Cash incentives for weight loss work only for males

When governments and healthcare providers offer people cash rewards for weight loss, an assumption is that cash rewards are versatile, working equally well for everyone – for example, for all genders. No research to date has tested for gender difference in response to financial incentives for weight loss. We show in an randomized controlled trial (RCT) (n = 472) that cash incentives for weight loss only worked for males. The RCT consisted of a 3-month, self-administered online weight loss program. Offering a US$150 incentive for a 5% weight loss more than tripled the proportion of males who were successful, compared with a no-incentive Control arm (20.9% vs. 5.9%). On average, males in the incentive arm lost 2.4% of weight over 3 months, compared with 0.9% in the Control arm. The same incentive had no such effect on females: The average weight loss in the incentive arm was not significantly different than in the Control (1.03% and 1.44%, respectively), nor was the proportion of participants meeting the 5% weight loss goal (8.6% and 8.7%, respectively). This study shows that males respond better than females to financial incentives for weight loss.

Metabolic Adaptation Delays Time to Reach Weight Loss Goals

BackgroundThe clinical relevance of metabolic adaptation remains to be fully determined, but its role as a driver of weight regain has been dismissed. It could be hypothesized that metabolic adaptation increases the length of time needed to reach weight loss goals. The aim of this study was, therefore, to determine if metabolic adaptation, at the level of resting metabolic rate (RMR), is associated with time to reach weight loss goals, after adjusting for confounders. Methods65 premenopausal women with overweight (BMI: 28.6±1.5 kg/m2; age: 36.4±5.9 years; 36 Whites and 29 Blacks) followed an 800 kcal/day diet until body mass index ≤25 kg/m2. Body weight and composition (4 compartment model (4CM) and dual x-ray absorptiometry (DXA)) and RMR (indirect calorimetry) were measured at baseline and after weight loss (after a 4-week weight stabilization period). Dietary adherence was calculated from total energy expenditure (TEE) determined by double labeled water measures and DXA body composition changes. Metabolic adaptation was defined as a significantly lower measured vs predicted RMR (from own regression model using 4CM data). A regression model to predict time to reach weight loss goals was developed including baseline body weight, baseline TEE, dietary adherence and metabolic adaptation as predictors. ResultsParticipants lost on average 12.5±3.1 kg (16.1±3.4%) over 155.1±49.2 days. Average dietary adherence was 63.6±31.0%. There was significant metabolic adaptation after weight loss (-46±113 kcal/day, P=0.002) and this variable was a significant predictor of time to reach weight loss goal (β=-0.1, P=0.033), even after adjusting for confounders (R2 adjusted = 0.59, P<0.001). ConclusionIn premenopausal women with overweight, metabolic adaptation after a 16% weight loss increases the length of time necessary to achieve weight loss goals. Trial registration ID (JULIET study)NCT00067873

4125 Plan for a Retrospective Evaluation of a Multi-Modal Weight-centric Prediabetes Intervention.

OBJECTIVES/GOALS: To determine if a multi-modal, interdisciplinary intervention delivered to a group of prediabetic patients will result in reduced rates of diabetes progression. This project is a retrospective evaluation that will exam the feasibility and possibly efficacy of this intervention. METHODS/STUDY POPULATION: We will evaluate outcomes of 50 participants for the clinic, aged 21-60 inclusive. Patients will have a Body Mass Index >25kg/m2 with a diagnosis of prediabetes. Patients must be non-pregnant, using approved contraception, and agree to not become pregnant for 1 year after enrollment. After enrollment, the initial treatment period is for 1 year and includes a 12 week low calorie diet plan, a 6-month intensive behavioral and lifestyle modification plan followed by a 6 month behavior reinforcement extension. Weight management medications may be used if appropriate for the patient from a clinical perspective during the 6-month intensive behavioral/lifestyle modification. RESULTS/ANTICIPATED RESULTS: It is anticipated that there will be decreased weight with a mean weight loss goal of approximately >10%. Furthermore, it is expect that there will be improvement of other markers of metabolic disease. These include improvement of lipid values (LDL-C, HDL-C, Triglycerides, Total Cholesterol) as well as blood pressure with expected blood pressures of below 130/80 in greater than 50% of participants. Finally, It is expected that 50% or greater participants will have improvement of glycemic control. It is anticipated that greater than 50% of participants will have improvement of glycemic control and achieve normoglycemia. These values will be determined based upon fasting glucose or A1c. DISCUSSION/SIGNIFICANCE OF IMPACT: The significance of this intervention is enormous. By demonstrating feasibility in this trial, we can work toward both assessing efficacy and possibly dissemination of this model program. If these interventions provide durable changes at scale, this could help slow the epidemic of obesity and obesity related comorbid conditions.

