title: A comparison of the effects of external control and self-control on the modification and maintenance of weight. Are smaller weight losses or more achievable weight loss goals better in the long term for obese patients? Self-administered programs for health behavior change: smoking cessation and weight reduction by mail. Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial Toward the development of self-help health behaviour change programs: weight loss by correspondence. Behavioral techniques in the treatment of obesity: a comparative analysis. Behavior therapy versus "will power" in the management of obesity. Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Promoting weight control at the worksite: a pilot program of self-motivation using payroll-based incentives. Financial incentive-based approaches for weight loss: a randomized trial.
abstract: In an experimental study of weight reduction , 62 obese men and women were administered a pretreatment question naire and r and omly assigned to three experimental treatment groups : ( a ) an external control group with a nonrefundable contingency ; ( 6 ) a self-control group with a refundable contingency ; and ( c ) a self-control group with a nonrefundable contingency . The results indicated that the self-control and external-control treatments were equally effective in producing reduction in weight . However , both self-control interventions were more effective than the external-control intervention in promoting maintenance of weight loss Weight losses and psychological well-being were examined at 30 months in 69 men and 61 women initially treated with behavior therapy as a function of ( a ) initial weight loss and ( b ) weight-loss goals .  Initial weight losses were positively , not negatively , related to weight loss at 30 months . Weight loss goals did not predict short-term or long-term weight loss . People who reached weight goals had better long-term weight losses than those who did not , but this finding was largely due to differences in initial weight loss . Psychological well-being at 30 months was not related to initial weight losses or goals . Although correlational rather than experimental , these results do not support the hypothesis that obese patients should be encouraged to set lower weight-loss goals Forty smokers and 47 overweight individuals were recruited for a home correspondence program for either smoking cessation or weight loss . Participants were assigned to one of four programs for changing their respective health behaviors : ( 1 ) a home correspondence program conducted entirely by mail , ( 2 ) the mail program with supplemental financial contigency contracts tied to completion of written homework , ( 3 ) the correspondence programs supplemented both by homework contracts and by regular calls to a telephone answering system , and ( 4 ) a st and ard behavioral group program which acted as a comparison condition . Results showed that all three correspondence approaches produced significant changes in health behaviors equal to the changes experienced by participants in the st and ard group program . The implication of these findings for development of low cost programs for disease prevention are discussed ABSTRACT BACKGROUND Previous efforts to use incentives for weight loss have result ed in substantial weight regain after 16 weeks . OBJECTIVE To evaluate a longer term weight loss intervention using financial incentives . DESIGN A 32-week , three-arm r and omized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week , followed by an 8-week maintenance phase . PARTICIPANTS Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMI s of 30–40.INTERVENTION Participants were r and omly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins ( control condition ) , or the same program with one of two financial incentive plans . Both incentive arms used deposit contracts ( DC ) in which participants put their own money at risk ( matched 1:1 ) , which they lost if they failed to lose weight . In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance ; in the other , no such distinction was made . MAIN MEASUREWeight loss after 32 weeks . KEY RESULTS Results were analyzed using intention-to-treat . There was no difference in weight loss between the incentive arms ( P = 0.80 ) . Incentive participants lost more weight than control participants [ mean DC = 8.70 pounds , mean control = 1.17 , P = 0.04 , 95 % CI of the difference in means ( 0.56 , 14.50 ) ] . Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain ; the net weight loss between the incentive and control groups was no longer significant ( mean DC = 1.2 pounds , 95 % CI , -2.58–5.00 ; mean control = 0.27 , 95 % CI , -3.77–4.30 , P = 0.76 ) . CONCLUSIONS Financial incentives produced significant weight loss over an 8-month intervention ; however , participants regained weight post-intervention The goal of this study was to evaluate a correspondence weight control program , and to assess the impact of three program elements ( weekly homework , interim weigh-ins , and participation deposits ) individually and in combination . All treated participants received 15 weekly st and ard lessons by mail . Three program features were varied factorially : a ) homework assignments , b ) interim weigh-ins and c ) a deposit refunded contingent on returning homework and /or attending interim weigh-ins . Participants were assigned r and omly to active treatment conditions or a delayed treatment control group .  