Several studies have suggested that financial incentives appear to help overweight and obese patients continue to participate in weight-loss programs longer and lose more weight than counterparts who do not receive such incentives. However, when financial incentives are removed, patients tend to regain the weight they had lost. “People are hard-wired to make choices that provide immediate gratification, even if it’s known that they will regret those choices in the long term,” says Steven L. Driver, MD, MPH. “The same is true when people are motivated to make healthy decisions.”
Testing a Financial Incentive Approach
At the American College of Cardiology’s 2013 annual meeting, Dr. Driver and colleagues presented data from a study that investigated whether providing continuous financial incentives for 1 year would encourage participants to achieve and maintain weight loss. “We hypothesized that financial incentives would help participants stick with the healthy behaviors they know they should practice more often,” Dr. Driver says. “This could therefore help them achieve sustainable weight loss.”
For the study, 100 patients between the ages of 18 and 63 with a BMI of 30 kg/m2 to 39.9 kg/m2 were randomized to education with or without financial incentives or to education plus a structured behavior modification plan with or without financial incentives. “All participants were given a weight loss goal of 4 lbs per month, which was adjusted based on the previous months’ weight,” explains Dr. Driver. Participants in the incentive arms could earn $10 for attending monthly weigh-ins. An additional $20 could be earned by those who met their goal weight for the month. However, those who failed to meet their goal lost $20 of their own money while still on the scale. That money was added to an ever-growing bonus pool.
Participants also were informed that they could earn half of the bonus pool money via lottery if they stayed in the program until the end of the study. Lottery tickets were earned for showing up to weigh-ins, meeting monthly weight-loss goals, and checking in with the study investigators weekly through a mobile health application. “Participants entered their weight into the application, and it calculated whether they were on track to meet their monthly goal,” Dr. Driver adds. “It also told them how much money was in the pool at that point.”
The Impact of Financial Incentives
Among patients in the financial incentive arms, 62% stayed in the program for the full 52 weeks, compared with a rate of just 26% for patients in the non-incentive arms (Table 1). “Patients in the incentive arms also lost about four times more weight than those in the non-incentives arms,” says Dr. Driver. “It’s important to note, however, that all participants were motivated and confident that they could lose weight at the start of the study. Our results suggest that—as with typical medical practice—motivating patients by impressing upon them the importance of weight loss may give them confidence, but that may not be enough. Financial incentives, on the other hand, can help patients stick with healthy behaviors.”
“Wellness programs that offer financial incentives will likely become increasingly en vogue among provider groups.”
Dr. Driver says that financial incentives did not appear to work well in isolation. “All study participants were given reliable, accurate information on the importance of eating healthy and achieving appropriate levels of physical activity. The incentives used in our analysis met the three key components of a successful wellness program [Table 2].”
Considering Financial Hurdles
Approximately 86% of large employers in the United States offer worksite wellness programs, many of which include financial incentives. However, tighter budgets may make it difficult for smaller employers and medical practices to provide such incentives. A pay-to-play structure like the one used in the study by Dr. Driver and colleagues has the potential to help offset some of the costs of these programs.
“With the rise of accountable care organizations, physicians will be relied upon to ensure that their patients are healthy overall,” says Dr. Driver. “Wellness programs that offer financial incentives will likely become increasingly en vogue among provider groups. Anyone who has a financial stake in keeping an employee healthy will look for what is making them ill and try to find ways to prevent these occurrences. Financial incentives are one piece of the puzzle.”
There is a need for further research in the area of financial incentives for weight loss, according to Dr. Driver. “We still aren’t sure if people develop a tolerance to such interventions or if these incentives need to become bigger over time to provide the same effects. Our study has taken a step in the right direction by showing that continuous incentives make a big difference, at least for 1 year. Future studies will need to explore the impact of financial incentives beyond 1 year and determine in which settings they can be most easily implemented.”
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