Do money incentives help people lose weight?

Everyone is losing their marbles over a new study that suggests money incentives help folks lose weight. As Yoni Freedhoff accurately pointed out, the media attention seems a bit excessive for a non-peer reviewed abstract presented at a conference and authored by someone who can gain financially from this concept catching on.

What’s even more interesting is that most seem to have forgotten that basically an identical study had already been published back in 2008 in one of the world’s top medical journals. In fact, we covered this study nearly 5 years ago on this very blog!

That not-so-new study suggested that monetary reward may be a better motivator for behavior change and ultimately, weight-loss, than the commonly touted health benefits.

Here’s the details of that peer-reviewed and published study:

Dr. Volpp and colleagues tracked the weight change in 57 obese individuals (30-70 years of age) who were randomized to either a no-treatment control group or to 1 of 2 financial incentive programs (a lottery incentive group, or a deposit incentive group). All participants were instructed to lower their weight (via diet and exercise) by 1 lb per week for the duration of the 16 week intervention, thus aiming for a total target weight-loss of 16 lbs. Individuals in the incentive groups received their financial rewards on a monthly basis, only if they had met or exceeded their target weight loss (1lb/wk). Those that failed to make the weight-loss goal were merely told how much money they would have received if they had been successful, whereas the control group received no reward regardless of their progress.

Over the course of the 4 month intervention individuals in the incentive groups earned an average of approximately $300, in contrast to $0 awarded to those in the control group. Interestingly, the average weight loss achieved by those receiving a financial incentive was significantly greater as compared to that of the control group (13-14lbs vs. 4 lbs, respectively). Furthermore, only 10% of individuals in the control group versus approximately 50% of those in the incentive groups achieved the target weight-loss of 16lbs.

However, during a subsequent 3-month follow-up, study participants gained back much of the lost weight after the cessation of the financial incentives – a finding which is common to most, if not all, weight-loss intervention studies.

This study extends findings of a previous investigation in which participants who were offered $14 per percent decrease in weight lost about 5lbs, while those who were offered no compensation lost 2lbs during the 3 month intervention.

So how can any of this be applied in the real-world?

The thinking goes – if an overweight individual has previously had trouble adhering to a diet and/or exercise program, investing some of his/her own money may provide a novel incentive to stay on track in order to avoid losing money – the basic concept of loss aversion.  For example, you can hand over $100 to a trusted friend/spouse/family member and sign a contract before embarking on a lifestyle change. This trusted individual is instructed to return the money in full if you achieve your goal, or otherwise to donate your money to a cause that you find distasteful – like the NRA or the Church of Scientology.

More than anything else, its a cute and gimmicky approach to providing incentive for weight loss, and the idea makes for great headlines (as recently illustrated). I’m sure financial incentives can work for some, but this is no obesity panacea.

Peter

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7 Responses to Do money incentives help people lose weight?

  1. Thanks for your take on this. I had seen the headline and read the articles too.

    My prediction is the “fat-basher” type of commenter will use this headline to pigeonhole all obese people as indulgent and weak-willed, saying: “See, when money’s on the line, they can give up the Twinkies! Anybody can lose weight when they make up their minds!”

    So it’s interesting that the recent headline articles don’t seem to mention the much earlier study which had a long-term follow-up: when the money runs out, the weight comes back. Can the money last forever?

    I recall reading statistics that something like 80% of people who go on restricted-calorie diets end up regaining all the weight they lost, plus a few pounds extra, within 1 to 4 years ( http://newsroom.ucla.edu/portal/ucla/Dieting-Does-Not-Work-UCLA-Researchers-7832.aspx ). It calls to mind a comment somebody made on a political blog… paraphrasing: “If 80% of airline trips ended in a crash, we probably wouldn’t be telling people they need more willpower and commitment to traveling. We’d probably redesign the airplane instead.”

    Given that 80% failure rate, we really need to redesign and redefine what we mean by “diet”, if we want to live in the real world!

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  2. Pingback: Do money incentives help people lose weight? | Ghump

  3. I wonder if negative money incentives work too, i.e. part of the success of programs like WeightWatchers may be that you stop paying when you reach your goal weight? Some people have suggested a “junk food tax” similar to taxes on alcohol and tobacco that might work as a negative incentive.

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  4. I do trust all of the concepts you have offered in your post. They’re really convincing and will certainly work. Nonetheless, the posts are very brief for beginners. Could you please prolong them a little from next time? Thank you for the post.

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  5. As you accurately pointed out, Peter, this approach is no “obesity panacea.” In fact, it’s patently ridiculous. Any study that doesn’t follow weight loss maintenance out for at least 5 years is useless. This is because, as you know (again), it is near impossible for anyone to maintain weight loss past this point. This is not because, as our culture maintains, that “obese” people are lazy, stupid, whatever… It is because our basic metabolic processes have evolved (since the appearance of multicellular organisms) to conserve energy in order to stave off starvation. Whenever anyone goes on a calorie-restricted diet, the body goes into starvation mode, metabolic rate slows down, and the urge to eat intensifies. In the end, no amount of conscious effort can trump our basic biology.

    The best approach to improving people’s health in Western/developed society is to encourage people to move towards “healthy-ER” lifestyles, something that requires support on all possible levels, and is a life-long effort for the individual and all those around him/her. Just because the one-third of people in Western society who are thin are offended by the sight of fat people doesn’t mean that they can force or cajole them into conforming or becoming invisible.

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  6. Jarret says:

    It’s interesting what factors play a role in people finding the motivation to lose weight. Over the past 20 years, obesity rates have increased by 10 percent in both Canada and the US.
    I find it curious how people can be motivated by $300, but not other factors (vanity, genuine concern for their health, financial savings on health care, etc).

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