Anyone who has ever tried to lose weight knows it’s tough to stay motivated. Researchers at the University of Pennsylvania wondered if cold, hard cash might do the trick.
I.B.M. employee Jodi Morrison won cash incentives for tracking her exercise at work. The investigators studied how cash incentives influenced weight loss among 57 people who were obese but otherwise healthy. One group of dieters was given $3 a day plus additional matching funds for meeting weight loss goals, meaning they could earn up to an extra $168 during a four-week period. A second group was eligible to compete in a cash lottery for $10 to $100 a day during the study period if they achieved weight loss goals. A third control group simply attended monthly weigh-in sessions.
At the end of 16 weeks, the dieters in the lottery group had lost an average of 13.1 pounds each, while those in the matching-funds group had lost an average of 14 pounds each, compared to just 3.9 pounds in the control group, according to a report published today the Journal of the American Medical Association.
Five people in the lottery group and seven in the matching-funds group lost more than 20 pounds each during the study period. Only one person in the weigh-in group lost that much weight.
The downside was that some of these dieters gained back much of the weight once the cash prizes dried up. Still, seven months later they remained an average of six to nine pounds lighter.
The study offers lessons to businesses about the value of regular cash incentives to encourage healthy behaviors among workers, said Dr. Kevin G. Volpp, director of the Center for Health Incentives at the University of Pennsylvania School of Medicine.
“The goal is to design a reward system in a way to help people in the short term do what’s in their long-term best interest,” said Dr. Volpp, an internist and health economist. “A lot of insurers are starting to spend a lot of money on incentive programs to improve health. This shows that providing tangible rewards with a higher degree of frequency makes the use of these dollars more effective.’’
The experience of workers at I.B.M. Corp., for instance, suggests that cash incentives can work in the real world. In 2004 the company introduced a rewards program encouraging workers to track their progress in healthful eating, exercise, and smoking cessation. In return for making the effort and logging in their results, the employees earn up to $300 in incentives a year.
Now the smoking rates among company workers is about 10 percent, half the national average. And participants in the exercise rebate program spend about 20 percent less on out-of-pocket health costs than other employees, which translates to individual savings of about $70 a year, according to I.B.M.
Jodi Morrison, 49, an I.B.M. administrative assistant for 19 years, lost 37 pounds and kept it off for the past two years. She says her commitment to regular exercise was boosted by the $300 annual cash reward offered by her employer.
“It was something I know I needed to do,’’ said Ms. Morrison of Sherman, Conn. “I think just knowing that I’m going to have to log my results in, and I’m going to be rewarded at the end, it just gives you the added push.’’
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From 1 to 25 of 75 Comments
Do as I say not as I do.
— Lee WardI work for a HEALTH DEPARTMENT on almost every desk there is a basket of mini chocolates. Today was the annual rum cake. I could hit my target weight better by telecommuting.
I wonder how long a program like this would be effective.
At first, the novelty of being financially rewarded for losing weight may give someone the little extra boost they need to stick with their weight loss program.
But eventually, even the prize money will become old news.
And as every yo-yo dieter knows, short term weight loss is usually balanced with an equal or even greater weight gain.
— DRIt would be wonderful if good health were in itself reward enough for losing weight and exercising. But, I’m not one to talk. Although I am stick thin from cancer treatments, I still need to exercise to improve my overall health. You’d think that hoping to reduce my tumor load would be incentive enough, but it is not; I never exercise. I still have yet to find the right carrot to dangle in front of my face.
http://everythingchangesbook.blogspot.com/
— Kairol RosenthalIf you sign up for a study, and you’re merely asked to check in once a month it must be pretty obvious that you’re in the control group, and thus you’re not getting some benefit that other participants are getting. That has to be disappointing and likely negatively impacted control group member behavior. Unless the analyst could control for that, the impact of the cash is overstated. Being left out, being discouraged, not being supported, has an enormous negative impact on a person’s psyche.
