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All Rights Reserved [Search All ] [ ] Input Search Term [ ] Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal Twitter Facebook More New Online Views 0 Citations 0 View Metrics * Download PDF * Full Text * Share Twitter Facebook Email LinkedIn * Cite This * Permissions * Comment Original Investigation December 5, 2022 Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods: A Randomized Clinical Trial Joseph A. Ladapo, MD, PhD^1; Stephanie L. Orstad, PhD^2; Soma Wali, MD^3; et al Judith Wylie-Rosett, EdD, RD^4; Chi-Hong Tseng, PhD^5; Un Young Rebecca Chung, BS^5; Miguel A. Cuevas, BS^5; Christina Hernandez, MPH^2; Susan Parraga, BS^2; Robert Ponce, BS^3; Victoria Sweat, MA^2; Sandra Wittleder, PhD^2; Andrew B. Wallach, MD^2,6; Suzanne B. Shu, PhD^7; Noah J. Goldstein, PhD^8; Melanie Jay, MD^2,9 Author Affiliations Article Information * ^1Department of Medicine, University of Florida College of Medicine, Gainesville * ^2Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York * ^3Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California * ^4Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York * ^5Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California * ^6Bellevue Hospital Center, New York, New York * ^7Cornell Dyson School of Applied Economics and Management, Ithaca, New York * ^8Anderson School of Management at UCLA, Los Angeles, California * ^9New York Harbor Veterans Health Affairs, New York, New York JAMA Intern Med. Published online December 5, 2022. doi:10.1001/ jamainternmed.2022.5618 visual abstract icon Visual Abstract editorial comment icon Editorial Comment related articles icon Related Articles author interview icon Interviews multimedia icon Multimedia audio icon Listen to this article Visual Abstract. Effectiveness of Financial Incentives for Weight Loss Among Patients With Obesity in Disadvantaged Neighborhoods View LargeDownload Full Text Key Points Question Is there a difference in weight-loss effectiveness of 2 financial incentive strategies using behavioral economic theory and a strategy of provision of weight-management resources? Findings In this randomized clinical trial, 668 patients with obesity living in low-income neighborhoods were randomized to 1 of 3 arms. At 6 months, the proportion losing at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group; mean percentage of weight loss was similar in the incentive arms. Meaning Outcome-based and goal-directed financial incentives were more effective than resources only for weight loss in this low-income population. Abstract Importance Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations. Objective To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources. Design, Setting, and Participants Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled. Interventions Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750. Main Outcomes and Measures Proportion of patients achieving 5% or greater weight loss at 6 months. Results The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being. Conclusions and Relevance In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03157713 Full Text Seamless Access Logo Access through your institution Add or change institution Comment Limit 200 characters [ ] Limit 25 characters [ ] Conflicts of Interest Disclosure Identify all potential conflicts of interest that might be relevant to your comment. 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The following information is required and must be completed in order to submit a comment: Thank You. Your comment submission was successful. Please allow up to 2 business days for review, approval, and posting. JAMA Internal Medicine Read More About Diversity, Equity, and Inclusion Health Disparities Health Inequities Obesity Diet Lifestyle Behaviors Health Care Economics, Insurance, Payment Download PDF Full Text Cite This Citation Ladapo JA, Orstad SL, Wali S, et al. Effectiveness of Goal-Directed and Outcome-Based Financial Incentives for Weight Loss in Primary Care Patients With Obesity Living in Socioeconomically Disadvantaged Neighborhoods: A Randomized Clinical Trial. JAMA Intern Med. 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