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Policy Framework
Obesity is associated with poor health and high health care costs and has been increasing in the United States for several decades. It has also been linked to such health conditions as diabetes, heart disease, hypertension, strokes, cancer, sleep disorders, and musculoskeletal pain and disability. Thus, efforts to encourage weight loss can improve health, reduce health care costs, and encourage healthy behavior, such as exercise and better diets.
Agenda, Scope, and Goals
One promising approach to helping people lose weight is to offer them financial incentives. One-third of companies in the United States offer or plan to offer financial rewards to encourage employees to pursue healthy behaviors, including losing weight. A recent study published by Dr. Kevin Volpp of the University of Pennsylvania in the Journal of the American Medical Association found that offering incentives that incorporate some of the lessons of behavioral economics encouraged weight loss among a group of obese patients in the Philadelphia Veterans Affairs health care system. MDRC has recently replicated Dr. Volpp’s findings using its own staff. However, both studies were small and involved very particular groups of people, so the results are suggestive rather than definitive.
Design, Sites, and Data Sources
MDRC’s study examined whether a financial incentive program encouraged overweight and obese individuals to lose weight and whether the weight loss was sustained after the end of the incentive program. A total of 49 employees in MDRC’s New York and Oakland, California, offices were randomly assigned to either the program (n=25) or the control group (n=24). To be eligible, they had to have a body mass index (BMI) of 25 or higher and agree to the terms of the study. Seventy percent were women and the mean age was 40.6 years (range of 23 to 63). The average BMI was 30.9 (range of 25.2 to 44.6).
All participants in both the program and control groups received an initial one-hour consultation and goal-setting session with a dietician. For the next six months, all participants were required to meet with the dietician once a month to get weighed. All participants received $30 for attending the monthly weigh-in. Individuals in the program group were also given a scale and were asked to weigh themselves every morning and enter their weight on the study’s website. As an incentive, the program group members were eligible to win a daily lottery for entering their weight onto a website. They had a 1 in 5 chance of winning $15 and 1 in 100 chance of winning $135. The winnings accumulated and the participants received the winnings only if they were at or below their weight loss goal at the end-of-the-month weigh-in.
Findings
For obese participants (BMI of 30 and greater), weight loss was significantly higher for the program than the control group through five months. By the six-month follow-up, this difference faded. There was no significance at six months for the full study sample. The average six-month weight loss was 13.3 pounds for the program group and 10.2 pounds for the control group. Regression results show that greater weight loss is significantly associated with having a higher BMI at baseline and higher lottery payouts. The average lottery payout to the program member during the six months was $249. Financial payouts were effective in encouraging weight loss for the first five months of the study for obese participants. There was no significant difference between the program and the control group at the one-year follow-up. The program group lost more weight initially, but then gained it back. This is consistent with an earlier study by Volpp and colleagues, which showed that financial incentives were effective in achieving short-term weight loss but could not be sustained after the incentives ended.
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