Financial incentives improve dietary intervention outcomes in adolescents with severe obesity

Financial incentives improve dietary intervention outcomes in adolescents with severe obesity | Image Credit: © Protsenko Dmitriy - © Protsenko Dmitriy - stock.adobe.com.

According to a new study published in JAMA Pediatrics, the addition of financial incentives (FIs) to meal replacement therapy (MRT) resulted in greater reductions in body mass index (BMI) and total body fat in adolescents with severe obesity. Data revealed these reductions came without an increase in unhealthy weight-control behaviors.¹

"Adolescent severe obesity is usually not effectively treated with traditional lifestyle modification therapy," wrote the study investigators, led by Amy C. Gross, PhD, of the University of Minnesota Center for Pediatric Obesity Medicine. "MRT shows shows short-term efficacy for body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) reduction in adolescents, and financial incentives (FIs) may be an appropriate adjunct intervention to enhance long-term efficacy."

To evaluate the effect of MRT plus FIs compared to MRT alone, the investigators developed a randomized clinical trial at a large health center in the Midwest, conducted from 2018 to 2022. Participants included adolescents aged 13 to 17 years with severe obesity, defined as at or greater than 120% of the 95th BMI percentile based on age and sex, or 35 or greater BMI, whichever was lower. Participants were unaware of the FI component of the trial until randomization or the end of the trial. Staff members of the study were blinded to treatment condition.

Exclusion criteria included²:

Type 1 or type 2 diabetes mellitus

- Previous (within 6 months) or current use of meal replacements

- Previous (within 6 months) or current use of medication prescribed primarily for weight loss

- Previous bariatric surgery

- Others

Throughout the trial, participants were provide pre-prepared meals that were well-balanced and calorically portioned (~1200 kcals/d) and individuals were instructed to eat only the meals provided, which were delivered to homes free of charge. Guidance for use of meals at school was provided and participants were encouraged to eat with family while at home.

FIs were provided based on body weight rather than BMI reductions to keep the process straightforward for participants in the MRT plus FIs group, according to the study investigators. For every 0.5% reduction in body weight from baseline, participants received a $20 gift card. All participants received reimbursement for completing study visits regardless of group assignment, up to $700.

The primary endpoint of the study was BMI percentage change from randomization to 52 weeks. Total body fat and cardiometabolic risk factors such as blood pressure, triglyceride to high-density lipoprotein ratio, heart rate variability, and arterial stiffness, were secondary outcomes.

Of the 126 adolescents with severe obesity, 63 received MRT plus FI and 63 received MRT only. The mean BMI reduction was greater by –5.9% (95% CI, -9.9-1.9% [P = .004]) in the MRT plus FI group compared to the MRT-only group. Additionally, the MRT plus FI group had a greater reduction in the mean total body fat mass by -4.8 kg (95% CI, -9.1 kg to -0.6 kg [P = .03]) and was cost effective compared to MRT alone (incremental cost-effectiveness ratio, $39 178 per quality-adjusted life year).

For the secondary outcomes, no significant differences in cardiometabolic risk factors or unhealthy weight-control behaviors were observed between groups, wrote the study investigators.

The investigative team concluded "adding FIs to MRT resulted in greater reductions in BMI and total body fat in adolescents with severe obesity without increased unhealthy weight-control behaviors. FIs were cost-effective and possibly promoted adherence to health behaviors."

References:

1. Gross AC, Freese RL, Bensignor MO, et al. Financial incentives and treatment outcomes in adolescents with severe obesity: A randomized clinical trial. JAMA Pediatr. Published online June 17, 2024. doi:10.1001/jamapediatrics.2024.1701

2. Weight loss with meal-replacement therapy in teens. ClinicalTrials.gov. Updated March 22, 2024. Accessed June 19,2024. https://clinicaltrials.gov/study/NCT03137433