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Outcomes in a Program that Offers Financial Rewards for Weight Loss
Abstract and Figures
A variety of approaches are being used to treat obesity and encourage weight loss. One promising strategy based on psychology and behavioral economics is to offer fi nancial incentives for weight loss. Obesity is costly to health insurance companies (Finkelstein, Fiebelkorn, and Wang 2003) and employers (Cawley, Rizzo, and Haas 2007), so for either or both of those organizations to offer monetary incentives for enrollees or employees to lose weight could be mutually benefi cial. This chapter studies data from a fi rm that coordinates a program of fi nan-cial incentives for weight loss in various work sites in the United States. We study attrition and weight loss in three types of incentive programs: one that offers no fi nancial rewards for weight loss, one that offers quarterly payments that rise in value with the amount of weight loss, and a third that takes deposits (bonds) that are only refunded if the employee achieves a specifi c weight loss goal, and also includes a quarterly lottery for those who have lost weight. Relative to previous studies of weight loss in response to fi nancial incentives, strengths of this study include a large sample size (2,407) and a long intervention (one year).
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... Dogbe and Gil, 2020 provides evidence that fiscal policies can help decrease obesity and increase welfare). It is also important to gather more evidence about the behavioral aspects and financial incentives that can help individuals attain the ideal weight (Cawley and Price, 2011). ...
The consequences of obesity for adults and children are well documented in the extant literature. We use panel data of 105 countries from 1990 to 2019 to estimate the effect of obesity on economic performance. We predict obesity using lagged values of child obesity as instruments. Predicted obesity has a negative and significant effect on productivity. This effect is independent of the effect of human capital and other macroeconomic determinants of economic performance. There is only weak evidence that this effect operates through the deterioration of human capital formation caused by childhood obesity.
... Challenges in facilitating behavior change, as it relates to human health, has led to increasing prominence of research investigating whether the use of incentive schemes (based on psychological and behavioral theory and research) might positively influence health-related behaviors [21]. As such, researchers have explored the potential value of incentives in the formation of exercise habits [22], weight loss [23,24], and smoking cessation [25]. Two recent systematic reviews reporting studies in adults found interventions based on providing financial incentives are more effective than usual care for encouraging healthy behavior change [26] and that lucky draw style rewards were an effective mechanism for upscaling [26,27]. ...
Childhood obesity is a concern in Australia and across the world. Community-based weight management programs are an important response to address childhood obesity. However, the scientific literature suggests that their effectiveness could potentially be enhanced by providing a structured incentive scheme. This proposal aims to determine the effectiveness of enhanced goal setting linked to a structured incentive scheme designed to improve the sustained health and wellbeing of overweight/obese children within the context of an existing community-based program.
This study is a cluster randomized controlled trial delivered within the context of the existing NSW “Go4Fun” program with a 10-week and 6- and 12-month follow-up (n = 40 sites, 570 participants) that compares the effectiveness of small changes to the program in which children were asked to set goals (supported by text messages) and were given rewards for achieving them (intervention). This will be compared to the standard/existing program (control), which did not have the same structured incentive program. Data will be collected for all participants at baseline, end of program, and at 6 and 12 months. The primary outcome is a mean change in body mass index (BMI) z score at the 12-month follow-up. Secondary outcomes include anthropometric measures (body weight, height, and waist circumference) and behavioral measures collected via validated questionnaires. A process evaluation (comprising surveys and focus groups) to determine acceptability and sustainability and to inform downstream translation will also be conducted.
This study will inform policy and program delivery as well as the broader evidence base regarding goal achievement and incentive schemes directed at children’s health-related behaviors and will provide evidence that is likely to be transferrable across a range of health conditions.
Trial Registration
ACTRN12615000558527 registered on 29 May 2015.
We examine the impact of an income windfall (from lottery win) on an individual's overweight and Body Mass Index (BMI). We use longitudinal data from the United Kingdom, where a large proportion of the population plays the lottery, and retrieve income effect estimates using time and individual specific fixed effects alongside a set of relevant controls. Although our findings suggest any income windfall may lead to a contemporaneous increase in overweight we document evidence that a £1,000 win reduces the probability of overweight in the range by up to 3% points 12 months after the lottery win. Estimates are heterogeneous across working hours and educational attainment. A £1000 lottery win reduces the risk of overweight among low educated individuals by 4.5–5 percentual points (pp)12 months after the lottery win.
