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Mar 10, 2013

Money Motivates People to Lose Weight

Weight-loss programs with cash incentives and penalties yield better participation and greater weight loss than those without.

People who received cash rewards as part of a one-year weight loss program shed more pounds than those who didn’t get these financial incentives, and they were also more likely to complete the program, according to research presented yesterday at the American College of Cardiology’s 62nd Annual Scientific Session in San Francisco. This meeting brings together cardiologists and cardiovascular specialists from around the world each year to share the newest discoveries in treatment and prevention.

The study enrolled 100 obese, but otherwise healthy adults between 18 and 63 years of age. Each person was enrolled in one of four weight loss groups: two with financial incentives and two without. All of the weight loss programs included education about health behaviors related to diet and exercise. Participants were given a monthly weight-loss goal of 4 pounds, which was adjusted based on each month’s weight. People in the financial incentives groups who met their weight-loss goals were awarded $20 each month, but they had to pay a penalty of $20 that went into a larger bonus pool if they failed to shed the weight. Participants from each incentive group who completed the study over a year were eligible to win a lottery of this pool.

Researchers found that money seems to talk when it comes to dropping pounds. Participants in the financial incentive groups lost more weight—9.1 pounds on average. In contrast, those who did not receive cash incentives only lost an average of 2.3 pounds. People in the cash incentive groups were also much more likely to keep up with the weight loss program over the long-term.

"Financial incentives can help us stick with the kind of healthy behaviors we wish we would more often," said Steven Driver, MD, MPH, resident physician in internal medicine at Mayo Clinic and the study’s lead investigator. "In our study, this meant losing more weight and keeping it off for a full year."

Even participants who were subject to financial penalties were more likely to continue to participate than those in the groups without financial incentives, possibly because taking this risk also made them eligible to earn rewards.

"Fear of losing money tends to motivate people about two and a half times more than the prospect of gaining the same amount of money, so we intentionally designed the incentives so that participants would have some of their own skin in the game," Dr. Driver said. "If you reached into your pocket and found a ten dollar bill you would be happy, but you wouldn’t be nearly as emotional as you would be if you expected to pull out a ten dollar bill and instead found a hole in your pocket."

This research may also inform future workplace wellness programs. Many employers and insurers have instituted workplace wellness programs in an effort to reduce insurance premiums and overall health care costs. These programs often include short-term financial incentives for employees who meet wellness goals, such as lowering blood pressure and losing weight. Previous studies have shown that financial incentives are effective in empowering people to exercise and lose weight over the short-term. However, this is the first study to examine the effects of a long-term incentive plan to help employees achieve sustained weight loss over a full year.

"Because of the high prevalence of obesity and the overall lack of effective treatment, we need to look at creative interventions to help people lose and maintain weight. Financial incentives may be one way to help with this," Dr. Driver said.

More than two-thirds of U.S. adults are overweight or obese, according to the Centers for Disease Control and Prevention. Overweight and obesity are linked to both diabetes and cardiovascular risk factors.

Questions for You to Consider

  • What is a healthy body mass index?
  • Body mass index, referred to as BMI, is a measurement used to estimate levels of body fat based on your height and weight. CardioSmart offers a BMI calculator to help you know your numbers. For adults, BMI under 18.5 is underweight, 18.5–24.9 is normal, 25.0–29.9 is overweight, and over 30 is considered obese.

  • What can I do to keep my weight in check?
  • Talk with your health care team. If you have or are at risk for heart disease, it is important to adopt heart healthy habits. This means being thoughtful about the kinds of foods you eat, how you prepare them and how many calories and how much fat you consume. Try to eat a low-fat diet that is rich in fresh fruits and vegetables, fish and lean meats. You should also carve out time to exercise every day. See CardioSmart’s Eat Better and Move More areas for more information.


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