December 10, 2008
Paying by the Pound
New research may point
the way to help the nation not only deal with rising healthcare costs associated
with the obesity epidemic but also provide an overlooked stimulus program
to spur economic growth.
The answer, according
to a new study published in the Journal of the American Medical Association
(JAMA), is in paying people to lose weight.
Dr. Kevin Volpp of
the University of Pennsylvania School of Medicine found that people, given
a financial incentive, lost weight more easily than more conventional
approaches to taking off the pounds. The promise of an immediate cash reward,
it seems, was a stronger motivator than all the other prospective benefits
participants might achieve over times.
Researchers put participants
in the study into two types of reward programs. The first was a lottery
system where people would collect winnings if they met daily goals.
The second program was
a deposit contract where participants used their own money. If they achieved
goals their deposit would have a bonus added at the end of the month. If
goals were not met, deposits were forfeited.
People in the first
program lost 13 pounds on average while the second group shed 14 pounds.
Individuals in the control group lost four pounds.
Dr. Volpp said the program was effective in achieving quick weight
loss but further
study was needed to determine if "they can be effective in sustaining
weight loss as well."
Discussion Questions:
Are incentive programs a long-term solution for businesses looking to
reduce healthcare costs? What are the most effective means for companies
to get their healthcare costs under control?
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I see lots of problems. What about anorexic people? How can they make money from this? It’s like paying people not to smoke. If you are a non smoker, it’s great. Where I used to work, you had to pay extra for your health insurance if you smoked or were overweight. Don’t pay people to lose weight, just charge them extra like any insurance company would. Or better yet, don’t hire them in the first place. Just pay people what they are worth and then just charge them accordingly for their health insurance premiums.
This one was a bit of a challenge for me to get my head around. I’m one of those that can’t seem to keep the weight on, so I had to spin the question around to “if someone paid me to put on weight, would I?”
The initial incentive might catch my interest, but they’d probably have to also hire me a personal trainer, a cook and an assistant who would stand by me to make sure I took the time to actually eat.
The point I’m making is that this initiative seems too one dimensional. While it might work for some, human behavior is far too complex to think that a simple ‘carrot’ will do the trick (but hey, maybe more real carrots are the answer!)
I have a fundamental problem with this concept. As a person who loves to cook and eat, self denial and restraint based on knowledge of the impact of excess weight and poor nutrition keeps my weight in a normal range. Why, then, should I not get a financial incentive for having a long employment history of good sense and self restraint?
Health and nutrition information is abundant, but even in years of rapid growth of organic food sales, obesity still rose in our country. It should not be the burden of corporate America to have to pay people extra to get them to lose weight. Maybe we should reverse that logic and insist they use their health benefits for behavior modification training if they want to keep their jobs. That is a different form of incentive that might have a much longer-term impact.
I don’t know if these results are really something that employers can take advantage of–I guess maybe if it was done like a 401(k) with employer match, but will that really translate into lower health care costs for the employer? That’s part of what’s wrong with the system today. Healthy people subsidize unhealthy people. If you spend that subsidy on weight loss incentives, will they stick around long enough for the unhealthy people to generate less costs?
I’m skeptical. I’m all for ways that employers can help employees be healthy, but I would see this as a perk, rather than a cost savings opportunity.
It seems that there is always a new diet being promoted. And they all seem to work…at least in the short term. In most cases those who participate end up gaining their weight back. (Right, Oprah?) The reason for this phenomenon is simple. The diets are unsustainable in the long term. They guide a dieter down a path that is not realistic or livable.
Financial incentives work the same way. While they are top of mind, they guide behavior. But, they do not address the inner reasons why people overeat. Consider, there are already financial incentives when people cut back on the amount of and the type of food that adds weight. At minimum, it is a smaller grocery bill.
We all know the consequences of being overweight. That alone should be enough to keep us all fit. But, it doesn’t. The reasons are much more ingrained in the psychological make-up of the overeater than any short term incentive can overcome.
Incentive programs only work if they produce long-term results. If they only cause people to take an immediate action, but not sustain the result, the program is a failure.