In this chapter, we recount some of the most pressing objections to character scepticism, pointing out their limitations and, when appropriate, incorporating their suggestions. From here, we consider what empirically informed moral improvement might look like by turning to the skill analogy. While the skill analogy provides a realistic rubric for becoming a better person, many of the questions concerning the details of how moral improvement might take place remain unanswered. When developing expertise in domains like chess and morality, a wide range of factors will likely be important and it is unlikely than any one individual factor will be especially important. Given this, for any account of moral improvement, our optimism should be bounded: the effect of any particular intervention is likely to be limited, in both magnitude and domain. Lastly, we consider how character scepticism has reshaped the way we think about moral responsibility, whether this is cashed out in reasons-responsiveness or self-expression accounts. While both views face challenges, by distinguishing the possession of the responsibility-making feature from failures to manifest that property in behaviour, we gain a certain degree of wiggle room that allows us to accommodate empirical findings while holding on to notions of responsibility. This chapter highlights that the ‘person-situationism debate’ has expanded far beyond its beginnings, giving way to new accounts of moral improvement and moral responsibility.
Purpose
The health costs associated with obesity are increasing in developed and emerging economies. Particularly important, though remaining underexplored, is the overall impact of health risks associated with being obese and overweight on the productivity of firms in a cross-country setting. The purpose of this paper is to address these issues.
Design/methodology/approach
This paper exploits the natural variation in the percentage of obese males in the population as an exogenous health risk randomly distributed across firms in each country.
Findings
Investigating this link for a sample of around 80 emerging countries, the evidence suggests a significant negative effect of health risks on productivity.
Research limitations/implications
The identification assumptions are checked using different approaches to establish the robustness of the empirical link.
Originality/value
This study helps us understand the microlevel effects of the rising average obesity rate. This knowledge is rare in emerging economies which are facing the highest risks of obesity and cardiovascular diseases associated with it.
We use a field experiment with over 200 participants to investigate the effect of incentives on grocery store purchases. We randomize participants to treatments where we incentivize produce purchases, provide tips for produce preparation, or both, and follow shopping behaviour for 6 months. Our informational treatment has a weak effect. However, we find an important price effect: modest incentives quadruple produce purchasing at our grocery store relative to the control group. After incentives are removed, the treatment group continues to purchase more produce at our grocery store. These long-term results are consonant with a habit-formation model, in contrast to standard price models or behavioural ‘crowd out‘ models.
Background
The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors.
Methods
We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library, Web of Science, and Education Resources Information Center, from Jan 1, 1990, to June 30, 2020, for studies with controlled evaluation designs that assessed multicomponent workplace wellness programmes. Investigators independently appraised the evidence and extracted the data. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. Pooled effects were calculated by inverse-variance random-effects meta-analysis. Potential sources of heterogeneity and study biases were evaluated.
Findings
From 10 169 abstracts reviewed, 121 studies (82 [68%] randomised controlled trials and 39 [32%] quasi-experimental interventions) met the eligibility criteria. Most studies were done in North America (57 [47%]), and Europe, Australia, or New Zealand (36 [30%]). The median number of participants was 413·0 (IQR 124·0–904·0), and median duration of intervention was 9·0 months (4·5–18·0). Workplace wellness programmes improved fruit and vegetable consumption (0·27 servings per day [95% CI 0·16 to 0·37]), fruit consumption (0·20 servings per day [0·11 to 0·28]), body-mass index (–0·22 kg/m² [–0·28 to –0·17]), waist circumference (–1·47 cm [–1·96 to –0·98]), systolic blood pressure (–2·03 mm Hg [–3·16 to –0·89]), and LDL cholesterol (–5·18 mg/dL [–7·83 to –2·53]), and to a lesser extent improved total fat intake (–1·18% of daily energy intake [–1·78 to –0·58]), saturated fat intake (–0·70% of daily energy [–1·22 to –0·18]), bodyweight (–0·92 kg [–1·11 to –0·72]), diastolic blood pressure (–1·11 mm Hg [–1·78 to –0·44]), fasting blood glucose (–1·81 mg/dL [–3·33 to –0·28]), HDL cholesterol (1·11 mg/dL [0·48 to 1·74]), and triglycerides (–5·38 mg/dL [–9·18 to –1·59]). No significant benefits were observed for intake of vegetables (0·03 servings per day [95% CI –0·04 to 0·10]), fibre (0·26 g per day [–0·15 to 0·67]), polyunsaturated fat (–0·23% of daily energy [–0·59 to 0·13]), or for body fat (–0·80% [–1·80 to 0·21]), waist-to-hip ratio (–0·00 ratio [–0·01 to 0·00]), or lean mass (1·01 kg [–0·82 to 2·83]). Heterogeneity values ranged from 46·9% to 91·5%. Between-study differences in outcomes were not significantly explained by study design, location, population, or similar factors in heterogeneity analyses.
