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

项目背景：行为经济学表明，我们长期无法使日常行为 能够帮助我们减肥的改变可能是“现在偏见”的结果，这是一种倾向于重视小， 眼前的回报胜过遥远未来的巨大回报。对我们中的许多人来说， 吃一种不健康的食物比对长期健康的难以捉摸的不满更有动力。 不健康饮食的后果。病人的激励可以克服目前的偏见，通过移动奖励， 健康的生活方式及时更新。在患者激励计划中，患者会得到有形的、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。Meta分析 随机试验发现，在激励期内，减肥激励措施是有效的，但 在取消奖励后，体重没有持续下降。因此，激励措施的关键挑战 计划不是实现减肥，而是保持它。拟议的研究测试的假设， 在先前的激励试验中发现的显著的体重恢复可归因于使用财务激励-例如， 现金或现金等价物在这些试验中。行为经济学的实验发现， 具有参与研究的经济激励的受试者调用由互惠定义的行为-努力 研究中的受试者给予的钱与他们得到的钱的数量成正比。当受试者 给予非经济激励，他们没有表现出任何回报-努力一直很高， 这取决于非财务激励的数量。通过使用经济奖励，以前的审判可能会援引 互惠的货币市场规范，例如当激励措施时，患者对减肥的努力很高 当他们被解雇时，他们被解雇了。我们假设非金钱奖励，比如 一张西雅图水手队棒球赛的门票，不会引起互惠或随之而来的体重反弹。 项目目的：本研究的目的是通过随机试验，测试提供 超重的退伍军人与财政或非财政激励为一磅体重减轻每周超过16 周主要结果是在32周-停止激励后16周的体重减轻。 次要结局包括16周和12个月时的体重减轻。 项目方法：我们将进行一个三臂随机化的病人奖励，每减少一磅， 一周超过16周三个治疗组将获得经济奖励、非经济奖励或 没有奖励。我们假设：1）16岁以上接受非经济奖励减肥的患者 32周时体重减轻的患者比未接受奖励的患者更大; 2） 接受非金钱奖励的减肥超过16周将经历减肥16周， 不低于接受经济奖励的患者的体重减轻; 3）体重恢复将更大 接受经济激励的患者与接受非经济激励的患者相比， 或者没有奖励我们还将进行干预后的定性访谈，并进行成本分析。

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.