Among treated males ( N = 14 ) , initial average weight loss and BMI reduction were 9.6 kg and 3.1 respectively ; average net weight loss and BMI reduction at one year follow-up were 5.8 kg and 1.9 respectively . Among treated females ( N = 128 ) , initial average weight loss and BMI reduction were 3.1 kg and 1.2 respectively ; average net weight loss and BMI reduction at one year were 2.3 kg and .88 respectively . Women in all treated groups , except lessons only , showed a greater BMI reduction than untreated controls at the end of treatment . Women in conditions including both homework and interim weigh-ins had greater initial BMI reductions ( M = 1.6 ) than those who received lessons only ( M = .76 ) . At one year , net BMI reductions were comparable across all treated groups . Of the 42 women initially registered in conditions that included both homework and weigh-ins , 12 who denied joining other programs lost at least 4.5 kg ( M = 7.1 ) during treatment , and 7 had a net loss of at least 4.5 kg ( M = 8.0 ) at one year without apparent involvement in any other program Abstract The relative efficacy of the major techniques typically used in behavioral treatment programs for weight reduction was investigated using obese adult volunteers . Study 1 compared the effects of self-monitoring , self-control procedures , monetary rewards , aversive imagery and relaxation training . These procedures result ed in significantly greater weight reduction than either a no treatment group or subjects who graphed and recorded daily weight . Self-monitoring of daily caloric intake was as effective as the other methods , both singly and combined , over a 4 week treatment period . Study 2 compared the long-term effects of self-monitoring vs the full complement of behavioral techniques used in Study 1 . The full behavior management program was significantly more effective , both during the treatment period and at 3 and 12 week follow-ups , although self-monitoring again produced substantial weight loss In a study of the management of obesity 43 patients were r and omly assigned to behavior therapy , will power , and no-treatment control groups .  The behavioral treatment involved contingency contracting , stimulus control , self-monitoring , energy expenditure , and group reinforcement procedures over an 18-week period . The will power patients were told to do the same thing as the behavior therapy patients ; however , instead of having formal contingencies and meeting regularly , they were told to apply " will power " on their own , as this was the most important aspect of losing weight . The third group was a st and ard  no-treatment control group .  Analyses of covariance indicated that ( a ) the behavior therapy group lost significantly more weight than the will power ( p less than .05 ) and no-treatment control ( p less than .01 ) groups , and ( b ) the will power and no-treatment control groups did not differ significantly from each other . An 18-week maintenance follow-up of the behavior therapy group indicated that there was no significant weight gain from the end of treatment to follow-up . Also , an analysis of time spent per patient suggested that the behavioral treatment employed in this study was more efficient than previous treatments OBJECTIVE To investigate the influence of weight loss expectations ( expected 1-year BMI loss , dream and maximum acceptable BMI ) on attrition in obese patients seeking treatment . RESEARCH METHODS AND PROCEDURES Obese subjects ( 1,785 ; 1,393 women ; median age , 46 years ; median BMI , 36.7 kg/m(2 ) ) seeking treatment in 23 medical Italian centers were evaluated . Baseline  diet  and  weight history , weight loss expectations , and primary motivation for seeking treatment ( health or improving appearance ) were systematic ally recorded . Psychiatric distress , binge eating , and body image dissatisfaction were tested at baseline by self-administered question naires ( Symptom Check List-90 , Binge Eating Scale , and Body Uneasiness Test ) .  