Interpretation
Workplace wellness programmes are associated with improvements in specific dietary, anthropometric, and cardiometabolic risk indicators. The heterogeneity identified in study designs and results should be considered when using these programmes as strategies to improve cardiometabolic health.
Funding
National Heart, Lung, and Blood Institute.
Background: Two thirds of UK adults are overweight or obese and at increased risk of chronic conditions such as heart disease, diabetes and certain cancers. Basic public health support for weight loss comprises information about healthy eating and lifestyle, but internet and mobile applications (apps) create possibilities for providing long-term motivational support.
Aims: To explore among people currently trying to lose weight, or maintaining weight loss, (i) problems, experiences and wishes in regards to weight management and weight loss support including e-health support; (ii) reactions to Functional Imagery Training (FIT) as a possible intervention.
Method: Six focus groups (N = 24 in total) were recruited from a public pool of people who had expressed an interest in helping with research. The topics considered were barriers to weight loss, desired support for weight loss and acceptability of FIT including the FIT app. The focus group discussions were transcribed and thematically analysed.
Results: All groups spontaneously raised the issue of waning motivation and expressed the desire for motivational app support for losing weight and increasing physical activity. They disliked calorie counting apps and those that required lots of user input. All groups wanted behavioural elements such as setting and reviewing goals to be included, with the ability to personalise the app by adding picture reminders and choosing times for goal reminders. Participants were positive about FIT and FIT support materials.
Conclusion: There is a mismatch between the help provided via public health information campaigns and commercially available weight-loss self-help (lifestyle information, self-monitoring), and the help that individuals actually desire (motivational and autonomous e-support), posing an opportunity to develop more effective electronic, theory-driven, motivational, self-help interventions.
Aheadline in a newspaper caught my attention several years ago: “A Little Extra Cash Inspires Employees to Lose Weight, Study Shows.” As an economist, my first reaction to the newspaper article was to scoff: So what else is new? “Incentives matter” is a fundamental axiom in economics on par with “there is no such thing as a free lunch.” My second reaction was more reserved and concerned: Employers are rewarding the wrong workers, those who eat too much and run up their firms’ health insurance costs. Firms should be rewarding workers who do not need incentives to lose weight. Otherwise, they run the risk of some workers gaining weight just to be paid to lose the added pounds. Employers who use weight-loss incentives also, inadvertently, encourage workers to gain weight before the first weigh-in! “Moral hazard,” which has come up time and again in this book, is a real and abiding problem that can raise its ugly head in the strangest places (even workplaces).
Overweight and obesity are increasing in the United States. Changes in diet and physical activity are important for weight control.
To examine the prevalence of attempting to lose or to maintain weight and to describe weight control strategies among US adults.
The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. Setting The 49 states (and the District of Columbia) that participated in the survey.
Adults aged 18 years and older (N = 107 804).
Reported current weights and goal weights, prevalence of weight loss or maintenance attempts, and strategies used to control weight (eating fewer calories, eating less fat, or using physical activity) by population subgroup.
The prevalence of attempting to lose and maintain weight was 28.8% and 35.1 % among men and 43.6% and 34.4% among women, respectively. Among those attempting to lose weight, a common strategy was to consume less fat but not fewer calories (34.9% of men and 40.0% of women); only 21.5% of men and 19.4% of women reported using the recommended combination of eating fewer calories and engaging in at least 150 minutes of leisure-time physical activity per week. Among men trying to lose weight, the median weight was 90.4 kg with a goal weight of 81.4 kg. Among women, the median weight was 70.3 kg with a goal weight of 59.0 kg.
Weight loss and weight maintenance are common concerns for US men and women. Most persons trying to lose weight are not using the recommended combination of reducing calorie intake and engaging in leisure-time physical activity 150 minutes or more per week.