Leisure Sedentary Behavior Levels and Meeting Program Goals in a Community Lifestyle Intervention for Diabetes Prevention

Background: The importance of leisure sedentary behavior (LSB) change in diabetes prevention efforts is not well known. This study examines the relationships between changes in self-reported LSB and the primary intervention goals (weight and moderate-intensity to vigorous-intensity physical activity [MVPA]) during a community-based translation of the Diabetes Prevention Program (the Group Lifestyle Balance Program). Methods: A total of 322 adults at risk for type 2 diabetes were recruited from 3 community centers, a worksite, and military site. Community and worksite participants were randomized to immediate or delayed-delivery (control) intervention. All military site participants (n = 99) received immediate intervention. Logistic and linear generalized estimating equations were used to determine associations between LSB changes and weight-related outcomes and MVPA. Results: Results were obtained for 259 (80.4%) participants. The LSB decreased after 6 and 12 months (mean [95% confidence interval]: −25.7 [−38.6 to −12.8] and −16.1 [−28.2 to −3.9] min/d; both P < .05). Each 20-minute reduction in LSB was associated with a 5% increase in odds of meeting the weight-loss goal (6 mo: odds ratio = 1.05 [1.002 to 1.102]; P = .042; adjusted model including MVPA), but LSB was not related to changes in reported MVPA minutes or MVPA goal achievement. Conclusion: Within the context of existing lifestyle intervention programs, reducing sedentary behavior has the potential to contribute to weight loss separately from reported MVPA improvement.

Efficacy of a Lifestyle Program Designed to Help Indigent, Obese Adult Patients Lose Weight

Introduction. Modest weight loss (5 to 7%) reduced the incidenceof type II diabetes in the Diabetes Prevention Program (DDP) trial.A DPP-inspired lifestyle intervention requiring minimal patientself-data collection and tailored to low-SES patients throughminimal cost was developed for our indigent, obese patients. Methods. Obese (BMI ≥ 30 kg/m2), indigent (≤ 200% FederalPoverty Level) adults (age 18 - 70) were offered a nocostweight loss intervention as an adjunct to their usual primarycare in a residency outpatient clinic. The interventionprovided options for diet plans and social support. The goalwas to achieve a 5% loss of body weight over six months. Results. The sample (n = 158) was 86% female and 62% white,with a median age of 45 and median BMI of 40.9. Two-thirds ofsubjects chose the 50% diet; YMCA membership was selected byall but one. The 5% weight loss goal was met by 12.8%; another8.7% gained that amount. Subjects who either had pre-existingYMCA membership or used their provided membership weresuccessful, relative to those who received but never used theirmembership (0.6% loss vs 0.9% gain; p < 0.05). Changes in weightover six months were observed in the youngest (gain of 3.9 lbs.,p < 0.05) and the oldest (loss of 4.0 lbs., p < 0.05) age quartiles. Conclusions. A DPP-inspired lifestyle intervention tailoredto low-SES patients did not lead to overall weight loss, reinforcingthat weight reduction programs must provide a significantamount of support for participants to see success.Older age and a behavioral commitment to physical activityimproved the likelihood of success. KS J Med 2016;9(4):83-87.

Association Between Monetary Deposits and Weight Loss in Online Commitment Contracts

Purpose: To examine the characteristics of voluntary online commitment contracts that may be associated with greater weight loss. Design: Retrospective analysis of weight loss commitment contracts derived from a company that provides web-based support for personal commitment contracts. Using regression, we analyzed whether percentage weight loss differed between participants who incentivized their contract using monetary deposits and those who did not. Setting: Online. Participants: Users (N = 3857) who voluntarily signed up online in 2013 for a weight loss contract. Intervention: Participants specified their own weight loss goal, time period, and self-reported weekly weight. Deposits were available in the following 3 categories: charity, anticharity (a nonprofit one does not like), or donations made to a friend. Measures: Percentage weight loss per week. Analysis: Multivariable linear regressions. Results: Controlling for several participant and contract characteristics, contracts with anticharity, charity, and friend deposits had greater reported weight loss than nonincentivized contracts. Weight change per week relative to those without deposits was −0.33%, −0.28%, and −0.25% for anti-charity, charity, and friend, respectively ( P < 0.001). Contracts without a weight verification method claimed more weight loss than those with verification. Conclusion: Voluntary use of commitment contracts may be an effective tool to assist weight loss. Those who choose to use monetary incentives report more weight loss. It is not clear whether this is due to the incentives or higher motivation.