In the end, we all want to be rich and skinny — right? This weekend, researchers from the Mayo Clinic will present the findings from a study on using financial incentives for weight loss. According to their results, people are much more motivated to shed some pounds when there’s the possibility of earning (or losing) even modest quantities of cool cash.
Across the Web, one news outlet after another has picked up the story as though this were a real “Eureka!” moment. But, in reality, this is kind of a “duh” situation. Few people would be surprised to learn that the prospect of getting richer can motivate us to tweak our behavior.
What’s really interesting about this research is the insights it yields into human psychology. This study is a great starting point to talk about what causes people to gain weight in the first place, and how we can use our knowledge of the human brain to create more successful weight management programs.
What’s the Deal?
The Mayo Clinic study lasted one year and involved 100 healthy adult Mayo employees and their dependents. All participants were between the ages of 18 and 63 and had a body mass index of 30 to 39.9 (meaning they qualified as obese on the BMI scale). Two groups received financial incentives; the other two didn’t. All groups were provided some kind of weight-loss education and/or behavior modification programs.
Participants were told their goal was to lose four pounds per month until they reached their individual, predetermined goal weight. Those in the financial incentives groups earned $20 per month if they met their goals and coughed up $20 into a different pool if they didn’t meet their goals. People in the financial incentives groups were also eligible to win the whole pool through a lottery.
Results showed that 62 percent of participants in the incentive groups completed the study, while only 26 percent of those in the non-incentive groups finished. Even more significant: The incentivized participants lost an average of 9.08 pounds, compared to 2.34 for the non-incentivized participants.
Why It Matters
While other research has found that financial incentives can motivate people to lose weight, the Mayo Clinic researchers say their study is the first to follow people for a full year Efficacy of a workplace-based weight loss program for overweight male shift workers: the workplace POWER (Preventing Obesity Without Eating Like a Rabbit) randomized controlled trial. Morgan, P.J., Collins, C.E., Plotnikoff, R.C., et al. School of Education, Faculty of Education and Arts, University of Newcastle, Callagahan, New South Wales, Australia. Preventive Medicine 2011 May;52(5):317-25. Financial incentives for weight loss: a randomized, controlled trial. John, L.K, Loewenstein, G., Troxel, A.B., et al. Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA. Journal of General Internal Medicine 2011 Jun;26(6):621-6. A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees. Finkelstein, E.A., Linnan, L.A., Tate, D.F., et al. RTI International, NC, USA. Journal of Occupational and Environmental Medicine 2007 Sep;49(9):981-9.. The findings suggest that the appeal of a fatter wallet doesn’t diminish over a long period of time, even if it means passing on the office donut tray every morning.
My initial thought on seeing this research was that people (myself included) have really skewed values. If every participant failed to meet his/her weight goal and put $20 into the pool every single month (which didn’t happen), the lottery winner could have earned a maximum of $24,000, while the most any one participant could possibly lose was $240. The first number is a lot of money — about a year’s worth of room and board in NYC — but it seems like nothing compared to the potential costs of being overweight or obese, which include expensive medical bills and negative health effects related to hypertension, diabetes, stroke, and coronary heart disease. Certainly the possibility of developing diabetes or heart disease — or dying — should be more frightening than losing $240? That’s merely the price of a fancy pair of shoes. Why does money motivate us to lose weight in situations where we probably wouldn’t otherwise change our behavior?
The answer isn’t that people are stupid, or delusional, or destined to be obese forever unless someone promises to pay them for hitting the gym. But these findings do give us some insight into how the human mind works. It reminds me of a phenomenon called temporal discounting, essentially the idea that it’s harder to imagine the impact of an event the farther away it is. This means the possibility of losing $20 at the end of the month seems a lot scarier than having a heart attack 20 years down the line. Likewise, earning $20 at the end of the month seems much more appealing than being able to sprint up the stairs at age 70.
In fact, we may be biologically wired to discount the value of faraway events. Research suggests that different brain mechanisms are at work when we try to make decisions about past, present, and future situations Neural activity in relation to temporal distance: differences in past and future temporal discounting. He, J.M., Huang, X.T., Yuan, H., et al. Southwest University, Beibei, Chongqing, China. Consciousness and Cognition 2012 Dec;21(4):1662-72.. Moreover, studies have found that certain groups of people — namely, more impulsive individuals and obese women — have a harder time than others at imagining future rewards Dissociable neural representations of future reward magnitude and delay during temporal discounting. Ballard, K., Knutson, B. Department of Psychology, Stanford University, CA, USA. Neuroimage 2009 March 1;45(1):143-50..
Since we know (to an extent) what the brain can and can’t do, the good news is we can develop strategies that might actually help people develop healthy behaviors. A bunch of apps currently on the market, including StickK and GymPact, offer users cash rewards for practicing healthy habits. And while right now these initiatives might seem kind of gimmicky, there’s evidence that financial incentives for healthy habits are going to become more commonplace in the future. One survey, released yesterday, suggests that by 2014, nearly half of companies will provide discounts on insurance costs for healthier employees. (Currently, 16 percent of companies say they use this policy.)
But money isn’t the only solution. Researchers like Dan Goldstein suggest that just seeing a computer-generated image of how we’ll supposedly look in the future can motivate us to practice healthier behaviors. Right now, Goldstein’s technology isn’t available to the general population, but it’s an excellent example of scientists thinking about ways to improve our health by working within the limitations of the human mind.
When it comes to using financial incentives to help people develop healthier habits, not everyone’s on board. Many of us have reservations about paying people to fix health conditions they theoretically may have brought on in the first place (as in the case of drug addiction) "Pay them if it works": discrete choice experiments on the acceptability of financial incentives to change health related behaviour. Promberger, M., Dolan, P., Marteau, T.M. Health Psychology Section, Department of Psychology, King's College London, UK. Social Science & Medicine 2012 Dec;75(12):2509-14. Acceptability of financial incentives to improve health outcomes in UK and US samples. Promberger, M., Brown, R.C.H., Ashcroft, R.E., et al. King's College London, London, UK. Journal of Medical Ethics 2011 Nov;37(11):682-7.. But it’s not just a matter of rewarding people for little things they should have been doing all along, like ordering salads at restaurants and hitting the treadmill after work. It’s about accepting that there are some things the human mind just can’t do, like envisioning ourselves lying on a hospital bed a few decades in the future, and subsequently swapping a cookie for an apple. Instead of fighting our limitations, we should work within them, until one day, we find the ideal system for tackling unhealthy behaviors on both physical and psychological levels.
What do you think about programs that offer financial incentives for practicing healthy behaviors? Let us know in the comments below or tweet the author at @ShanaDLebowitz.