Obesity intervention failures abound

I’ve had a busy week, so I’ve had less time to blog than I’d like. I’ve been meaning to get to this study in Health Affairs, “Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study“:

Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior, but the effectiveness of those adjustments is controversial. We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight. They were randomly assigned to a control arm, with no financial incentive for achieving the goal, or to one of three intervention arms offering an incentive valued at $550. Two intervention arms used health insurance premium adjustments, beginning the following year (delayed) or in the first pay period after achieving the goal (immediate). A third arm used a daily lottery incentive separate from premiums.

About 200 obese employees took part in a workplace wellness program to lose weight. Some were randomized with a financial incentive ($550) if they met their 5% weight loss reduction goal. After a year, the incentive was shown not to make a difference. This is important, because such programs are built on the idea that incentivizing employees to do things (like lose weight) with financial incentives (like reduced premiums) will work. They won’t. Even direct financial incentives don’t work.

On Twitter, Amitabh Chandra reminded me of an older study in NEJM, “A School-Based Intervention for Diabetes Risk Reduction“:

BACKGROUND We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes.

METHODS: Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [±SD] age, 11.3±0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels.

This is a school based RCT with more than 4600 students participating.  The intervention focused on nutrition, physical activity, behavioral knowledge and skills, and communications and social marketing. And, after all of middle school, they found that the intervention did not reduce the prevalence of overweight and obesity. There were some submeasures that changed, but come on… if after a couple years you can’t reduce overweight and obesity, then it’s hard to keep justifying this type of intervention.

Some days…


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