P2702 - Financial Incentives for Obesity Management in Adolescents and Young Adults: A Systematic Review and Meta-Analysis With Implications for Gastrointestinal and Metabolic Health

Umar Farooque, MBBS¹, Ana Beatriz Nardelli da Silva, MD², Letícia Rocha Campos, ³, Ana Clara Felix de Farias Santos, ⁴, Maite Silva Martins Gadelha, MD, MBA⁵, Gabriel Moraes de Oliveira, MD⁶, Fernanda Valeriano Zamora, MD⁷
1Health Education England, East of England, United Kingdom, Luton, England, United Kingdom; 2Federal University of Pará, Belém, Para, Brazil; 3Universidade de Ribeirao Preto, Ribeirão Preto, Sao Paulo, Brazil; 4City University of São Paulo, São Paulo, Sao Paulo, Brazil; 5University of Edimburgh, Edinburgh, Scotland, United Kingdom; 6Massachusetts General Hospital, Harvard Medical School, Somerville, MA; 7Uerj, Belo Horizonte, Minas Gerais, Brazil

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 (Table 1). Pooled results showed no significant effects of financial incentives on systolic blood pressure (SMD 0.17, 95% 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) (Figure 1), 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.

Discussion: 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.

ChatGPT (OpenAI) was used for language clarity and grammar refinement. All scientific content, data, and analysis are original and solely by the authors


Figure: Table 1. Baseline characteristics of included studies
NA: not available; RCT: randomized controlled trials; BMI: body mass index


Figure: Figure 1. Forest plot comparing percentage weight change between financial incentive and standard care groups in adolescents and young adults with obesity.

Disclosures:
Umar Farooque indicated no relevant financial relationships.
Ana Beatriz Nardelli da Silva indicated no relevant financial relationships.
Letícia Rocha Campos indicated no relevant financial relationships.
Ana Clara Felix de Farias Santos indicated no relevant financial relationships.
Maite Silva Martins Gadelha indicated no relevant financial relationships.
Gabriel Moraes de Oliveira indicated no relevant financial relationships.
Fernanda Valeriano Zamora indicated no relevant financial relationships.

Umar Farooque, MBBS¹, Ana Beatriz Nardelli da Silva, MD², Letícia Rocha Campos, ³, Ana Clara Felix de Farias Santos, ⁴, Maite Silva Martins Gadelha, MD, MBA⁵, Gabriel Moraes de Oliveira, MD⁶, Fernanda Valeriano Zamora, MD⁷. P2702 - Financial Incentives for Obesity Management in Adolescents and Young Adults: A Systematic Review and Meta-Analysis With Implications for Gastrointestinal and Metabolic Health, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.