— BarbaritaWe’re paying kids to do school work and now we’re paying adults to lose weight?
I suppose experimenting for the sake of proper research is fine, but I hope this kind of monetary reward does not become the norm.
— YesolWhat’s especially interesting about these findings is that the incentives aren’t that good. Even a very mild incentive seems to work.
There has also been at least theoretical work done on negative incentives. The practical way to approach this is to select an organization you detest. Write a check to them for an amount of money that makes you cringe. Give that check to a responsible friend with the instructions that they need to send it to the organization unless you meet a specific weight loss goal by a specific time. It’s pretty easy to imagine that the combination of having to part with your money and support something you hate could motivate you to reach a goal to avoid these certainties.
— MarcThere was a discussion on Motherlode about the merits/failures of offering money as an incentive to your children, and the reaction was very mixed. I wonder if it’s morally any different when adults are offered cash incentives (by their employers, no less)?
— DanielleJudgmental Mode On (grin/blush):
Good grief! Whatever happened to good old self-motivation? I lost 40+ pounds in 2004, and have maintained most of that weight loss. I didn’t need anybody to pay me to do that. (My current BMI is 21.8.)
— JohnJDear NY Times Health Reporter,
Why are there no channels of communication open between Mayor Bloomberg’s office and the general public, as relates to health and wellness program suggestions ? United States Government is supposed to be “of the people for the people” and should be able to capitalize on the combined strenghts of the public at large. ‘Big Business’ has seen the advantages of recieving ideas from the public and has responded by creating mechanism’s for tapping into these streams. With health and fitness so much the language of today, will Mayor Bloomberg’s administration follow the private sector’s lead ? There is an absolutely new, and uniquely effective ‘wellness’ program that is starting to positively impact the peoples of upstate NY, but falls on deaf ears where it is needed most.The population of NYC will eventually become aware of, and benefit from, the Goal Bands Game program. The question is, why the delay ?
FROM TPP — I can’t answer your question. There are many competing priorities.
— James MentzerIf the US adopts some form of national healthcare or insurance system, there should definitely be a cost scale related to obesity. If you’re overweight, your monthly premium is higher, with how much higher determined by how much you’re overweight. It is getting cash for losing weight.
Most insurance companies today don’t factor overweight in to their premium tables (mostly age, gender and smoker status) even though the links between obesity and long term health risks are well known. Yet they do “ding” customers for minor injuries that are related to staying fit. I banged up my knee after years of running, went to the doctor (no surgery, just a short course of meds and one month of PT) and the next time I applied for insurance, I was put in the high risk category. It nearly tripled my premium.
So I have a huge financial incentive to stop running, and become an overweight couch potato. Its idiotic!
— CEAPayment as an incentive is a just reward for weight loss . In these economic times for those who might still have jobs a little extra cash has a lot of value. we will need to figure out how to have a national wellness service for those without employment, those whose numbers will grwo as fst as those without medical insurance.
But doing a “weight” thing will get the results of some weight loss in the short run and a recouping the loss and gaining more weight over time.
Weight loss explained and properly used as a tool to get healthy breathing, movement, nutrition, attitude and rest brings the needed elements together so that what is really lost is not weight, a mythological being of almost no consequence, but the loss of unhealthy behavior and life styles that will be eliminated forever.
Healthy living also produces an effect that goes beyond a slight and then growing decrease in out-of-pocket medical expenses. That positive side effect is that the reduction of the use of medical care will reduce the many known and unknown adverse side effects of medical care received (MCR). Healthy people do not get hospital acquired infections (aka HAIs which now claims about 100,000 Americans each year) or harmful side effects of powerful and popular prescription drugs (also associated with 100,000 American deaths each year) for the simple reason they are not hospitalized or on prescription drugs.
Wellness and health also reduce unnecessary tests, scans, and treatment that reasonable researchers and expert commentators say claim many hundreds of thousands of Americans each year.