There are a myriad of reasons why people make bad choices that may eventually lead to health problems. The root causes of those initial decisions need to be addressed. Whether it’s the demise of many physical education and health classes in schools, the over-processing and over-sweetening of food, the lack of healthy portion control, etc, we need to teach people how to eat well and take proper care of their bodies and then reward continual good behavior.
I agree with Nikki. This should be an optional perk that stimulates participation by example. This kind of thing has already seen success to motivate folks to stop smoking, so why not try it? There are certainly wonderful long-term benefits and the program could very well better educate those that still need more information on the impact of their choices. Sometimes peer pressure is a good thing.
Just coincidentally, yesterday I heard the Smothers brothers discussing a related control problem – world population. Tommy it seems had learned a valuable approach in relation to the pet rabbits he had in a hutch in the back yard. He hid behind a barrel in the back yard, and every five minutes would leap out and shout, “Stop that!” :>)
Seriously, short term incentives seem misguided when long term behavioral changes are needed. The question isn’t how to lose weight, but what kind of life you live for the rest of your life. With few exceptions, if you will start living it, weight and everything else will come to the equilibrium dictated by your new permanent regimen. The goal should be a new life, not a new weight. [OK, 40 years ago I went from 235 lbs to 185 lbs, and have stayed, mostly, within 10 lbs of that since. What happened between my ears was more important than what happened around my waist.]
So if I get this article, it says that if I was fat, I could make more money if I lost weight. But if I took care of my body, I would make less? I would think there would have to be an incentive for those who are at their “ideal” weight.
Put me down as opposed–flatly. Too many of these proposals confuse a simplistic metric–weight–with fitness, as if there could be no such animal as an overweight athlete.
But we do exist.
As a competitive tennis player who shops in the plus-size department, I can’t tell you the number of times I’ve shocked a new (thin) doubles partner who didn’t expect me to move well on the court: “I didn’t think you would get that ball!” The rejoinder: “I’m fat–not slow.”
My cardiovascular numbers are what you’d expect from anyone who exercises aerobically for 90 minutes at a time, 4-5 days a week.
And I’m not alone. Last week’s Newsweek featured a My Turn column from a runner who’s a size 14. She runs about 15 miles a week and enters races occasionally.
So weight alone only tells a part of the story.
Wanna pay me to play tennis? Terrific–my club bills are manageable, but not cheap.
But let’s get over our national obsession with food deprivation. Clearly not everyone who eats dessert is going to die.
Dr. Kevin Volpp nailed it when he noted that the weight losses were short-term. Every diet gets challenged by the weight-loss carousel: folks lose weight for a while, then gain it back.
And folks on a diet get crabby. Would you rather employ overweight people in a good mood or crabby folks losing weight for a few months who’ll probably gain it all back again?
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I see lots of problems. What about anorexic people? How can they make money from this? It’s like paying people not to smoke. If you are a non smoker, it’s great. Where I used to work, you had to pay extra for your health insurance if you smoked or were overweight. Don’t pay people to lose weight, just charge them extra like any insurance company would. Or better yet, don’t hire them in the first place. Just pay people what they are worth and then just charge them accordingly for their health insurance premiums.
This one was a bit of a challenge for me to get my head around. I’m one of those that can’t seem to keep the weight on, so I had to spin the question around to “if someone paid me to put on weight, would I?”
The initial incentive might catch my interest, but they’d probably have to also hire me a personal trainer, a cook and an assistant who would stand by me to make sure I took the time to actually eat.
The point I’m making is that this initiative seems too one dimensional. While it might work for some, human behavior is far too complex to think that a simple ‘carrot’ will do the trick (but hey, maybe more real carrots are the answer!)
I have a fundamental problem with this concept. As a person who loves to cook and eat, self denial and restraint based on knowledge of the impact of excess weight and poor nutrition keeps my weight in a normal range. Why, then, should I not get a financial incentive for having a long employment history of good sense and self restraint?
Health and nutrition information is abundant, but even in years of rapid growth of organic food sales, obesity still rose in our country. It should not be the burden of corporate America to have to pay people extra to get them to lose weight. Maybe we should reverse that logic and insist they use their health benefits for behavior modification training if they want to keep their jobs. That is a different form of incentive that might have a much longer-term impact.
