Modest financial incentives help with weight loss

Linking payments to weight, rather than behaviors, marginally more effective

More than a third of American adults struggle with obesity, according to the Centers for Disease Control and Prevention.

Beyond the personal cost to individuals (increased risk of diabetes, heart disease, and some cancers, as well as increased social stigma and bias in the workplace), our health care system spends more than $175 billion a year year to treat diseases related to obesity.

results of a field experiment published in JAMA Internal Medicine argue that strategic spending in the form of direct payments to people who are lower income and obese may be an effective way to encourage weight loss.

Participants who received weight management resources (such as a Weight Watchers membership) and a series of financial incentives for reaching certain milestones were more likely to have lost 5% of their body weight in six months than participants who received the resources , but not cash. carrot.

Money as extra motivation

Between November 2017 and March 2020, more than 650 people (each low-income and obese; 80% were women) were enrolled in this study through two New York City hospitals (Bellevue and NYU Langone Health ) and Olive View-UCLA Hospital. A team of 16 researchers, including Noah Goldstein, Soma Wali, Chi-Hong Tseng, Un Young Rebecca Chung, Miguel Cuevas, and Robert Ponce from UCLA, classified the participants into one of three treatment groups.

Joseph A. Ladapo, MD, PhD, University of Florida; Stephanie L. Orstad, PhD, NYU Langone Health; Soma Wali, MD, Olive View-UCLA Medical Center; Judith Wylie-Rosett, EdD, RD, Albert Einstein College of Medicine; Chi-Hong Tseng, PhD, UCLA; A young Rebecca Chung, BS, UCLA; Miguel A. Cuevas, BS, UCLA; Christina Hernandez, MPH, NYU Grossman School of Medicine; Susan Parraga, BS, NYU Grossman School of Medicine; Robert Ponce, BS, Olive View-UCLA Medical Center; Victoria Sweat, MA, NYU Grossman School of Medicine; Sandra Wittleder, PhD, NYU Grossman School of Medicine; Andrew B. Wallach, MD, Langone Health of New York University; Suzanne B. Shu, PhD, Cornell Dyson School of Applied Economics and Management; Noah J. Goldstein, PhD, UCLA; Melanie Jay, MD, New York University Langone Health

A kind of control group received resources to help them focus on weight management. That included a one-year membership to WW Freestyle, the current brand of Weight Watchers. Participants were encouraged to attend a meeting at least twice a month. Participants were also given a digital scale and encouraged to weigh themselves at least three days a week, as well as use an app-based food diary to keep track of what they ate. They also received a Fitbit tracking device and were encouraged to commit to at least 75 minutes (increased to 150 minutes midway through the study) per week of moderate to vigorous physical activity.

A second group received the same resources and a series of financial payments for reaching certain behavioral goals, but the payments were not directly tied to weight loss. The maximum that could be earned was $750 over six months, including $150 for attending at least two of the WW Freestyle meetups in the first month, and then $60 for each month they also attended two of the meetups per month. Participants in this group could also be paid for keeping a weight loss journal, recording their weight at least three times a week, and reaching exercise milestones.

A third group received the same resources, but their financial incentives—again, a maximum of $750 over six months—were tied to reaching specific weight-loss milestones. Participants in this group would receive $50 if they lost at least 1.5% to 2.5% of their starting weight in the first 30 days, or $100 if they lost more than 2.5%. At the two- and three-month weigh-ins, they were eligible for another $50 if their weight loss was at least 2.5% to 5% or $100 if their weight loss was more than 5%. In the last three months, the payment for a weight loss of 2.5% up to 5% was increased to $100 per month and $150 for each month if the weight loss was greater than 5%.

The researchers focused on how many people in each group managed to lose at least 5% of their starting weight at six months. The researchers chose the six-month approach based on previous research establishing that it takes that long for a change in behavior to begin to stick as a lifestyle habit. Nearly 500 of the original 688 registrants were still participating at the six-month mark. That being said, the participants were followed for a full year and 364 of them remained active for 12 months.

Results included:

  • Among the participants who received support and resources but no financial incentive, 22% had lost at least 5% of their weight at six months. After a full year, almost a third had lost at least 5%, a significant increase.
  • Among participants who received financial incentives for reaching behavioral goals, 39% lost at least 5% of their starting weight after six months. A year later, 42% reached that level, a slight uptick.
  • Among those paid for targeted weight loss, 49% lost at least 5% of their body weight within six months. At the one-year mark, this group experienced some relapse, with 41% showing at least a 5% loss of body weight.

The researchers point out the limits of the compressed time frame of this study. The encouraging results of financial incentives, especially when linked to behavioral goals, warrant the study of whether the same incentives can drive weight loss that persists over longer periods.

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