie E Collins, 2018. "Financial incentives for objectively-measured physical activity or weight loss in adults with chronic health conditions: A meta-analysis," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-16, September.

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