Attrition and BMI change at 12 months were prospect ively recorded . RESULTS At 12 months , 923 of 1,785 patients ( 51.7 % ) had discontinued treatment . Compared with continuers , drop-outs had a significantly lower age , a lower age at first dieting , lower dream BMI , a higher expected 1-year BMI loss , and a higher weight phobia . At logistic regression analysis , the strongest predictors of attrition at 12 months were lower age and higher expected 1-year BMI loss . The risk of drop-out increased systematic ally for unit increase in expected BMI loss at 12 months ( hazard ratio , 1.12 ; 95 % confidence interval , 1.04 to 1.20 ; p = 0.0018 ) . The risk was particularly elevated in the first 6 months . DISCUSSION Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program ; the higher the expectations , the higher attrition at 12 months . Unrealistic weight goals should be tackled at the very beginning of treatment Thirty-six individuals participated in a worksite weight-loss program  in which the central component was a self-motivation program of biweekly payroll deductions refunded contingent on meeting self-selected weight-loss goals . Half were assigned to early treatment and the remainder to a delayed treatment control group .  Nine additional individuals also enrolled at the time of  delayed treatment  and were included in descriptive analyses of factors associated with weight loss . Results showed low program attrition over 6 months ( 6 % ) and mean weight losses ( 12.3 lb ) that are competitive with those obtained in clinical setting s. Although not different at baseline , participants in the delayed treatment group lost more than twice as much weight as those in the early treatment condition . This difference was interpreted as either a strong seasonal effect or a critical mass effect related to the proportion of employees at the worksite participating in the program . We conclude that self-motivation programs for health behavior change using the payroll system as an organization framework offer a promising new methodology for promoting healthful behaviors in work setting CONTEXT Identifying effective obesity treatment is both a clinical challenge and a public health priority due to the health consequences of obesity . OBJECTIVE To determine whether common decision errors identified by behavioral economists such as prospect theory , loss aversion , and regret could be used to design an effective weight loss intervention . DESIGN , SETTING , AND PARTICIPANTS Fifty-seven healthy participants aged 30 - 70 years with a body mass index of 30 - 40 were r and omized to 3 weight loss plans : monthly weigh-ins , a lottery incentive program , or a deposit contract that allowed for participant matching , with a weight loss goal of 1 lb ( 0.45 kg ) a week for 16 weeks . Participants were recruited May-August 2007 at the Philadelphia VA Medical Center in Pennsylvania and were followed up through June 2008 . MAIN OUTCOME MEASURES Weight loss after 16 weeks . RESULTS The incentive groups  lost significantly more weight than the control group ( mean , 3.9 lb ) . Compared with the control group , the lottery group lost a mean of 13.1 lb ( 95 % confidence interval [ CI ] of the difference in means , 1.95 - 16.40 ; P = .02 ) and the deposit contract group lost a mean of 14.0 lb ( 95 % CI of the difference in means , 3.69 - 16.43 ; P = .006 ) . About half of those in both incentive groups met the 16-lb target weight loss : 47.4 % ( 95 % CI , 24.5%-71.1 % ) in the deposit contract group and 52.6 % ( 95 % CI , 28.9%-75.6 % ) in the lottery group , whereas 10.5 % ( 95 % CI , 1.3%-33.1 % ; P = .01 ) in the control group met the 16-lb target . Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups ( 9.2 lb ; t = 1.21 ; 95 % CI , -3.20 to 12.66 ; P = .23 , in the lottery group and 6.2 lb ; t = 0.52 ; 95 % CI , -5.17 to 8.75 ; P = .61 in the deposit contract group ) than in the control group ( 4.4 lb ) , these differences were not statistically significant . However , incentive participants weighed significantly less at 7 months than at the study start ( P = .01 for the lottery group ; P = .03 for the deposit contract group ) whereas controls did not . CONCLUSIONS The use of economic incentives produced significant weight loss during the 16 weeks of intervention that was not fully sustained . The longer-term use of incentives should be evaluated . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00520611
target: Group refunds , deposit not paid as lump sum , participants setting their own deposit size and additional behaviour change techniques were associated with greater weight loss during treatment .
  Post-treatment , there was no significant effect of MCCs on weight loss .
  There was a significant small-to-medium effect of MCCs on participant retention during treatment .
  Research er-set deposits paid as one lump sum , refunds delivered on an all-or-nothing basis and refunds contingent on attendance at classes were associated with greater retention during treatment .
  Post-treatment , there was no significant effect of MCCs on participant retention .
  The results support the use of MCCs to promote weight loss and participant retention up to the point that the incentive is removed and identifies the conditions under which MCCs work best
background: Financial incentives to improve health have received increasing attention , but are subject to ethical concerns .
  Monetary Contingency Contracts ( MCCs ) , which require individuals to deposit money that is refunded contingent on reaching a goal , are a potential alternative strategy .
  This review evaluates systematic ally the evidence for weight loss – related MCCs .