The Effect Of Loss And Gain Incentives On Wearable Tracker Adherence And Step Count In Teens With Obesity

PURPOSE: Physical activity is essential to pediatric weight, but teens and their families often face challenges that hamper adherence. Monetary incentives improve adherence to medical/lifestyle regimens in other populations, especially when framed as a loss versus a gain; however, data on incentives in pediatric weight management are lacking. Wearable technology for step tracking is attractive as it is inexpensive, and teens are familiar with it. Objective: We report on the findings of a behavioral economic study of loss- and gain-framed incentives on adherence to tracker usage and meeting step goals in teens with obesity. METHODS: A three-arm randomized control trial was used to evaluate the effects of incentives on PWMP adherence. Teens (13-18 years) attending a PWMP were randomized to 1 of 3 groups: a usual care/control group (CG), a gain incentive group (GG), and a loss incentive group (LG). Monthly overall adherence score points (Range: 0-100) were calculated based on participating in the study (0 to 10 points), steps per day per tracker (0 to 30 points), completion of a daily dietary log (0 to 30 points), and monthly medical visits (0 to 30 points). Teens in the GG and LG could earn up to $100 per month depending on their adherence score. ANOVA, Kruskai-Wallis or Chi-square were used to evaluate differences in overall adherence and subscale scores. RESULTS: Sixty teens were enrolled in the study, with a mean age of 15.3 + 1.4 years, BMI 38.9 + 6.9, 61.7% female, 46.7% Medicaid, and 68.3% identifying as White. Physical activity monthly adherence scores were higher in the GG (15.7 + 11.6) than in the LG (14.59 + 12.0, p = 0.02) and the CG group (10.0 + 9.8, p < 0.001). Those in the GG wore their tracker 64.4% of the time compared to the LG (47.9%) and CC (26.0%), p < 0.0001. The mean number of steps on days worn did not differ significantly in the groups with the GG 7462 steps per day, the LG 7420 steps per day, and the CG 5805 steps per day. Overall adherence points per month were also greater in the GG (67.9 + 27.2) compared to the LG (44.7 + 27.1) and the CG (30.4 + 30.3). CONCLUSIONS: Monetary incentives improve adherence to physical activity, but contrary to Behavioral Economic Theory, our early results suggest that gain-framed incentives are superior to loss-framed incentives for physical activity adherence in pediatric weight management. CCHMC place outcomes award