S776 Financial Incentives for Obesity Management in Adolescents and Young Adults: A Systematic Review and Meta-Analysis With Implications for Gastrointestinal and Metabolic Health

Introduction: Pediatric and early adult obesity disproportionately affects socioeconomically and racially marginalized groups, contributing to disparities in cardiometabolic and gastrointestinal (GI) outcomes such as nonalcoholic fatty liver disease (NAFLD). While behavioral interventions are key to management, engagement is often limited by barriers like cost, transport, and competing priorities. Financial incentives have been proposed as scalable tools to improve adherence. This study assessed their impact on weight and metabolic outcomes in adolescents and young adults with overweight or obesity, with implications for health equity. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) evaluating financial incentives versus standard care in individuals aged ≤35 years with a body mass index (BMI) ≥25 kg/m² were included. Primary outcomes included changes in weight (kg and %), BMI, and blood pressure. A random-effects model was used for meta-analysis. Risk of bias was assessed using RoB 2, and evidence certainty was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. Results: Three RCTs involving 408 participants were included. Pooled results showed no significant effects of financial incentives on systolic blood pressure (SMD 0.17, 95% confidence interval [CI]: −0.61; 0.96), diastolic blood pressure (SMD −0.01, 95% CI: −0.54; 0.52), weight loss (SMD −2.12 kg, 95% CI: −6.22; 1.98), percentage weight loss (SMD −1.49, 95% CI: −3.92; 0.94), or BMI (SMD −2.10, 95% CI: −6.08; 1.89). High heterogeneity (I² > 84%) and low to very low certainty of evidence on GRADE assessment suggest considerable variability and uncertainty in the effectiveness of financial incentives. Conclusion: Financial incentives alone did not significantly improve weight or metabolic outcomes in adolescents and young adults with obesity. These results highlight the limitations of incentive-only approaches in tackling disparities in obesity-related GI outcomes. To advance health equity, such incentives may need to be part of broader, culturally tailored, community-based interventions. Future studies should focus on equity-driven, participatory models that address structural barriers in early-life obesity. Note: ChatGPT (OpenAI) was used for language clarity and grammar refinement. All scientific content, data, and analysis are original and solely by the authors.