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Behavioral Strategies

Behavioral strategies for obesity and prevention control focus on teaching behavioral management skills and structuring the social environment to provide support for people trying to initiate or maintain weight change. Strategies often include individual or group behavioral counseling and will often involve coworkers, family members, and other intermediaries who are part of an individual's social environment. Behavioral methods may involve modeling or demonstration, participatory skill development, individual benchmarking (i.e., goal-setting and achievement), providing feedback, providing incentives or disincentives, or providing materials necessary to enhance the desired behavior (e.g., pedometer, food journals).

Promising Practice: Behavioral Practices With Incentives

Behavioral practices teach behavioral management skills, modeling or demonstration, participatory skill development, and individual benchmarking (i.e., goal-setting and achievement), and provide feedback and building social support for behavioral patterns. Such practices are complemented by in-kind or financial incentives, typically given for participation and completion of the program.

Evidence of Effectiveness

We identified 17 studies that evaluated the effectiveness of the use of behavioral practices with incentives.29, 86-102 Fourteen studies29, 85-90, 92-96, 98, 99 measured weight, with a median effect size of −6.24 lbs.

Examples of How These Strategies Were Implemented

Description: A Worksite Weight Management Program to Reinforce Behavior
Participants had weekly contracts that specified a nutrition and physical activity goal.86 Behaviors were monitored directly on the contract and verified by a friend or relative each day. Each day one point was earned when a required target behavior was achieved.

Duration: 6 months

Location, Gender, Industry Setting: US, Males and Females, School

Human Resources: Program leader, friends/relatives, nutritionist, exercise physiologist

Financial Resources: Not reported

Promising Practice: Behavioral Practices Without Incentives

These programs teach participants specific behavioral skills that enable them to incorporate physical activity and improve their nutrition through modeling or demonstration, participatory skill development, individual benchmarking (i.e., goal-setting and achievement), feedback, and building social support for behavioral patterns. These programs did not offer incentives. The typical behavioral practice consisted of one-on-one or group consultations with personalized goals or plan of action to improve employees' nutrition, increase their physical activity, or help them lose weight..

Evidence of Effectiveness

We identified 47 studies that evaluated the effectiveness of the use of behavioral practices without incentives.59, 103-148 Thirty-four studies59, 103, 104, 106-109, 111, 114-117, 120, 122, 123, 125, 127-130, 132-136, 138, 139, 142-148 measured weight, with a median effect size of –5.81 lbs. Seven studies118, 121, 124, 126, 131, 137, 141 reported a BMI change with a median effect size of –0.24 kg/m2.

Examples of How These Strategies Were Implemented

Description: Intervention that focused mostly on physical activity and secondarily on nutrition.137  The intervention group was offered 7 counseling sessions using the Patient-centered Assessment and Counseling for Exercise and Nutrition (PACE) program. This program uses the stages of change model for participant intervention based upon which stage of change the participant is in. Subjects in both the intervention and control group received written information about several lifestyle factors. All subjects randomized into the intervention group were offered seven individual consultations, which were each 20 minutes in duration and given by a physiotherapist

Duration: 9 months

Location, Gender, Industry Setting: Netherlands, Males and Females, Government

Human Resources: Physiotherapists, counselors, a Dutch commercial company offering individual counseling to organizations carried out the intervention

Financial Resources: Not reported

Description: The volunteer leaders were trained one session per week for 5 one hour sessions. Both the volunteer led and professional led groups used the "Learn to Be Lean" weight loss program. The program consisted of 12 meetings held 1 hour weekly for the first 8 weeks, and then biweekly for 8 more weeks. The first 8 weeks taught behavioral skills for weight loss and the second 8 weeks was designed to help with maintenance. Workbooks were provided to all group members. Weight and height were measured at the initial meeting, 16 weeks and at the 4 month follow-up.136

Duration: 2 months

Location, Gender, Industry Setting: US, Males and Females, Company

Human Resources: Pawtucket Heart Health Program health professionals who were trained and supervised by clinical psychologists (nutritionist and exercise physiologist),  in house volunteers

Financial Resources: Not reported

Description: Mobile health promotion program offered by CIGNA health plan, participants received verbal and written information on how to reduce their high health risks including and instructional session on proper types and methods of exercise, health-related 'brown bag' seminars.113 Participants were screened at baseline and after approximately 6 months participation in the program.

Duration: 6 months

Location, Gender, Industry Setting: US, Males and Females, Company

Human Resources: Physician's assistant, mobile program staff

Financial Resources: Not reported

Promising Practice: Weight-Loss Competitions and Incentives

Competitions and incentives consist of rewards for weight loss and behavioral change to increase physical activity or improve nutrition. The rewards can be in-kind, financial, or the honor or pride of winning. The incentives can vary in size and by type and can be used for screening, enrollment, compliance (i.e., staying in the program), completion of the program, and maintenance of the changes after completion of the program.
*These practices do not include teaching behavioral management skills, modeling or demonstration, or participatory skill development.

Evidence of Effectiveness

We identified 16 studies that evaluated the effectiveness of the use of competitions and incentives.149-164 Twelve studies149-156, 160-163 measured weight, with a median effect size of –6.51 lbs. Two studies157, 164 measured percent body fat with skinfold measurements and reported a median effect size of –1.58%.

Examples of How These Strategies Were Implemented

Description: Comparison of three worksite weight-loss competitions
Worksite intervention focusing on individual, team, and gender team competitions as a motivator for weight loss.151 Money pool as a monetary prize. Winners received part of the monetary prize. Participants were weighed weekly.

Duration: 3 months

Location, Gender, Industry Setting: Unknown Location, Males and Females, Company Setting

Human Resources: Member (not employed by the worksite) of the Research Team weighed participants

Financial Resources: Subjects contributed $5 to a pool, and management matched all donations.

Additional Resources

Partnership for Prevention's Investing in Health: Proven Health Promotion Practices for Workplaces* (PDF-1.7Mb)
This resource will help workplaces of all sizes choose effective health promotion practices at work. See Physical Activity and Nutrition. p.15.

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