SHOULD YOU GET PAID TO LOSE WEIGHT? DR RAJ PERSAUD CONSULTANT PSYCHIATRIST EXAMINES THE LATEST SCIENTIFIC RESEARCH ON WHETHER MATERIAL OR FINANCIAL INCENTIVES CAN HELP WEIGHT LOSS.

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SHOULD YOU GET PAID TO LOSE WEIGHT?

HOW TO HELP YOURSELF LOSE WEIGHT FROM THE LATEST PSYCHOLOGICAL RESEARCH WHICH EXAMINES FINANCIAL INCENTIVES AS A WAY OF ENCOUARGING WEIGHT LOSS

RAJ PERSAUD CONSULTANT PSYCHIATRIST

The vast majority of people seem to have severe difficulty adopting healthy lifestyle changes, like giving up an addictions to drugs or alcohol or even perhaps losing weight. These continuing addictions or bad habits often have very negative consequences on those at the centre at the problem, and others around them.

The cost to society at large is also huge – for example the health, policing and social services bill for alcohol dependency alone is massive. As a result of adding up those costs and others – doctors have wondered if giving these sufferers some kind of material or financial incentive to change might work. Particularly as it often seems all else has failed.

One theory here is that if we are going to have to spend a large sum on the consequences of obesity, why not offer some financial incentive to those who are over-weight to shift the pounds? This money would be spent anyway, on the various impacts of the negative health consequences. If you offer a financial incentive to lose weight, this is money better invested in the longer run than just mopping up the consequences, as it means people are healthier and a host of positives flow from this, plus it’s in all probability cheaper as well.

If it turned out financial incentives worked, how could the individual harness this to help them lose weight? After all, it’s notable that various work health insurance programs in the USA are tailored along these lines, as it makes sense in a private system where employers foot large health insurance premiums, to incentivise their employees to lose weight and take other measures to look after their health.

Rachel Burns at the Department of Psychology, University of Minnesota, USA, and colleagues has just published a paper in the prestigious academic journal ‘Annals of Behavioral Medicine’ which reviews the scientific evidence of whether giving yourself financial incentives could help you lose weight.

Her colleagues and her found on reviewing the evidence to date that incentives which depended on group, rather than individual, performance in weight loss did indeed seem to be effective.

In other words, let’s say you got together with a group of friends, and promised yourselves a holiday, but only if as a group, you lost a certain amount of weight? The peer pressure and group support of this kind of incentive does seem, from the scientific literature to have an effect on helping motivation to lose weight.

Rachel Burns and colleagues’ study, entitled; ‘A Theoretically Grounded Systematic Review of Material Incentives for Weight Loss: Implications for Interventions’, reviewed whether all sorts of different material incentives were helpful in assisting weight loss. They looked at studies of programs where you got given a lottery ticket to enter for a big money prize if you lost sufficient weight, as well as incentives from hard cash, gifts and even the opportunity to sign up for educational classes.

Generally speaking the various scientific studies conducted on these found material incentives, outside a group context, didn’t do well in assisting weight loss, particularly in the longer term.

However, another fascinating technique the researchers examined is termed ‘negative reinforcement’. What this basically means instead of gaining money if you lose weight, you lose it if you don’t. These incentive interventions come in two main ways – ‘deposit contracts’ and ‘payroll deductions’.

In ‘deposit contracts’, money deposited by the participants at the start of the program, is incrementally refunded as specified weight loss goals are met. Failure to meet the weight goal results in forfeiture of your funds. Payroll deductions are similar in that a predetermined amount of cash is deducted from your wage pay-checks, and returned only if a specified weight loss goal is met.

The authors of this review again found that group-based deposit contracts in which refunds follow on the average weight loss of a group of people, rather than individual weight reductions, are particularly effective in producing weight loss.

The authors conclude their review of material incentives for weight loss with the general finding that the possibility of losing your own money seems to be more motivating than the possibility of earning extra cash. This appears to be particularly true when you stand to lose a large sum.

“Losses loom larger,” is the key catchphrase it seems, in that the perceived disadvantage of losing money seems much larger than is the perceived advantage of gaining the same amount of money. This is a well known effect in psychology found more generally across the field and not just in weight loss.

So it would seem the take home message is material or financial incentives to lose weight might work but only in a particular way – get together as a group and agree some pooled important resource which you will lose (say this year’s holiday) if you don’t achieve the group target of a weight loss goal by a specific date.

Good luck with this scheme, as it’s not going to be immediately popular with your friends, but according to the latest scientific research, is indeed most likely of all the material incentive schemes to be effective.

The authors of this research review caution, however, that the grave danger of all such material incentive schemes is that they may deprive of us of so-called ‘intrinsic’ motivation. This is the motivation to do something for the pleasure and benefits ‘intrinsic’ to the task.

Once you start paying people to do something, it’s a well known psychological phenomenon that they seem to stop enjoying doing it for itself, and start to devalue the benefits intrinsic in the activity. It’s a bit like if we did a thought experiment where the state started to pay parents to look after children, then parents would begin, after a while to feel they were doing it for the money rather than the intrinsic rewards of rearing your own children.

For these reasons it might be material incentives should be used cautiously and with a strong side interest to keep the intrinsic motivation going. Perhaps material incentives can be of best use when they help kick start a group of people into taking part in a program, but hopefully the need for them could dwindle with time.

REFERENCE:

A Theoretically Grounded Systematic Review of Material Incentives for Weight Loss: Implications for Interventions Ann. Behav. Med. DOI 10.1007/s12160-012-9403-4 Rachel J. Burns, B.A.S. & Angela S. Donovan, M.S. & Ronald T. Ackermann, M.D., M.P.H., F.A.C.P. & Emily A. Finch, M.A. & Alexander J. Rothman, Ph.D. & Robert W. Jeffery, Ph.D.

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