Wellness and healthy life styles can primarily prevent illness and disease. When the medical model of detection and treatment is needed, healthier people will have better chances of coming out alive. They will be better when ill because they have learned to understand how to support their bodies and will be in a better position to participate in regaining their health. They will also have a better motivation: get back to vibrant living that they once enjoyed.
— ed gHow much they lose really doesn’t mean much. Yeah carrot and stick work to get people to crash diet. If you’re PAYING Jenny Craig or weight watchers you’ll lose weight, if you are being paid you’ll lose weight to get the money.
Look at the same groups 2 years down the track. My wager is you’ll find those who lost the most weight have also gained the most back, while those who lost a modest amount are much the same weight as they were (ie they gain it back but it isn’t that much and they don’t add to it).
Weight loss per se is not the key to good health for most people. And even for those for whom it IS, losing is a double edged sword given the rate of gain back and add. It is a rational decision to say better to work hard at maintaining current overweight status than to diet and end up obese in 2 years time.
— JillyflowerOprah just admitted she weighs 200 pounds. Given her height, that means she is obese, per this article:
http://tv.yahoo.com/oprah-winfrey/contributor/30579/news/urn:newsml:tv.ap.org:20081209:people_oprah_winfrey_weight__ER:51912
If Oprah can’t lose weight and keep it off over her lifetime, it can’t be done. Period. Nobody has more will power, money, chefs, health assistants, and help than Oprah.
But this is what I have been saying in this space for almost a year now: lifetime weight loss is a waste of time, money and energy.
I don’t mean weight loss by actors to get a part, or weight loss by athletes in order to compete in a fight, race, time trial, etc. Nor do I mean weight loss to fit into a wedding dress, or tuxedo. These can all be done, and are done regularly.
I mean that losing a significant amount of weight (over 40 pounds) and keeping this weight off over the course of one’s lifetime is, for all practical purposes, impossible. Nor is it desirable.
Yo-yo dieting is more harmful than staying at one weight, even if that weight is high.
Accept who you are, what your constitution is, what your metabolism is, what your propensity to exercise is, then try to be as healthy within these parameters as possible. Anything else is a waste of time, energy and money. Forget hypnosis, diet pills, spas, the newest diet book, speed, cocaine, cigarettes, etc.
Think overall health, don’t think weight loss. Move everyday, even if it simply gardeining, house work, taking the stairs in public buildings, parking farther away on purpose, etc. Figure out what movements you like doing and what will work in your lifestyle.
— Rob L, N Myrtle Beach SCIMHO, most of these types of studies focus on the wrong things. Sure, there are plenty of folks out there who are ignorant about good nutrition and exercise, but most people who WANT to lose weight have educated themselves to some degree on the topic. Many of these people have also had success in losing some weight.
Keeping it off longterm is another story entirely. It takes a great deal of dedicated lifestyle change, commitment, and support to accomplish this. We should be looking at systems to retrain people in the ways they think about and react to food and the emotional issues surrounding it, and providing the necessary support. There are no quick and easy solutions.
— CindySWhile the points various readers have made about the long term efficacy of this type of program are certainly valid, I find the general idea to be absolutely fascinating. People who engage in unhealthy behaviors such as smoking and over eating cost companies thousands of dollars a year (I believe it was around $2000/yr for smokers), and it actually makes financial sense for companies to pay people to adhere to healthier behaviors.
A lot of people have stated that people “should” be able to lose weight without the monetary reward, as if there was some sort of higher morality attached to having a healthy lifestyle. Personally, I’m far more in favor of monetary incentives than shaming people.
— SWe need to change the entire American lifestyle — and what we eat and drink is secondary.
Americans are stressed out. Some studies link the stress hormone cortisol to weight gain. Stress makes it hard to make good decisions — it leads to binge eating for many.
Most places, walking is dangerous or impractical. Notice that New York City residents tend to be thinner than rural people? Because they have plenty of sidewalks and places to go. In the suburbs or country, walking on the side of the road is dangerous and unpleasant — litter, unleashed dogs, and racing cars to name a few issues.
