June 24, 2024 – Imagine having the ability to lose twice as much weight just by receiving supportive text messages and financial incentives. For men battling obesity, this progressive approach proved more practical than traditional weight management programs. Could this be the long run of successful weight reduction strategies?
Yes, in accordance with a recent study published in The Journal of the American Medical Association. The results were also presented last month on the European Obesity Congress in Venice, Italy.
“The men told us that the text messages made them feel supported and that they felt like other men were struggling with the same issues,” said study researcher Pat Hoddinott, MB, BS, PhD, chair of primary care on the University of Stirling in Scotland. They also liked that the 12-month study required only 4 weigh-in appointments, not the monthly weigh-in appointments typical of other programs. And the cash didn't hurt, either: Those within the group testing the mixture of text incentives and money were in a position to gain 400 kilos (about $500) in the event that they met all weight-loss goals.
Study details
Because 26% of men within the UK are obese, Hoddinott and her colleagues desired to see if the mixture of day by day text messages and money rewards would help men drop a few pounds no matter their socioeconomic status. The researchers used an endowment fund to offer money in the beginning for everybody within the group who received text messages and rewards.
The researchers randomly assigned 585 men, who were on average slightly below 51 years old, weighed 118 kilograms, and had a body mass index of 37.7, to one in all three groups: the text message and incentive group, the text message only group, or the waitlist, which served as a control group.
“The men did not join for the money,” said Hoddinott. “That is a pretty important point. They did not know they were getting money [before being randomized to that group].”
If the men met all three weight loss goals during the study period, they received a total of about $500. However, they lost money each time they failed to meet any of the three goals. If they hadn't lost 5% of their starting weight after three months, they lost about $63; if they hadn't lost 10% after six months, they lost $190; and if they didn't maintain that 10% weight loss after a year, they lost $253.
Another new feature: “The text messages are written by men for men,” Hoddinott said. The text messages were identical for the combination and text-only groups and made no mention of financial incentives.
And the researchers asked the men to choose the texts that worked for them. “We didn't tell the boys what to do,” she said.
Examples: One text began by saying, “OK, that is what it looks like. Some texts can be helpful, others may not.” Other texts included tips from the men themselves, such as remembering “the facility of meal prep” to avoid overeating and planning for special occasions.
After 12 months, the men who received text messages and financial incentives lost the most weight, an average of 4.8% of their baseline weight, or about 13 pounds. The group that received only text messages lost an average of 2.7%, or about 6.6 pounds. The waitlist group lost 1.3% of their baseline weight, or about 3.3 pounds.
On average, men in the SMS and incentive group received $159 of the $500, while 14%, or 27 of the 196 men in the combination group, received the full $500.
While the weight difference between the combination group and the text-only group was statistically significant, there was no significant difference in weight loss between the text-only group and the waitlist group, according to the researchers.
Expert opinion
“People tend to respond to financial incentives when they are well designed,” said Joseph A. Ladapo, MD, PhD, professor of medicine at the University of Florida College of Medicine in Gainesville, who also found that financial incentives Helping people lose weight.
It is important to provide “appropriately large” financial incentives, he said. Some studies have failed because the incentives were not large enough to change behavior.
In the new study, “the burden loss amongst study participants was modest but comparable to what we typically see in interventions aimed toward behavior change,” he said.
Ladapo wants to know whether the men in the study adopted healthier habits. He said that's a strong indicator of how likely people are to maintain their weight long-term.
Even though the GLP-1 receptor agonists (semaglutide and tirzepatide) are so popular, the studies are and will remain important, he said.
“These drugs are very effective, however it is evident that folks gain a variety of weight back once they stop taking them, and cyclical weight reduction and weight gain is proven to be bad for health.”
And some prefer not to take medication, Ladapo said, so other effective approaches will continue to be needed.
Pending questions
Would this approach work for women? Some research suggests that these incentives work better for men than women, Hoddinott says, so a separate study for women would be needed.
“We actually need to do that on women,” she said. “It's quite possible that it’ll work just as well on women.”
It shouldn’t be yet known whether the text and the financial incentives will ensure long-term preservation. Hoddinott's team continues to be tracking the boys, now for twenty-four months.