Small Cash Rewards Pay Off in Weight Loss Plans

A spoon with cash, representing a cash reward for weight loss. (iStock Photo)

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People who received small cash bonuses for their degree of participation in an Internet weight loss program shed more pounds than those who were not offered bonuses and they kept much of the weight off, according to a new study out of the University of Connecticut.

The findings, published this month in Obesity, could help employers evaluate the incentives they offer for healthy behavior with an eye toward reducing overall health insurance costs. More than 67 percent of large employers currently use some form of financial incentives.

Tricia M. Leahey, associate professor of allied health sciences.
Tricia M. Leahey, associate professor of allied health sciences.

“Many companies are using large rewards – over $300 – to promote weight loss,” said Tricia Leahey, associate professor of allied health sciences at UConn and the study’s lead researcher. “Our results suggest that small incentives and an evidence-based incentive structure may not only yield excellent weight loss outcomes but may also be cost-effective.”

Researchers examined the weight loss success of 268 people—primarily female—after three months in the statewide obesity initiative, Shape Up Rhode Island 2012. They caught up with the participants again nine months later to learn whether they had been able to maintain their weight losses. On top of participating in the Internet weight loss program, some members of the study were offered financial incentives while others were not.

At the end of three months, the group of participants who received incentives – averaging $2.66 per week –had both followed the program requirements to a greater extent than those who had not received money, and had lost more weight. The weight loss difference at three months between the group that received the monetary rewards and the group that did not was significant: 6.4 percent versus 4.3 percent.

The rewards were offered if participants submitted information on their weight, calorie intake and activity to the website for a specific number of days. Reminders to submit information referenced the financial incentive: “Don’t miss out on your money, be sure to submit your information by Sunday at midnight.” Additionally, those who lost an exceptional percentage of body weight were also entered into either a $50 or $100 raffle, depending on their weight loss.

A major concern about the use of financial incentives for behavior change is that, when removed, participants will regain the weight, a phenomena that has been demonstrated in previous studies in which participants received amounts in the order of several hundred dollars.

That was not the case with the smaller incentives. The most money a participant in the study could earn in a week was $10, according to researchers. Yet nine months after completing the Internet program, members of the incentive group had maintained an overall 3.1 percent loss as compared to the 1.2 percent of those in the Internet-only group.

Researchers based the amount of the bonuses on behavioral economics principles, which suggest that better results might be obtained by providing frequent small incentives, varying the size of the incentive and rewarding behavior change in addition to weight loss.

“Our small incentives may have facilitated participants’ attribution of weight loss to their own personal efforts rather than large rewards,” said Leahey. “Also, by rewarding self-monitoring, we may have facilitated the development of that habit, which contributed to better long-term weight control.”

Leahey collaborated on the study with faculty at the Alpert Medical School of Brown University, the University of California San Francisco, Miriam Hospital, Idaho State University, and Shape Up. The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.