Financial vs. Non-financial Rewards for Weight Loss and Weight Maintenance: A Randomized Controlled Trial

减肥和维持体重的经济与非经济奖励：随机对照试验

• 批准号: 10016132
• 负责人: PAUL L. HEBERT
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016132
• 关键词: Address; Affect; Affective; Area; Behavior; Behavioral; Body Weight decreased; Cardiovascular system; Caring; Characteristics; Chronic; Chronic Disease; Cost Analysis; Development; Distant; Eating; Effectiveness; Emotional; Exhibits; Failure; Food; Future; Goals; Grant; Health; Health behavior; Incentives; Interview; Manufactured Baseball; Meta-Analysis; Methods; Morbidity - disease rate; Motivation; Obesity; Overweight; Participant; Patients; Randomized; Randomized Controlled Trials; Rewards; Running; Testing; Thinking; Time; Unhealthy Diet; Veterans; Weight; base; behavioral economics; cost; emotional reaction; experience; experimental study; field study; financial incentive; follow-up; health goals; healthy weight; incentive program; intervention cost; mortality; post intervention; primary outcome; programs; randomized trial; secondary outcome; socioeconomic disparity; treatment group; weight loss program; weight maintenance

Project Background: Behavioral economics suggests that our chronic inability to make the daily behavioral changes that can help us lose weight may be the result of “present bias,” which is a tendency to value small, immediate rewards over large rewards in the distant future. For many of us, the immediate gratification of eating an unhealthy food is a more powerful motivator than is the elusive dissatisfaction of the long-run health consequences of an unhealthy diet. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time. In a patient incentive program, patients are given tangible, timely rewards for achieving specific health goals, such as losing one pound per week over 16 weeks. Meta analyses of randomized trials have found that incentives for weight loss are effective during the incentive period, but the weight loss was not sustained after the incentive was removed. Thus, the key challenge to an incentive program is not achieving weight loss, but maintaining it. The proposed study tests the hypothesis that the significant weight regain found in prior incentive trials can be attributed to use of financial incentives—e.g., cash or the equivalent of cash—in those trials. Experiments in behavioral economics have found that providing subjects with financial incentives for participating in a study invokes behavior defined by reciprocity—the effort the subjects gave in the study was proportional to the amount of money that they were given. When subjects were given non-financial incentives, they exhibited no reciprocity—the effort was consistently high and did not vary with the quantity of the non-financial incentive. By using financial incentives, prior trials may have invoked money-market norms of reciprocity, such that patients’ efforts toward weight loss were high when incentives were offered, and reduced when they were discontinued. We hypothesize that non-financial rewards, like tickets to a Seattle Mariners baseball game, will not invoke reciprocity or the consequent weight regain. Project Objectives: The goal of this study is to test, through a randomized trial, the effectiveness of providing overweight Veterans with financial or non-financial incentives for a one pound weight loss per week over 16 weeks. The primary outcome is weight loss at 32 weeks—16 weeks after the discontinuation of the incentives. Secondary outcomes include weight loss at 16 weeks and 12 months. Project Methods: We will conduct a three-armed randomized of patient incentives for losing one pound per week over 16 weeks. The three treatment groups will receive financial incentives, non-financial incentives, or no incentives. We hypothesize that: 1) patients who receive non-financial incentives for weight loss over 16 weeks will have greater weight loss at 32 weeks than patients who do not receive incentives; 2) patients who receive non-financial incentives for weight loss over 16 weeks will experience weight loss at 16 weeks that is not inferior to the weight loss of patients who receive financial incentives; and 3) weight regain will be greater among patients who received financial incentives compared to patients who received non-financial incentives or no incentives. We will also conduct post-intervention qualitative interviews and perform a cost analysis.

项目背景：行为经济学表明，我们长期无法使日常行为 可以帮助我们减肥的改变可能是“当前偏见”的结果，这是一种看重小事的倾向， 对于我们许多人来说，眼前的回报胜过遥远未来的巨大回报。 吃不健康的食物是比对长期健康难以捉摸的不满更强大的动力 不健康饮食的后果可以通过改变奖励来克服目前的偏见。 在患者激励计划中，及时给予患者切实的、及时的奖励。 实现特定的健康目标，例如在 16 周内每周减掉一磅。 随机试验发现，减肥激励措施在激励期内是有效的，但 激励措施取消后，体重减轻并未持续，因此，激励措施面临的主要挑战是。 该计划不是实现减肥，而是维持减肥。拟议的研究检验了以下假设： 在之前的激励试验中发现的体重显着反弹可归因于经济激励的使用，例如， 现金或现金等价物——在这些试验中，行为经济学实验发现，提供现金。 因参与研究而受到经济激励的受试者会引发由互惠定义的行为——努力 受试者在研究中所给予的金额与他们所获得的金钱成正比。 获得非经济激励，但他们没有表现出互惠——他们的努力始终很高，而且没有表现出回报。 随非经济激励的数量而变化。通过使用经济激励，先前的试验可能已援引。 货币市场的互惠规范，当激励措施出现时，患者减肥的努力就会很高 我们提供了这些奖励，并在它们停止时减少了这些奖励，例如非经济奖励。 西雅图水手队棒球比赛的门票不会引发互惠或随之而来的体重反弹。 项目目标：本研究的目标是通过随机试验测试提供的有效性 超重退伍军人，在 16 岁以上每周减重一磅，并受到经济或非经济激励 主要结果是在激励措施停止后 32 周至 16 周时体重减轻。 次要结果包括 16 周和 12 个月时的体重减轻。 项目方法：我们将对每人减掉一磅的患者进行三组随机激励 超过 16 周的三个治疗组将获得经济奖励、非经济奖励或 我们认为：1）16 岁以上接受非经济减肥激励的患者。 32 周时，与未接受激励的患者相比，体重减轻幅度更大 2) 接受激励的患者； 在 16 周内接受非经济减肥激励措施将在 16 周时实现体重减轻，即 不亚于接受经济激励的患者体重减轻；并且3）体重反弹会更大； 接受经济激励的患者与接受非经济激励的患者相比 或没有激励措施。我们还将进行干预后定性访谈并进行成本分析。