Date of Completion

9-6-2011

Embargo Period

9-6-2011

Advisors

Michael M. Copenhaver; Valerie B. Duffy

Field of Study

Allied Health

Degree

Master of Science

Open Access

Open Access

Abstract

Abstract:

Purpose: The present study aimed to evaluate the effect of a financial incentive on weight loss and diabetes risk score (DRS) following a tailored National Diabetes Education Program (NDEP) weight loss intervention among adults who are overweight/obese and who are at risk for type 2 diabetes. An additional aim to evaluate changes in weight loss self-efficacy (WLSE), exercise self-efficacy (ESE), healthy eating score (HES) and movement through the stages of change (SOC) from pre to post intervention.

Design: Four long-term care facilities, from one corporation, were randomly assigned to either an Incentivized Program (IP) or a Non-Incentivized Program (NIP). All facility employees were asked to follow a weight loss program for 16-weeks and a 3-month follow-up, with a goal of losing 1 or 1 ½ pounds a week. All had a one-on-one hour-long consultation session with a Registered Dietitian and/or Health Educator, which included setting weekly weight loss goals. IP participants could bank $10 for every 1 or 1 ½ pounds they lost up to $160, but needed to lose a minimum weight (11 or 14 pounds) to receive any cash incentive. The IP group also could participate in “Win Big,” where participant’s weekly cash deposit with achieving weight loss goal was matched by the Program. IP participants who maintained the intervention weight loss at 3-months follow-up would receive an additional $100. The NIP participants received no financial incentive.

Results: Seventy-three employees completed the 16 weeks program and 3-month follow-up; 35 from the IP group and 38 from the NIP group. Most were middle-ages females with at least a high school diploma. There was a significant weight loss for the IP group at the completion of the study compare to the NIP group (p<0.05). The mean weight loss for IP group was (Mean ± SE) 7.40 ± 1.88 pounds and for NIP group was (Mean ± SE) 2.17 ± 1.36 pounds. The total weight loss for the IP group was 304.8 pounds and the total weight loss for NIP group was 148.4 pounds. Neither group showed a significant reduction in BMI from pre-post intervention. Diabetes risk score also showed significant reduction in the IP group compare to the NIP group using nonparametric procedure (p<0.05). Percentage of participants in the IP group that improved in waist circumference was 80% compared to 73% of participants who improved in the NIP group. Overall SOC and HES scores increased for both groups, while overall WLSE and ESE scores from baseline to 3-month follow-up decreased for the IP group but remained unchanged for the NIP group. The IP group had a higher percentage of participants improve in almost all chronic conditions. Participants who lost at least 5% of weight had higher percentage of participants who improved in overall SOC (p value 0.04), WLSE, ESE, HES, waist circumference, self-reported general health, energy level, and almost all chronic conditions. Percentage of participants, who lost at least 5% of weight, that improved in waist circumference was 100% compared to 67.90% of participants who improved and did not lose at least 5% of weight.

Conclusions: This study demonstrated the effectiveness of a monetary incentive in a weight loss program for individuals who are overweight and obese and at high risk for type 2 diabetes, based on weight and DRS. Those who lost 5% of weight showed higher improvements in overall SOC, WLSE, ESE, HES, waist circumference, self-reported general health, energy level, and almost all chronic conditions. Further testing of longer-term use of monetary incentives is needed to determine whether it would lead to sustained weight loss.

Major Advisor

Pouran D. Faghri

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