Americans have less leisure/ vacation time than people in most developed countries. The average American works long hours, comes home exhausted sits and watches t.v., becomes even more tired….a vicious cycle. Not to mention meals on the run. Time constraint is probably the top issue for lack of recreation/exercise.
Overweight people, particularly women, tend to be self-conscious. Most feel like they have to lose weight BEFORE joining a gym, or participating in sports, because obesity is seen as a moral failure and people make rude remarks to them. (just read the above.)
We’re surrounded with plentiful, delicious food. Great restaurants (big portions), lavish markets, lots of ready-to-go prepared food. In many other countries, it just takes more work to get a good meal.
What seems silly is when media has dieticians explain what healthy portions are, or there’s a new study that reveals “eating in moderation and exercise will help you lose weight!”
It’s not lack of information — it’s lack of time, opportunity, relaxation, confidence, and too much access to tempting but fattening food. Those prone to weight gain have to create a lifestyle that supports healthy living.
— JackieI like this! It’s not just the cash, I bet most of the people would keep the weight loss over the $ at the end of the study if given a choice.
I think it completely re-frames the problem. Too often people look at dieting as punishment for being ‘bad’ or ‘gluttonous’ or ‘lazy’, this turns it into something that deserves praise. No more guilt, the dieters felt good. People do things they feel good about.
— ATo Rob, #13:
As usual, I disagree and I agree with you (I like these mysteries of life, so I enjoy most of your comments).
What I dislike about this point of view you so often express: I hate the idea of resigning oneself to overweight. I like the idea of pushing through to a new and better level in living. If it’s too difficult to reach some kind of “goal,” it’s probably possible to at least maintain weight (stop gaining), or even to take off and keep off 5 or 10% of body weight. Even this much helps.
And some people actually DO take off weight and keep it off. I’m glad they don’t give up before they try.
What I like about your point of view: We should all accept ourselves, as we are. Weight management shouldn’t be motivated by self-loathing, and there should not be a social stigma associated with fat. It’s just fat, it’s not character. People can be beautiful AND fat, for sure.
Overall, I don’t buy into the idea that overweight coexists with “health.” I believe that excess weight is a burden on the body that just cannot be a good thing, even with fairly good “metabolic health.” Everything is relative, of course. It’s all a matter of the degree of overweight, and the baseline health of the individual.
I don’t see this as an all-or-nothing issue. I think that Oprah should or could feel good that she doesn’t weigh 300 pounds, because she’s probably capable of that. I think she should reflect on her weight and fitness history, and be more realistic about a weight she can maintain without a punishing, self-defeating diet and exercise regimen.
But I don’t believe she should throw in the towel.
— WesleyWhere weight loss plans and activites are concerned, there is often too much emphasis on the amount and/or speed of weight lost - the club member who lost three pounds in the last week gets much more applause than the member who lost only a half pound, even if the latter is a very short-statured person who shouldn’t be losing any faster than that. This is counter-productive. Goals should be tailored to the individual, and a sustainable life style should be the objective. For people in middle age, simply maintaining one’s weight may be evidence of healthy habits.
Companies who wish to reward health-conscious employees might do so with a quarterly bonus that offsets a health insurance premium.
— Barbarahm, I have an idea, why not have your local gym charge you a certian amount extra every month for membership, and specify how often you want to exercise. Then you only get back the extra money every month if you stick to your goals?
FROM TPP — Some gyms do that. I was speaking with someone yesterday who told me about a gym that gave rebates if you visited 50 times a year. It makes sense. If you use the gym that often, you are more likely to renew a membership I would think.
— kit katOprah (writer number 13) has no incentive to lose weight. It’s not about money, power, chefs, or anything other than the sheer, “you gotta wanna,” period.
As for cash incentives: I am a professional Weight Loss coach and I work for a very large organization that specializes in weight loss.