Previous studies of the relationship between body weight and wages have found mixed results. This paper uses a larger data set and several regression strategies in an attempt to generate more consistent estimates of the effect of weight on wages. Differences across gender, race, and ethnicity are explored. This paper finds that weight lowers wages for white females; OLS estimates indicate that a difference in weight of two standard deviations (roughly 65 pounds) is associated with a difference in wages of 9 percent. In absolute value, this is equivalent to the wage effect of roughly one and a half years of education or three years of work experience. Negative correlations between weight and wages observed for other gender-ethnic groups appear to be due to unobserved heterogeneity.
There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
The current widespread concern with weight reduction rests on at least two assumptions: first, that weight-reduction programs are effective; second, that they are harmless. Recent studies indicate that such programs may be far from harmless.1,2 This report documents their ineffectiveness. The results of treatment, as reported in the medical literature of the past 30 years, are first reviewed. The results of routine treatment of 100 consecutive obese persons in the Nutrition Clinic of the New York Hospital are then reported.Review of the Literature
Hundreds of papers on treatment for obesity have been published in the past 30 years. Most, however, do not give figures on the outcome of treatment, and of those that do, most report them in such a way as to obscure the outcome of treatment of individual patients. Some authors, for example, report the total number of patients and the pounds lost without making clear
Items considered valuable by the subject and originally his property were surrendered to the researcher and incorporated into a contractual system of prearranged contingencies. Each subject signed a legal contract that prescribed the manner in which he could earn back or permanently lose his valuables. Specifically, a portion of each subject's valuables were returned to him contingent upon both specified weight losses and losing weight at an agreed-upon rate. Furthermore, each subject permanently lost a portion of his valuables contingent upon both specified weight gains and losing weight at a rate below the agreed-upon rate. Single-subject reversal designs were employed to determine the effectiveness of the treatment contingencies. This study demonstrated that items considered valuable by the subject and originally his property, could be used successfully to modify the subject's weight when these items were used procedurally both as reinforcing and as punishing consequences. In addition, a systematic analysis of the contingencies indicated that punishing or aversive consequences presumably were a necessary component of the treatment procedure.
Obese adolescents were assigned randomly to one of four treatment groups in a 2×2 factorial design. The factors were monetary reinforcers (for weight loss vs. caloric change), and frequency of therapeutic contact (five times vs. one time per week). Subjects in all treatment groups participated in classes for 15 weeks to learn behavioral self-management skills taught by health counselors with the aid of videotaped instructional materials. The treatment group receiving rewards for weight loss and coming to the clinic five times per week was the only group to reduce significantly in percent overweight during the treatment program. Treatment effects for this group were maintained over a 6-month follow-up period. Clinically and statistically significant changes in recommended directions in blood pressure, total cholesterol, high density and low density lipoproteins, and triglycerides were correlated with changes in weight. Subjects expressed satisfaction with participation in the program. The results suggest that frequent monetary and social reward help young persons achieve and maintain weight loss.
This paper presents a problem which I believe has not heretofore been analysed2 and provides a theory to explain, under different circumstances, three related phenomena: (1) spendthriftiness; (2) the deliberate regimenting of one’s future economic behaviour— even at a cost; and (3) thrift. The senses in which we deal with these topics can probably not be very well understood, however, until after the paper has been read; but a few sentences at this point may shed some light on what we are up to.
Although recent weight-loss studies suggest that newer methods more reliably produce clinically significant weight losses, maintaining these weight losses remains problematic and little researched. The present study assigned successful weight losers to one of three maintenance treatments: monthly financial contingencies for weight maintenance, monthly financial contingencies for participation in skills training sessions to solidify behavioral changes, and no treatment. Participants were males and females (N=85) who had completed a 15-week weight-loss program and had lost 10% or more of their body weight. The study lasted for one year beyond initial treatment. Across the three maintenance conditions subjects regained approximately 40% of their weight losses during the year. Mean loss after initial treatment was 29.1±9.1 lbs and at one year 17.3±15.6 lbs. Neither weight regain nor percent of subjects successfully maintaining their weight losses differed significantly across treatment conditions. Financial incentives for weight maintenance appeared the most promising in terms of the number of successful participants, but this success was offset by a large dropout rate. Points for future research are discussed.