A randomized trial of financial incentives for maintenance of weight loss

确定治疗肥胖症的有效策略既是临床挑战，也是公共卫生优先事项。 超过70%的美国人口超重或肥胖，而中年肥胖则意味着更高的肥胖率。 住院率。老年人的医疗保险支出、残疾和死亡风险。而 各种方法都成功地实现了初始体重减轻，维持初始体重的技术， 减肥在很大程度上是不成功的。这项3组随机对照试验将比较 （1）基于彩票的激励措施的有效性和成本效益，（2）传统的直接支付，以及（3） 在6个月内成功减掉至少5公斤体重的患者在没有激励的情况下每天提供反馈 参与慧俪轻体（前期），将为一些研究参与者提供奖励， 6个月后（I期），受试者将再随访6个月，以检查 停止奖励（第二阶段）。共188例受试者将被随机分配至3组。具体 目的是评估在前期期间基线体重减轻5 kg或以上的受试者：（1） 每日彩票为基础的财政激励措施的有效性，相对于通常的护理组，对维护 在随后的6个月内体重减轻;（2）直接支付奖励的有效性相对于 平时护理组维持体重减轻的情况;（3）彩票基础与 在第一阶段（第12个月）结束时，对维持减肥的直接支付财务奖励。在 此外，我们将评估干预组与对照组相比， 通常的护理组停止干预后，我们将评估的成本效益 维持减肥的激励措施。这项研究将建立在我们成功的努力，使用彩票为基础的 健康激励中心经验丰富的团队合作， 行为经济学的伦纳德戴维斯研究所卫生经济学（LDI CHIBE）在大学 宾夕法尼亚州和杜克大学。 相关性（参见说明）： 这项研究将有助于提高创新战略的有效性的宝贵知识， 在中年和老年美国人中保持体重减轻。这对于降低发病率至关重要 以及美国老年人的死亡率，并更广泛地改善美国人口的健康状况。 因为肥胖在美国人中非常普遍。'

Identifying effective strategies for treating obesity is both a clinical challenge and a public health priority. Over 70% of the U.S. population is overweight or obese, and obesity in nniddle age translates into higher rates of hospitalization. Medicare expenditures, disability, and mortality risk among older adults. While a variety of approaches are successful in achieving initial weight loss, techniques for maintenance of initial weight loss have largely been unsuccessful. This 3- arm randomized controlled trial will compare the relative effectiveness and cost-effectiveness of (1) lottery-based incentives, (2) traditional direct payments, and (3) daily feedback without incentives among patients who successfully lost at least 5 kg over 6 months during participation in Weight Watchers (Pre Phase), incentives will be provided to some study participants for the following 6 months (Phase I), and subjects will be followed for 6 more months to examine effects following cessation of incentives (Phase II). A total of 188 participants will be randomized into the 3 arms. Specific Aims will be to assess among participants who lose 5kg or more of baseline weight during Pre Phase: (1) the effectiveness of a daily lottery-based financial incentive, relative to the usual care group, on maintenance of weight loss over the ensuing 6 months; (2) the effectiveness of a direct payment incentive relative to the usual care group oh maintenance of weight loss; (3) the comparative effectiveness of lottery based and direct payment financial incentives on maintenance of weight loss at the end of Phase I (month 12). In addition, we will assess the degree to which weight loss is maintained in the intervention groups compared to the usual care group following cessation ofthe interventions, and we will assess the cost-effectiveness of incentives for maintenance of weight loss. This study will build on our successful efforts using lottery-based incentives for weight loss in partnership between experienced teams at the Center for Health Incentives and Behavioral Economics ofthe Leonard Davis Institute of Health Economics (LDI CHIBE) at the University of Pennsylvania and at Duke University. RELEVANCE (See instructions): This study will contribute valuable knowledge about the effectiveness of innovative strategies to improve maintenance of weight loss among middle aged and older Americans. This is central to reducing morbidity and mortality rates among older Americans and improving the health ofthe US population more broadly since obesity is extremely common among Americans. '