It is commonly suggested that money can't buy happiness. However, it may buy willpower. While some employers and insurance agencies have had limited success in the past trying to get people to quit smoking or eat healthier by offering up the gift of money, a new study has taken a different approach. And the results are encouraging.
Researchers from the Mayo Clinic in Rochester, Minnesota have demonstrated that a yearlong program to instill willpower has been largely successful, thanks in part to the way they conducted the study. The program included 100 overweight or obese Mayo employees and instead of just offering a monetary reward to get them to change their ways, they turned it into a game. And who doesn't like a fun game, especially when prizes are involved?
To be sure, the Mayo offered the participants a $20 cash reward if they could lose four pounds in a month during the 12-month study. However, they would risk losing $20 if they did not meet monthly goals. But where other similar studies failed, this one succeeded because it not only offered simple rewards for simple goals, it also offered dieters multiple ways to achieve their goals and even gave participants a chance to recoup their penalties when they failed in a particular month.
The study, which is set to be presented at the annual meeting of the American College of Cardiology beginning this weekend in San Francisco, was able to help 62 percent of those who joined the program meet or exceed their goals. Only 26 percent of participants in a control group who were not offered incentives or penalties met their goals.
INCENTIVES NOT TRAINING WHEELS
Dr. Steven Driver, resident physician of internal medicine at the Mayo Clinic, said that incentives are "not like training wheels where people learn healthy habits and then will continue them on their own" – you have to keep them going or people will falter.
And for those who wish to set up a similar system in their workplace, Driver said the key is to make it self-sustaining, such as offering both rewards and penalties. And it's a good idea to have people pay up in advance when beginning such a study. People don't like the fact that they have to pay penalties after receiving bad news. He said during the Mayo study, one woman panicked after stepping onto the scale only to find out she had to pay for her weight gain.
"She headed for the door" but later came back and paid, Driver said. "People in Minnesota are pretty honest."
Driver, who owns stock in GymPact, a firm that offers financial incentives for exercising, said the weight-loss industry is "way ahead" of the science of incentive-based dieting. "We needed to do some research to see what works," he said.
"Financial incentives and disincentives can help people lose weight, and keep it off for one year," Driver said. "It's not about getting rich, it's about being held accountable."
Of the 100 obese employees who took part in the 12-month program, 50 were offered weight-loss counseling, monthly weigh-ins and a three-month gym membership. The other half of the group was offered all these plus financial incentives and penalties.
GOALS
The aim of the study was to have each employee lose four pounds per month up to a goal that was determined for their starting weight. Those who met the monthly goal got a voucher to collect a cash reward when the study ended. But if they failed, they had to pay a penalty to the naughty jar. The penalty money was used to help pay the rewards. The rest was put into a lottery that anyone could win, regardless if they met their weight-loss goals or not.
Driver said that the participants "saw that if they stuck with it, they had a chance at winning more than they had lost" by the end of the study period.
Participants in the financial incentives group also earned $10 per month and a ticket for the lottery for coming to the monthly weigh-ins and also texting their weights to study leaders each week, according to Dr. Don Hensrud, chief of preventive medicine at the Mayo. He said that in the end, people could have lost as much as $240 or won as much as $360, plus a shot at winning the lottery fund.
At the conclusion of the study, 27 of the 50 incentive participants came out ahead moneywise. Overall, the average weight lost in the incentive group was nine pounds; in the non-incentive group, the average weight lost was 2.3 pounds.
Dr. Kevin Volpp, director of the University of Pennsylvania's Center for Health Incentives and Behavioral Economics (CHIBE), said the results of the study are promising. However, he cautioned, people need to lose a lot more than nine pounds to make a big difference in their health.
"There's been an explosion of interest in this" and most large companies now provide incentive-based programs similar to this one, Volpp told the Associated Press.
Volpp has also seen success in a similar study he published in 2009 in the New England Journal of Medicine(NEJM). In that study, it was shown that people were three times more likely to stop smoking for six months if they were offered up to $750.
He said the program worked because of the way it was designed. Poorly designed studies with inadequate funding have proven ineffective. "If you do a low-budget incentive program, it may have little effect," he said shortly after his 2009 study.
CHALLENGES
With significant resources, come significant results. However, Driver acknowledged that more research is needed to see how long changes like the one in his study last. "The real challenge is to extend this research, and see if we can develop a sustainable financial incentive model that lasts for longer than one year," he said.
"The challenge is how to help people lose weight in a way that is sustainable. This is more data that financial incentives and disincentives do play a role in what our behaviors are, but things like this are not likely to make a long-term impact on the obesity epidemic by themselves," noted Dr. Scott Kahan, director of the National Center for Weight and Wellness.
"We need to be thinking about a comprehensive approach that addresses much more than increasing initial motivation," he explained to Denise Mann of US News. "We need to maintain this motivation over time."
For Audrey Traun, 29, a lab specialist at the Mayo, the cash incentive was a big motivator for her. She lost 40 pounds during the yearlong program.
"I was impressed. I didn't think I was quite capable of that," said Traun. She said, however, that as the study went on, the cash became less important to her and she found "it was actually more motivating to see my progress — pounds lost and how my clothes were fitting," she said.
Traun said she used the $400 she earned for a family vacation.
The Mayo program follows a similar 2008 study published in JAMA where 57 overweight and obese individuals were randomly assigned to monthly weigh-ins or two weight-loss incentive programs. One included a lottery and one a contract that required a deposit. In that study, the incentive group lost an average of 13 to 14 pounds, while the control group lost only four pounds.
