1. Method
What types of incentives elicit weight control in adults?: A systematic review of
behavioral interventions
Zakkoyya H. Lewis BS, Maria C. Swartz PhD, MPH, Elizabeth J. Lyons PhD,
MPH
The University of Texas Medical Branch, Galveston TX
Background
ConclusionsResults cont.
ZHL is supported by a Predoctoral Fellowship Grant from the American
Heart Association (16PRE27090012). MCS is supported by the Cancer
Prevention and Research Institute of Texas, Comparative
Effectiveness Research on Cancer in Texas (RP140020) and the
National Institute on Disability, Independence Living and Rehabilitation
Research, Department of Education (90AR5009). EJL is supported by
a Mentored Research Scholar Grant in Applied and Clinical Research,
MRSG-14-165-01-CPPB, from the American Cancer Society and by a
Beginning Grant-in-Aid, 13BGIA17110021, from the American Heart
Association.
The funding agencies had no role in the study design; data
collection, management, analysis, or interpretation; and does not
hold ultimate authority over these activities.
Zakkoyya Lewis, BS, ATC
PhD Candidate
American Heart Association Fellow
301 University Blvd, Galveston, TX,
77551
Division of Rehabilitation Sciences
O 409.772.2576
E zalewisp@utmb.edu
References
Acknowledgements
• Incentives are often provided in weight control interventions,
but they may inhibit autonomous motivation
• Weight-control incentives have been evaluated under
dimensions of operant conditioning1
• Gamification is an alternative incentive structure that may
better support autonomous motivation and result in weight
maintenance
• The purpose of this review was to characterize
different incentive structures (operant conditioning,
gamification) and synthesize evidence of their
effectiveness in weight control interventions
1. Burns RJ, Donovan AS, Ackermann RT, et al.: A Theoretically
Grounded Systematic Review of Material Incentives for Weight
Loss: Implications for Interventions. Annals of Behavioral Medicine.
2012, 44:375-388.
2. Björk S, Holopainen J: Patterns in Game Design. Hingham,
Massachusetts: Charles River Media, Inc., 2005.
• Relevant articles were retrieved from Medline OVID, Medline
Pubmed, Web of Science, CINAHL, Cochrane Central,
PsycINFO, and reference searching
• The following search terms were used:
o Weight, obesity, obese, overweight, or body mass index
o Reward*, incentive*, reinforc*, gamif*, motivat*, encourag*,
or entic*
o Interven* or randomiz*
o Diet or activit*
o Behavio*
• Out of the 2,130 retrieved, 14 studies (15 articles) were
included
Results
Reference
Study
duration,
follow-up
Incentive
type
Incentive
structure
Game elements2
Reference
Study
duration,
follow-up
Incentive
type
Incentive
structure
Game elements2
Almeida,
2015
6 mo.,
6 mo.
Monetary
Positive-
fixed
Social interaction, symmetric
information
Morgan,
2011*
14 wk. Gift voucher
Positive-
fixed
Collaborative action, competition,
cooperation, social interaction,
team balance, team play, tradeoffs
Faghri,
2014*
16 wk.,
12 wk.
Monetary
Positive- ,
positive/
negative-
fixed
Arithmetic rewards, betting,
risk/reward, social interaction
Morgan,
2014ᵻ
3 mo.,
3 mo.
Personally
selected
Positive-
variable
Player decided results, social
interaction
Finkelstein,
2007*
3 mo.,,
3 mo.
Monetary
Positive-
fixed
none
Petry,
2011*
12 wk. Prizes
Positive-
variable
Collection, luck, perceived chance,
score
Galbo,
2011*
16 wk.,
3 mo.
Monetary
Positive-,
positive/
negative-
fixed
Arithmetic rewards, betting,
investments, risk/reward
Pope,
2014
12 wk.,
12 wk.
Monetary
Positive/
negative-
fixed
Red Queen dilemma, symmetric
information
Garcia,
2014
12 wk.
Points/
prizes
Positive-
variable
Budget action, collecting,
collection, immersion, luck,
perceived chance, score, social
interaction, tradeoffs
Racette,
2015
1 yr. Prizes
Positive-
fixed
Collecting, collection, save points,
score, social interaction
Jeffery,
2003 ᵻ
12 mo.,
6 mo.
Monetar
y
Positive-
fixed
Social interaction
Ratliff,
2012*
8 wk. Monetary
Positive-
fixed
Social interaction
John, 2011
24 wk.,
36 wk.
Monetary
Positive/
negative-
fixed
Arithmetic reward, betting,
investments, risk/reward, time
limits
Volpp,
2008*
16 wk.,
3 mo.
Monetary
Positive-
variable;
positive/
negative-
fixed
Arithmetic rewards, betting,
collection, investments, luck,
perceived chance, risk/reward,
score, time limits
*significant weight change in the intervention group compared to the control group at the end of the intervention
significant weight change in the intervention group compared to the control group at follow-upᵻ
• Incentives were awarded for change in
diet, exercise, and weight
• Most interventions were less than 1 year
• Interventions were “gamified” by providing
a median of 4 game elements (range 0-9)
• Nine studies found a significant group
difference at the end of the intervention,
and two found significant group difference
at follow-up
• Incentives appear to be effective in the
short-term but their effect in the long term
is inconclusive
• Although the interventions were not
classified as “gamified”, nearly all studies
incorporated game elements
• Gamified incentives may result in
maintained weight loss but more research
is needed