I don’t know if these results are really something that employers can take advantage of–I guess maybe if it was done like a 401(k) with employer match, but will that really translate into lower health care costs for the employer? That’s part of what’s wrong with the system today. Healthy people subsidize unhealthy people. If you spend that subsidy on weight loss incentives, will they stick around long enough for the unhealthy people to generate less costs?
I’m skeptical. I’m all for ways that employers can help employees be healthy, but I would see this as a perk, rather than a cost savings opportunity.
It seems that there is always a new diet being promoted. And they all seem to work…at least in the short term. In most cases those who participate end up gaining their weight back. (Right, Oprah?) The reason for this phenomenon is simple. The diets are unsustainable in the long term. They guide a dieter down a path that is not realistic or livable.
Financial incentives work the same way. While they are top of mind, they guide behavior. But, they do not address the inner reasons why people overeat. Consider, there are already financial incentives when people cut back on the amount of and the type of food that adds weight. At minimum, it is a smaller grocery bill.
We all know the consequences of being overweight. That alone should be enough to keep us all fit. But, it doesn’t. The reasons are much more ingrained in the psychological make-up of the overeater than any short term incentive can overcome.
Incentive programs only work if they produce long-term results. If they only cause people to take an immediate action, but not sustain the result, the program is a failure.
There are a myriad of reasons why people make bad choices that may eventually lead to health problems. The root causes of those initial decisions need to be addressed. Whether it’s the demise of many physical education and health classes in schools, the over-processing and over-sweetening of food, the lack of healthy portion control, etc, we need to teach people how to eat well and take proper care of their bodies and then reward continual good behavior.
I agree with Nikki. This should be an optional perk that stimulates participation by example. This kind of thing has already seen success to motivate folks to stop smoking, so why not try it? There are certainly wonderful long-term benefits and the program could very well better educate those that still need more information on the impact of their choices. Sometimes peer pressure is a good thing.
Just coincidentally, yesterday I heard the Smothers brothers discussing a related control problem – world population. Tommy it seems had learned a valuable approach in relation to the pet rabbits he had in a hutch in the back yard. He hid behind a barrel in the back yard, and every five minutes would leap out and shout, “Stop that!” :>)
Seriously, short term incentives seem misguided when long term behavioral changes are needed. The question isn’t how to lose weight, but what kind of life you live for the rest of your life. With few exceptions, if you will start living it, weight and everything else will come to the equilibrium dictated by your new permanent regimen. The goal should be a new life, not a new weight. [OK, 40 years ago I went from 235 lbs to 185 lbs, and have stayed, mostly, within 10 lbs of that since. What happened between my ears was more important than what happened around my waist.]
So if I get this article, it says that if I was fat, I could make more money if I lost weight. But if I took care of my body, I would make less? I would think there would have to be an incentive for those who are at their “ideal” weight.
Put me down as opposed–flatly. Too many of these proposals confuse a simplistic metric–weight–with fitness, as if there could be no such animal as an overweight athlete.
But we do exist.
As a competitive tennis player who shops in the plus-size department, I can’t tell you the number of times I’ve shocked a new (thin) doubles partner who didn’t expect me to move well on the court: “I didn’t think you would get that ball!” The rejoinder: “I’m fat–not slow.”
My cardiovascular numbers are what you’d expect from anyone who exercises aerobically for 90 minutes at a time, 4-5 days a week.
And I’m not alone. Last week’s Newsweek featured a My Turn column from a runner who’s a size 14. She runs about 15 miles a week and enters races occasionally.
So weight alone only tells a part of the story.
Wanna pay me to play tennis? Terrific–my club bills are manageable, but not cheap.
But let’s get over our national obsession with food deprivation. Clearly not everyone who eats dessert is going to die.
Dr. Kevin Volpp nailed it when he noted that the weight losses were short-term. Every diet gets challenged by the weight-loss carousel: folks lose weight for a while, then gain it back.
And folks on a diet get crabby. Would you rather employ overweight people in a good mood or crabby folks losing weight for a few months who’ll probably gain it all back again?