A $3.1 million grant awarded to the University of Vermont and the University of South Carolina by the National Institutes of Health could play a part in curbing the nation’s obesity epidemic, expected to cost the United States about $900 billion by 2030, if present trends continue.

The five-year grant will fund research to determine if adding economic incentives to online behavioral weight-loss programs will enable them to achieve the same positive results as their in-person equivalents.  

Co-principal investigators on the grant are Jean Harvey, chair of UVM’s Department of Nutrition and Food Science, and Delia Smith West, a professor in the University of South Carolina’s Department of Exercise Science.

Behaviorally-based lifestyle interventions, considered the gold standard in the field, have been shown to successfully produce clinically significant weight loss among participants.

However, the availability of these programs -- which are therapist- or coach-led and rely on participant journaling, feedback from the coach, and positive group dynamics in weekly meetings -- is limited beyond major population centers and university towns.

To extend their reach, many behavioral programs are now offered online. But earlier studies have shown that the internet programs aren't as effective as the in-person versions. In a study conducted by Harvey in 2010, participants in an online program lost an average of 12.1 pounds in six months, while participants in an in-person group with the identical design lost an average of 17.6 pounds.

In the new program, participants will be paid a small amount of money for meeting behavioral goals like counting calories, keeping journal entries and exercising, with the payments increasing if weight loss goals are reached. Research has shown that economic incentives are effective in helping subjects change unwanted behaviors such as smoking.

“With the number of people who are obese or overweight, we are facing a true health care crisis in America,” said Harvey. “Fortunately, weight losses of as little as five to seven percent of body weight, which are routinely achieved in in-person behavioral programs, can ameliorate many of the health issues associated with obesity. Our goal with this study is to see if adding a behavioral economics component can lift online programs to that level of effectiveness. Given their ease of access, they could be a difference-maker in American public health.”  

The research will also test the cost-effectiveness of programs that make use of behavioral economics, Harvey said. 

A James Beard Foundation winner, Harvey's research has been continuously funded by the National Institutes of Health since 1997.