Paying People to Lose Weight

Dec. 10, 2008— -- Suzie Velarde, a 38-year-old patient accounts representative at the Poulsbo Medical Center in Poulsbo, Wash., had struggled with her weight for years.

Velarde was about 40 pounds overweight, trying desperately to find the perfect diet to help her shed the pounds and keep them off. But nothing she tried seemed to work.

"I tried low-carb, low-fat, low-everything diets," Velarde said. "But it was hard to stay motivated. I always felt like I was not doing the right thing."

That was until the Seattle-based Group Health Cooperative health-care system, her employer, encouraged all employees to enter into a weight loss challenge in 2006.

The challenge, part of an overall employee wellness program, was an incentive-based weight loss program that rewarded employees who had lost the most weight with prizes.

All the employees participating in the challenge contributed money to a lottery that would go to the "biggest loser" of the group at the end of the three-month challenge, Velarde said

Out of all the participants in the challenge, Velarde won second place with an overall weight loss of 40 pounds, bringing her to a healthier weight.

Such programs that offer financial incentives to those who meet their weight loss goals may indeed be an effective approach to weight loss -- at least in the short term -- according to a new study published in the Journal of the American Medical Association.

But there's a catch. The research only confirms the short-term success of such weight loss programs. And the researchers found that for many people, keeping the weight off proved to be another challenge altogether.

As for Velarde, while almost all of the program's participants successfully lost weight through the incentive-based challenge, she said she was one of the few people in the group to keep the weight off.

"I think a lot of [the participants] did low-carb diets and gained the weight back on after the challenge," Velarde said. "I have seen firsthand that a lot of people, once the incentive is gone, gain all of the weight back, and then discouragement returns for them."

Converting Dollars to Pounds

In the study, researchers from the University of Pennsylvania looked at 57 people, dividing the participants into three groups: one group that only submitted to monthly weigh-ins, and two other groups that had the monthly weigh-ins and were involved in one of two different financial incentive weight loss plans. All groups had a target weight loss of 16 pounds in 16 weeks.

One of the financial incentive groups had to put their money into a pool, much like the program in which Velarde participated. If participants did not meet their 1-pound-per-week weight loss goal, they had to forfeit the money they deposited. But those who met their goals were rewarded with extra money.

Participants in the other financial incentive group were not required to deposit their own money into a pool, but rather were entered into a financial lottery in which they had the chance to win money for meeting their weight loss goals.

Results showed that after the 16 weeks, people in the monthly weigh-in group without any financial incentives had lost 4 pounds, while those in the deposit group had lost 14 pounds and those in the lottery group had lost 13 pounds.

"We demonstrated that an incentive program that provides frequent positive feedback can be very effective at changing behavior," said lead study investigator Dr. Kevin Volpp, director of the Leonard Davis Institute of Health Economics Center for Health Incentives at the University of Pennsylvania in Philadelphia.

Money for Nothing?

Although the study demonstrates the success of such incentive-based weight loss programs, the participants were not followed long enough to show whether such programs have long-term success.

"A key challenge in weight loss interventions is to both attain initial weight loss and to maintain that weight loss over periods of 12 months or more," the researchers said. "Further testing of longer term use of these incentives is needed to determine whether longer use would lead to sustained weight loss."

Still, many diet experts say that they encourage the use of incentives for weight loss to their patients.

"I use this philosophy when patients tell me that there is no way that they can possibly lose a lot of weight -- and I make the point to them that it all depends on what the incentive is," said Dr. Carl Lavie, medical director of cardiac rehabilitation and prevention at Ochsner University's Heart and Vascular Institute in New Orleans. "Let's say a man is 250 pounds and his ideal weight is 180, and he does not think that he can even lose 10 pounds, much less 30 or 40. I make the point of asking him if someone offered you $10 million if you lost 40 pounds in so many months, do you think you could do it -- they all say 'absolutely.'"

But many diet experts remain wary of the long-term success of such incentive-based approaches to weight loss.

"The problem with the reward approach is once the money was not available, the incentive is lost and weight is quickly regained," said Dr. Jana Klauer, a private practice physician specialist in nutrition and metabolism and author of "How the Rich Get Thin."

"The idea is really no different from that of losing weight for a special occasion and then regaining after the event has passed."

And although the most recent study on incentive-based weight loss programs bolstered the success of using financial rewards for meeting weight loss goals, it also showed that the effectiveness of this technique began to wane in time.

"While this intervention worked, the benefit was fast disappearing at the seven-month mark," said Dr. David Katz, director of medical studies in public health at the Yale University School of Medicine in New Haven, Conn. "That is about the same success seen with almost any fad diet."

So while experts believe that an incentive-based weight loss program is often successful in helping someone to jump-start weight loss, most agreed that the weight loss achieved through such a program cannot be sustained without finding a deeper motivation for weight loss that goes beyond the financial reward at the end of one program.

"If we are going to achieve lasting change in health behavior, we need to help people to internalize the sense of responsibility to self and self-care and to value their own well-being," said Martin Binks, director of behavioral health and research director at the Duke Diet and Fitness Center. "This speaks to the necessity of treating the whole person."

In Velarde's case, finding the larger goal beyond simply winning the lottery at the end of her weight loss challenge is what allowed her to keep the weight off for the last year and a half.

"My son was my biggest motivator," Velarde said. "He was in wrestling in school, so watching him eat healthy and exercise every day was what motivated me to eat healthy and exercise. I wanted to keep up with him, and, I thought, 'if he can be motivated, then I can, too.'"

"It's definitely a lifestyle change," she said, "as opposed to a quick-fix diet or an incentive diet."