The meetings I conduct at some companies where the firm pays 1/2 (sometimes more) of our fee have the poorest weight loss record; those whose employees pay the full fee for service themselves do much better.
I’ve been doing this for 10 years — and the anecdotal evidence points to the fact that if $$ is involved, the member will lose the weight more effectively if that money is out of pocket.
Such is the battle of the bulge.
Ellen
— EllenInstead of paying people to lose weight, how about paying people to increase their lung capacity, lower their cholesterol or blood pressure or increase their fitness? And then rewarding them for maintaining those improved levels? These are certainly more objective measures of health, and would also offer benefits to employees who may not need to lose weight, but whose fitness could be improved.
It’s not just about weight people. Wasn’t there a woman profiled on Oprah who lost some large amount of weight by eating one meal a day of fast food and nothing else? Do you really think THAT was healthy?
— JMWhat about people who work out, eat healthfully, and don’t lose weight?
I worry about things like this because very quickly carrots can turn into sticks. I am heavy despite a healthful diet and 4-5 hours a week of moderate exercise (plus more hours of light exercise: I am on my feet a lot, I walk a lot, and I garden and do housework).
Some people will drop weight fast and easily; for other people, every pound is a struggle.
And trust me, it’s not that we WANT to be fat. I’m so tired of the shaming behavior. Some of us come from peasant stock. Some of us really don’t burn food as fast. I suppose I could consign myself to a life of carrot sticks and water, but should I really HAVE to, when my blood pressure, blood sugars, blood cholesterol and triglycerides are all well within the “healthy” range, and I can outrun people 20 years my junior and 40 pounds lighter than me?
— rickiAnd in response to the post suggesting that there be a “surcharge” for obese people under a national health insurance system …
I’m really sick and tired of this nonsensical argument that fat people should pay more for health insurance simply because they are fat. Not all fat people have health problems. In fact, MOST fat people don’t have health problems related to their weight.
It’s just that the way statistics are framed. We hear that the rate of type II diabetes is 65% higher among obese people than among people of normal weight. But strangely, we never find out what the rate is in either group — just how much higher it is among fat people.
Here’s reality, though. Say 1 in 1000 normal weight people have type II diabetes. That means that 65 in 1000 obese people have it. That’s 6.5%, not the 100% you’d expect given the media hysteria. BTW, I had to make these numbers up, because I cannot find the rate of diabetes among the normal weight population. That’s probably because the pharmaceutucal companies don’t want us to know how low those numbers actually are.
If you want to penalize people because they have diabetes, high blood pressure, high cholesterol, whatever, fine. But those surcharges should apply to everyone with those conditions. And let me tell you, there’s no surer way to make people avoid getting proper treatment for a condition than to tell them that they have to pay more because they have it. It won’t stop them from getting sick and needing more care; it will just make them less likely to get early intervention that will prevent worse problems.
When it comes down to paying for something that benefits other people, you’re getting a real bargain by helping to offset my medical costs. I pay the same school taxes as a person with children, even though my husband and I have chosen not to have them. I pay into the Social Security and Medicare systems, even though they’ll likely be bankrupt long before I’m old enough to benefit from them (assuming I don’t die of fat first). We bought a house we could easily afford, but our tax dollars will be used to help irresponsible people stay in houses they could afford only by taking out a negative amortizing mortgage and hoping their salaries and the value of the house would go up sufficiently to refinance the purchase a few years later.
We live in a society. Sometimes, we get more than we give. Other times, we give more than we get. Don’t like that? Take yourself off to a hermitage. But stop trying to justify your prejudice by with arguments like “you cost me money” because you cost this fat woman a LOT more than I’ll ever cost you.
— JMAt Wesley, #18: In your world, every rainbow has a pot of gold at the end of it, right?
You simply cannot divorce weight and shame in our culture. You can chip away at it over time, but we have a long, long way to go. Mental health is as important as physical health, and sometimes acceptance can bring a measure of relief to the whole self that 20 pounds and a lot of compliments on the new dress cannot.
— Janet V