Log2Lose: Incenting weight loss and dietary self-monitoring in real-time to improve weight management

摘要 在过去的40年里，肥胖症的流行率以惊人的速度增长。即使是适度的减肥， 至少5%改善临床参数和生活质量。有效的行为减肥计划教 参与者的行为策略，以创造和维持热量不足。两个最强的长期预测因素- 这些项目中的长期减肥是初始减肥和饮食自我监测。随着时间的推移，这些 现象下降，限制了计划的有效性。增加初始减肥和自我减肥的经济激励措施 监测之所以具有吸引力，是因为它们可以相对容易和低成本地向大量人口提供。 雇主和支付者已经开始为健康行为和结果提供经济激励， 缺乏充分的证据基础，无法为此类干预措施的最佳设计提供信息。拟定的研究将 评估哪种激励方法具有最大的影响和持久性-激励临时减肥， 饮食自我监测，或两者兼而有之。测试激励这些现象的影响的研究表明， 一些承诺增加短期减肥。很少有研究评估激励对长期的影响 减肥;检查内在或外在动机的中介作用;或计算程序成本或 财政激励措施的成本效益。在拟定的双中心、随机、单盲、 纵向2x2因子研究，称为“Log 2Lose”，我们通过评估个体来解决这些局限性。 以及近实时激励每周减肥和饮食自我监测对6个月的联合作用。 减肥和随后的减肥维持。来自麦迪逊社区的肥胖症患者， WI和达勒姆，NC将接受18个月的干预，包括：1.一个激励减肥计划 6个月（第一阶段），2。一个激励的体重维持计划6个月（第二阶段），和3。一个非- 持续6个月的体重维持计划（第三阶段）。受试者将随机接受 每周减肥、饮食自我监测的辅助激励措施，两者兼而有之，或两者都不。我们将测量 在6（主要终点）、12和18时达到具有临床意义的体重减轻≥5%的受试者比例 个月我们将评估外在和内在动机是否介导干预效果;计算 干预成本;并计算四个研究组的成本效益比。我们的财务激励措施 干预措施的设计是通过使用现有技术和自动化的过程， 分析数据以提供近乎实时的激励。干预可以与各种减肥配对 由临床医生或付款人提供的干预措施，或集成到各种面向患者和消费者的 技术.这项研究的完成将有助于我们确定和实施 有效、经济、可扩展的方法，以减少肥胖和相关健康的患病率 结果。

Abstract In the past 40 years, the prevalence of obesity has increased at an alarming rate. Even modest weight loss of at least 5% improves clinical parameters and quality of life. Efficacious behavioral weight loss programs teach participants behavioral strategies to create and maintain a caloric deficit. The two strongest predictors of long- term weight loss in such programs are initial weight loss and dietary self-monitoring. Over time, these phenomena decline, limiting program effectiveness. Financial incentives to increase initial weight loss and self- monitoring are appealing because they can be delivered to large populations with relative ease and at low cost. Employers and payers have begun to provide financial incentives for health behaviors and outcomes despite an inadequate evidence base to inform the optimal design of such interventions. The proposed study will evaluate which incentive approach has the greatest impact and durability—incentivizing interim weight loss, dietary self-monitoring, or both. Studies testing the effects of incentivizing these phenomena have showed some promise for increasing short-term weight loss. Few studies have evaluated incentive effects on long-term weight loss; examined the mediating role of intrinsic or extrinsic motivation; or calculated program costs or cost-effectiveness of financial incentive interventions. In the proposed two-site, randomized, single-blinded, longitudinal 2x2 factorial study, known as “Log2Lose,” we address these limitations by evaluating the individual and joint effects of incentivizing, in near real-time, weekly weight loss and dietary self-monitoring on 6-month weight loss and subsequent weight loss maintenance. People with obesity from the communities of Madison, WI and Durham, NC will receive an 18-month intervention comprising: 1. An incentivized weight loss program for 6 months (Phase I), 2. An incentivized weight maintenance program for 6 months (Phase II), and 3. A non- incentivized weight maintenance program for 6 months (Phase III). Participants will be randomized to receive adjunctive incentives for weekly weight loss, dietary self-monitoring, both, or neither. We will measure the proportion of participants achieving clinically significant weight loss of ≥5% at 6 (primary endpoint), 12, and 18 months. We will assess whether extrinsic and intrinsic motivation mediate intervention effect; calculate intervention costs; and calculate cost-effectiveness ratios across the four study arms. Our financial incentives intervention was designed to be scalable by using available technology and automating the process of analyzing data to provide incentives in near real-time. The intervention could be paired with various weight loss interventions offered by clinicians or payers, or integrated into a variety of patient and consumer-facing technologies. Completion of this study will contribute to our long-term goal of identifying and implementing efficacious, cost-effective, scalable approaches to reduce the prevalence of obesity and associated health outcomes.