June 24, 2024 – Imagine losing twice as much weight just by receiving supportive text messages and financial incentives. For men struggling with obesity, this innovative approach proved more effective than traditional weight management programs. Could this be the future of successful weight loss strategies?
Yes, according to a study recently published in The Journal of the American Medical Association. The results were also presented last month at the European Congress on Obesity in Venice, Italy.
“Men told us they felt supported by the text messages, and it made them feel that other men were struggling with the same issues,” said study researcher Pat Hoddinott, MB, BS, PhD, chair in primary care at the University of Stirling in Scotland. They also liked that the 12-month study required only four weigh-ins, not the monthly weigh-ins typical of other programs. And the money didn’t hurt, either: Those in the group testing the combination of text incentives and money stood to gain 400 pounds (about 500 U.S. dollars) if they met all the weight loss targets.
Study Details
With 26% of men in the U.K. living with obesity, Hoddinott and her colleagues wanted to see if the combination of daily text messages and cash incentives would help men, no matter what their socioeconomic status, lose weight. The researchers tapped an endowment fund to put money in at the start for everyone in the group getting texts plus incentives.
The researchers randomly assigned 585 men, on average nearly 51 years old and weighing 260 pounds with a body mass index of 37.7, to one of three groups: the text message and incentive group, text messages alone, or the wait list, which served as the control group.
“The men weren’t joining for the money,” Hoddinott said. “That’s quite an important point. They didn’t know they were getting money [before being randomized to that group].”
If the men met all three weight loss targets during the study period, they would get the total sum of about $500. But they would lose money each time they failed to meet one of the three targets. If they didn’t lose 5% of their starting weight after 3 months, they’d lose about $63; if they didn’t lose 10% after 6 months, they’d lose $190; and if they didn’t maintain that 10% loss at a year, they’d lose $253.
Another novel feature: “The text messages are written for men by men,” Hoddinott said. The text messages were identical for the the combination and text-only groups, and did not mention financial incentives.
And the researchers told the men to pick and choose which texts work for them. “We weren’t telling men what to do,” she said.
Examples: At the start, a text read: “OK, here’s the deal. Some texts will be useful, and others maybe won’t.” Other texts included tips from the men themselves, such as remembering “the power of meal prep” to avoid overeating and planning for special occasions.
At the 12-month mark, the men getting texts and financial incentives lost the most, averaging 4.8% of their start weight, or about 13 pounds. The text-only group averaged a 2.7% loss, or about 6.6 pounds. The group wait-listed lost 1.3% of their starting weight, or about 3.3 pounds.
On average, those in the text and incentive group received $159 of the $500, while 14%, or 27 of the 196 men in the combination group, got the full $500.
While the difference in weight between the combination group and the text-only group was statistically significant, the difference in weight loss in the text-only group and the wait list group did not differ significantly, according to the researchers.
Expert Perspective
“People tend to respond to financial incentives if they’re well-designed,” said Joseph A. Ladapo, MD, PhD, a professor of medicine at the University of Florida College of Medicine, Gainesville, who has also found that financial incentives help people lose weight.
It’s important, he said, to use “reasonably large” financial incentives. Some studies, he said, have failed due to using incentives that aren’t large enough to shift behavior.
For the new study, “the amount of weight that study participants lost is modest, but comparable to what we typically see in interventions that are focused on behavior change,” he said.
Ladapo would like to know if the men in the study adopted healthier habits – as he said that is a strong predictor of how likely people are to keep the weight off long-term.
Even with the popularity of the GLP-1 receptor agonists (semaglutide and tirzepatide), the studies are important and will remain so, he said.
“These drugs are very effective, but it’s clear that people regain a lot of weight when they stop using them, and cyclic losing and regaining weight has been shown to be bad for your health.”
And some prefer not to take medications, Ladapo said. So other effective approaches will continue to be necessary.
Hanging Questions
Would this approach work for women? Some research suggests these incentives work better for men than for women, Hoddinott said, so a separate study for women would be needed.
“We’re very keen to do this in women,” she said. “It’s quite possible it does work as well in women.”
Whether the text and financial incentives will work for long-term maintenance is not yet known. Hoddinott’s team is still following up on the men, now at the 24-month point.
