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2 April 2013 Annals of Internal Medicine Tip Sheet

Below is information about an article being published in the April 2 issue of Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of a study, contact Megan Hanks at mhanks@acponline.org or 215-351-2656 or Angela Collom at acollom@acponline.org or 215-351-2653.

1. For Greater Weight Loss, a Group Cash Incentive Trumps Individual Rewards

A group-based financial incentive leads to greater weight loss than an individual incentive for obese employees. An estimated 67 percent of employers use financial incentives to help their employees adopt healthier behaviors, with the goal of decreasing chronic disease and curbing health care costs. Researchers sought to determine the effectiveness of two financial incentive designs – group-based and individual – for obese employees trying to lose weight. One-hundred-and-four employees with a body mass index (BMI) between 30 and 40 kg/m2 were randomly assigned to one of three weight loss groups. In the first group (control, or no financial incentive), participants were given a link to the Weight-control Information Network of the National Institute of Diabetes and Digestive and Kidney Diseases and were scheduled for monthly weigh-ins and reminded by an automated e-mail or text message to attend the weigh-ins. After the weigh-in, an automated message notified participants of whether they met or did not meet their weight-loss goal for the period. In the second group (individual incentive), individuals were given the same information as the first group, but were also told that $100 would be set aside for them at baseline, four weeks, eight weeks, 12 weeks, 16 weeks, and 20 weeks, and that the $100 would be electronically transmitted to them if they at least met their target monthly weight-loss goal. After each weigh-in, an automated message notified the participants of their earnings, or what they would have earned if they had met their target. In the third group (group incentive), participants were divided into groups of five but were not told the identity of their fellow group members. Each group of five was given the same weight-loss information as the other groups, but also was told that they would earn $500 to split among just the members of the group who at least met their target weight-loss goal for the month. Those who didn’t meet their goals were not part of the split. If no participant met the weight-loss goal, then no money was distributed. As in the other groups, an automated message notified participants of their earnings or what they would have earned. After 24 weeks, participants receiving the group incentive lost on average of about 7 pounds more than those receiving individual incentive, and an average of almost 10 pounds more than those in the control group. Twelve weeks after the incentive intervention ended, group incentive participants maintained greater weight loss than control group participants, but not greater than individual incentive participants. According to the authors, the group incentive could be more effective because participants had the opportunity to earn a reward larger than $100 for achieving a weight-loss goal. The author of an accompanying editorial writes that due to the high costs of health care and lost productivity associated with obesity, employers should consider financial incentive programs to encourage employee weight loss money well-spent.

2. Higher Blood Levels of Long-chain Omega-3 Polyunsaturated Fatty Acids Protect Against Death

Older patients with higher blood levels of individual and total omega-3 polyunsaturated fatty acids (?3-PUFAs) have lower mortality than their peers, especially coronary heart disease-related death. Observational studies have shown a benefit from dietary ?3-PUFA levels, but most of those studies relied on self-reported dietary intake and/or looked at cardiovascular risk factors rather than clinical outcomes such as mortality. Researchers studied 2,692 U.S. adults aged 69 – 79 to determine the association between plasma individual and total ?3-PUFA levels on total and cause-specific mortality among healthy adults not receiving fish oil supplements. Phospholipid fatty acid levels and cardiovascular risk factors were measured in 1992. In 2008, plasma individual and total ?3-PUFA levels were assessed against total and cause-specific mortality and incident total (fatal plus nonfatal) CHD and stroke. The researchers found that patients with higher baseline levels of individual and total ?3-PUFAs had decreased total mortality, primarily due to fewer cardiovascular events.

3. Statins May be More Tolerable than Discontinuation Rates Suggest

Patients may discontinue statin use unnecessarily, jeopardizing health benefits of therapy. Doctors frequently prescribe statins to patients with high cholesterol. In research studies, statins are effective and well-tolerated. Few trial participants experience side effects such as tiredness and muscle aches, and even fewer stop taking their medication because of those side effects. Conversely, in clinical practice, statins are commonly discontinued, and patients fail to experience the cardiovascular benefits of preventive therapy. Researchers studied medical records for patients receiving a statin prescription between January 2000 and December 2008 to investigate the reasons for statin discontinuation and the role of statin-related events (symptoms believed to have been caused by statins) in routine care settings. Over the eight-year study period, more than one half of the patients discontinued their statin, at least temporarily. And approximately one fifth of those patients reported a statin-related event. One half of those patients were challenged to restart a statin, and more than 90 percent of them were taking a statin one year later, making it unlikely that they had true statin intolerance. The author of an accompanying editorial notes that adherence could be an issue because patients are not accustomed to taking a drug every day for the rest of their lives. Regardless, he writes that better strategies are needed to promote statin adherence because statins can greatly reduce population prevalence of atherosclerotic cardiovascular disease.