By Alisdair Stirling
An evaluation of the first NHS weight loss programme to use financial incentives showed that patients typically shed 4kg over 12 months and that almost half achieved 'clinically significant' weight loss of 5% or more of body weight.
Researchers said that the scheme at NHS Eastern and Coastal Kent – which involved payments of between £70 and £425 to individuals – could be adopted as a model elsewhere in the NHS.
The region used the Pounds for Pounds (P4P) programme by the commercial company Weight Wins. Participants received a weight loss guide with advice for healthy eating and exercise, and set their own monthly goals for weight loss.
The 402 participants had a mean baseline weight of 101.8kg, with 77% having a BMI of more or equal to 30kg/m2. P4P credited them monthly for cumulative weight loss up to a maximum target weight loss rate of 3.2kg a month, and for maintenance weight loss. At plan completion, participants received their accumulated financial rewards, plus a bonus of 50% of the total maximum reward if they had achieved their final target weight.
Clinically significant weight loss – of 5% or more of body weight – occurred in 45% of participants, and estimated weight loss at 12 months was 4kg. This ties in with the recommended 5-10% weight reduction in NICE guidance on obesity, and for overweight patients with diabetes and cardiovascular diseases.
The researchers concluded that the average weight loss was comparable to other evaluations of non-medical weight loss interventions. The pilot cost £75,000, and mean cost per kg weight loss was £46.64, but the researchers called for a randomised controlled trial to determine the clinical and cost effectiveness of such schemes.
Research lead Dr Clare Relton, a research fellow at the University of Sheffield, said: 'A financial incentive weight loss programme may be acceptable to the general public and to NHS employees, and to both men and women.'
Dr David Haslam, a GP in Hertfordshire and chair of the National Obesity Forum, said: 'I used to think that financial incentives were the wrong way to go about this. There is the concern that motivation will disappear when the money isn't there. But the evidence is pretty good – 4kg over a year is quite good. If we are interested in health gains then this does the business.'
Asked if there is a need to address underlying psychological reasons behind obesity among some patients, Dr Haslam said: 'Not necessarily. If their motivation for doing the programme is that they want to look better, then that is good enough.'
Dr Paul Singer, a GP in Luton who took part in the Counterweight Project to tackle obesity, also cautioned that the long term benefits were not clear, but added: 'There is no difference in using cash incentives to using medicines – if it's good outcomes that we are looking for.'
Incentive schemes may soon be recommended by NICE, which has been consulting on plans to encourage people to lose weight and stop smoking.
Journal of Public Health Advance Access 29 March 2011
Cash incentives 'aid weight loss'
