Paying obese people to lose weight doubles their rate of fat loss, a study finds.
Researchers instructed 668 morbidly obese adults in New York City and Los Angeles to lose 10 pounds (or 4.5 kg) within six months.
They found that two-thirds offered financial rewards of up to $750, but for those who only offered devices to aid weight loss, half lost weight.
Dr. Melanie Jay, a physician at NYU Langone, said her study provided “solid evidence” that cash incentives could help solve America’s bulging waistline.
Estimates show that four out of ten American adults are obese. Maps from last week showed West Virginia, Arkansas and Kentucky to be the most obese states in America.
The study showed that participants in the cash incentive groups lost the 10 lbs (4.5 kg) goal within six months, but those in the other group only reached halfway the goal
This graph shows the weight loss in kilograms per month during the study. It shows that the group received no monetary incentives (black line), monetary incentives associated with compliance with behavioral changes (orange), and monetary incentives associated with total weight loss (blue)
In the study – published today in JAMA Internal Medicine — scientists recruited 668 people between November 2017 and May 2021.
Participants weighed an average of 218 pounds (lbs) (98.8 kg) at the start of the study, with a BMI of nearly 38 — putting them in the morbidly obese range.
They all came from low-income households making less than $40,000 a year, with more than eight in 10 being women and between the ages of 18 and 70. The majority had a Hispanic background.
What were the different financial strategies?
Researchers randomized morbidly obese adults into three different groups.
All groups were offered weight loss training, WW Freestyle membership (formerly Weight Watchers), scales, and a FitBit to assist.
But only two were given a financial incentive to get them to reach the goal of losing five percent of their weight, or about 10 pounds (4.5 kg) in six months.
Cash linked to behavioral changes:
- $150 in month one only for enrolling and attending half of the weekly weight management sessions;
- $60 per month from months two to six to attend at least half of the weekly weight management sessions;
- $30 per month in the study for completing at least five days of their food diary per week and recording their body weight at least three days per week;
- $20 per month in the first three months for 75 minutes of physical activity per week, and in the following three months for 150 minutes of physical activity per week.
Cash linked to weight loss. All percentages are compared to the weight at the start of the study:
- $50 in month one for losing 1.5 to 2.5 percent or weight, or $100 for losing more than 2.5 percent;
- $50 per month for losing 2.5 to 5 percent of body weight, or $100 per month for losing more than five percent of weight in months two to three;
- $100 per month for losing 2.5 to 5 percent of body weight, or $150 for the loss of more than five percent in months four to six;
They were split into three groups, each tasked with losing about five percent of their body weight — or 10 pounds (4.5 kg) — within six months.
All participants participated in a weekly local weight management program meeting and received annual membership to the WW Freestyle commercial weight loss program.
They also received a digital scale, a food diary and a FitBit tracking device to track their progress.
All participants were advised to attend a minimum of two WW Freestyle classes per month, weigh themselves three times per week, keep a food diary five days per week and exercise for 75 minutes per week. For months four to six, the activity goal was increased to 150 minutes per week.
Researchers verified this by checking records, FitBit data, and attendance records.
One group was not offered any financial incentives to adhere to the program.
But two other groups were offered financial incentives that allowed them to earn up to $750 during the study period.
In one group — called the results-oriented group — participants were offered money based on how often they attended classes, exercised and kept the food diary.
Each was paid $150 for registering and attending half of their weight management classes in the first month.
They were also offered $60 a month for attending at least half of the weekly program sessions during months two through six, $30 a month for using the food diary five days a week, and weighing themselves three times a week , and $20 per month for completing the food diary. physical activity goals.
In the other group — called the “goal-oriented” group — participants’ money incentives were linked to how much weight they lost.
In the first month, they were offered $50 for losing 1.5 to 2.5 percent of their weight or $100 if they lost more than 2.5 percent.
In months two to three, they were offered $50 a month if they lost 2.5 to 5 percent of their weight, or $100 a month if they lost more than five percent.
And in months four to six, they got $100 a month for losing 2.5 to 5 percent of their weight or $150 a month for more than five percent.
All weight loss percentages were compared to weight at the start of the program.
Once the goals were met, money was paid to the participants to ensure there were rewards attached.
The results showed that those who received money lost on average twice as much weight as those who did not receive financial incentives.
Those in the goal group earned $440 during the study period, while those in the outcome group lost $303.
People in the results-oriented group lost the most after six months, which equates to an average of 10.6 lbs (4.8 kg).
But those in the goal-oriented group lost nearly the same amount of weight on average at 4.5 kg.
Those in the no-incentive group lost 4.9 pounds (2.2 kg) during the study period.
Dr. Jay said: ‘Our study provides hard evidence that offering incentives, especially monetary rewards, even for as little as six months, helps resource-constrained people struggling with obesity to lose weight.
“However, any form of weight loss incentive can work, even if it’s just offering the tools to help it do so.”
Participants were also followed up after a further six months to determine whether weight loss had been maintained.
Of the money groups, only the goal-oriented team continued to lose weight, shaving off an additional 2 pounds (0.9 kg).
The results-oriented group maintained their weight loss and those who did not receive a monetary reward lost another 0.5 kg.
About 61 participants dropped out or stopped attending appointments within the first six months for the goal-based group, compared to 51 in the incentive group and 54 in the no-cash incentives group.
Dr. Jay said, “New tools are needed beyond encouragement and education to help some people who struggle with obesity.”
“There is no one-size-fits-all solution to America’s worsening weight problem. Our national approach should include multiple approaches, including incentives tailored to the different needs of groups most affected by obesity-related diseases and conditions, such as type 2 diabetes, heart disease and some cancers.”