Pounds for dollars: Can money motivate weight loss? (Reuters)

NEW YORK (Reuters Health) – Obese people might be more likely to lose weight if they have money riding on their success — but the pounds may creep back once the financial carrot is gone, a small study finds.

Researchers found that a program in which people stood to lose cash should they fail to lose weight seemed to motivate them, but the motivation didn’t last.

Everyone in the study received weight loss counseling, but some also signed a “deposit contract,” in which they put their own money at risk. Those individuals lost an average of nine pounds over eight months. That compared with only one pound among study participants who had no money to lose.

But nine months after the weight-loss program ended, the financial-incentive group had gained back most of the weight.

The findings, published in the Journal of General Internal Medicine, suggest that money can motivate people to shed weight in the short term. But, as in so many studies on weight loss, keeping the pounds off is the hardest part.

“That’s the great challenge,” said lead researcher Leslie K. John, of Carnegie Mellon University in Pittsburgh, Pennsylvania. “This is just another example of how hard weight-loss maintenance is.”

Still, John told Reuters Health, the findings and those from past studies suggest that financial incentives can work.

Last October, for example, a different research team reported that giving free prepared meals as part of a structured weight loss program helped obese people lose weight.

Incentives “are really effective in the short- and medium-term,” she said, adding that the question now is how to make them pay off in the long run.

For the current study, John and her colleagues randomly assigned 66 obese adults, mostly men, to either have a counseling session with a dietitian plus monthly weigh-ins, or the same program plus the deposit contract.

Under the contract, participants could deposit up to $3 per day in an account that the researchers matched dollar-for-dollar. If at the end of the month, they had reached their weight-loss goal — up to one pound per week — they would collect a cash reward. If they failed to shed enough weight, they forfeited the money.

According to John, part of the reasoning behind financial incentives is that people will respond more readily to the immediate threat of losing money than to the distant threat of weight-related health problems.

There’s also the principle of “loss aversion,” John said. That is, people tend to put greater value on avoiding a loss than winning a gain.

In this study, the threat of losing money did seem to push people to lose more weight. However, only a few participants (seven out of 66) actually met the study goal of shedding one pound per week over the first 24 weeks.

And nine months after the weight-loss program ended, the average weight loss in the financial-incentive group was only one pound below the average initial weight.

John said that more research is needed to see how the initial success of the plan can be extended for the long haul. It may be that financial incentives have to continue, or be varied in some way.

In the real world, money for weight loss could be offered by insurance plans, John said. “Obesity is hugely costly to insurance companies, so they have financial incentives to look at this.”

Some insurance companies and larger employers are already experimenting with different types of incentives — from gift cards to breaks on premium costs — to get people to have health screenings, like blood pressure and cholesterol checks, or take up healthy habits, like joining a gym.

Along with insurance companies, some local health authorities are trying to use money to coax people away from bad habits. In Dundee, Scotland, a local program offers smokers grocery discount cards for each week they stay off of cigarettes, for up to three months (longer for pregnant women who quit). Participants have to commit to regular carbon-monoxide breath tests to keep them honest.

Whether all of these plans will translate into better health remains to be seen.

John said she is “cautiously optimistic” that financial incentives can help people lose weight. But, she added, “I think we still need to show that the weight loss can be maintained.”

SOURCE: http://bit.ly/hmDfta Journal of General Internal Medicine, online January 20, 2011.