Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults

"Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial" published online, Annals of Internal Medicine
Mitesh S. Patel, MD, MBA, MS; David A. Asch MD, MBA; Roy Rosin, MBA; Dylan S. Small, PhD; Scarlett L. Bellamy, ScD; Jack Heuer, EdD; Susan Sproat, MS; Chris Hyson, MEd; Nancy Haff, MD; Samantha M. Lee, MD; Lisa Wesby, MS; Karen Hoffer, BS; David Shuttleworth, MS; Devon H. Taylor, BS; Victoria Hilbert, MPH, RD; Jingsan Zhu, MBA, MS; Lin Yang, MS; Xingmei Wang, MS; and Kevin G. Volpp, MD, PhD

Here is the abstract - or what counts as abstract in medical journals:

"Background: Financial incentive designs to increase physical activity have not been well-examined.

Objective: To test the effectiveness of 3 methods to frame financial incentives to increase physical activity among overweight and obese adults.

Design: Randomized, controlled trial. (ClinicalTrials.gov: NCT 02030119)

Setting: University of Pennsylvania.

Participants: 281 adult employees (body mass index ≥27 kg/m2).

Intervention: 13-week intervention. Participants had a goal of 7000 steps per day and were randomly assigned to a control group with daily feedback or 1 of 3 financial incentive programs with daily feedback: a gain incentive ($1.40 given each day the goal was achieved), lottery incentive (daily eligibility [expected value approximately $1.40] if goal was achieved), or loss incentive ($42 allocated monthly upfront and $1.40 removed each day the goal was not achieved). Participants were followed for another 13 weeks with daily performance feedback but no incentives.

Measurements: Primary outcome was the mean proportion of participant-days that the 7000-step goal was achieved during intervention. Secondary outcomes included mean proportion of participant-days achieving the goal during follow-up and mean daily steps during intervention and follow-up.

Results: The mean proportion of participant-days achieving the goal was 0.30 (95% CI, 0.22 to 0.37) in the control group, 0.35 (CI, 0.28 to 0.42) in the gain-incentive group, 0.36 (CI, 0.29 to 0.43) in the lottery-incentive group, and 0.45 (CI, 0.38 to 0.52) in the loss-incentive group. In adjusted analyses, only the loss-incentive group had a significantly greater mean proportion of participant-days achieving the goal than control (adjusted difference, 0.16 [CI, 0.06 to 0.26]; P = 0.001), but the adjusted difference in mean daily steps was not significant (861 [CI, 24 to 1746]; P = 0.056). During follow-up, daily steps decreased for all incentive groups and were not different from control.

Limitation: Single employer.

Conclusion: Financial incentives framed as a loss were most effective for achieving physical activity goals.

Primary Funding Source: National Institute on Aging."

Here is a write up by medpage today.

"There's plenty of previous research on the behavioral economics concept of loss aversion, or people's tendency to prefer avoiding losses to getting gains. In an interview with MedPage Today, co-author Mitesh Patel, MD, MBA, also at UPenn, said that the results were in line with what they were expecting.
But he added that this study was the first to test the loss aversion principle in a prospective study of employees with physical activity as an outcome."

Here is a figure from a write up by UPenn